Access To and Patterns of Use of Oral Health Care Among Elderly Veterans

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Abstract
Utilization of The Department of Veterans Affairs (VA) dental care system is best understood in the context of the health care system at large. Veterans' use of dental care is apparently influenced by a wide variety of factors that include: barriers to access to non-VA systems (such as a lack of health insurance and the inability to afford non-VA care); ineligibility for VA services (such as absence of a service-connected disability); characteristics of the VA delivery system itself (such as eligibility priorities, geographic distribution of VA facilities, and quality of VA care); and characteristics of the veteran population (such as veterans' illness level, their perceived need for care, and their satisfaction with and perceived quality of VA care). The Department of Veterans Affairs offers a unique opportunity to study the effect of certain delivery system characteristics on utilization behavior and veterans' use of specific dental services. Health services research on the VA oral health care system will 1) provide information useful to improve veterans' oral health and the effectiveness and efficiency of VA dental care delivery and 2) improve our understanding of utilization behavior in large public sector health care systems that are surrounded by private sector health care settings. The following topics should be included in a VA oral care health services research agenda: development of a uniform, system-wide dental care data base; an understanding of the long-term benefits that result from the use of specific dental services and determination of the services that are the most cost-effective; an understanding of the characteristics of delivery systems and of the dental care providers who promote the most appropriate, effective, and efficient care; a better understanding of how VA makes veterans aware of their eligibility; an understanding of the relationship between medical and dental care use in the VA system; and an understanding of the degree to which discontinuity exists in dental care services of veterans.

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