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OBJECTIVE: To identify associations between child, caregiver, and family-level factors and child dental utilization. RESEARCH DESIGN: Cross-sectional oral health survey. PARTICIPANTS: Caregivers and one study child (ages 0-17) from Mexican migrant families in northern San Diego county, CA (n=142). METHODS: Caregivers reported on child's dental care utilization history and related factors, including: child (age, gender, dental insurance, source of care, believed to have cavities), caregiver (marital status, income, education, acculturation level, depressive symptoms), and family cohesion. Descriptive and logistic regression models identified predisposing, enabling, and need factors associated with child dental utilization during the past year. RESULTS: Most (76%) children had visited the dentist in the past year, while 8.6% had never been. Child factors (gender, insurance), caregiver factors (education, depressive symptoms), and family cohesion were each associated with child dental utilization in the bivariate analyses. In the final adjusted model, uninsured children were less likely to have a past year dental visit compared to insured children (Odds Ratio (OR) = 0.23, 95% Confidence Interval (CI) = 0.06-0.96). Children whose caregivers visited the dentist were 4.29 times more likely to visit the dentist in the past year (CI=1.36-13.61). Higher caregiver education was positively associated with child dental utilization (OR=4.50, CI=1.50-13.55). CONCLUSION: Child age and dental insurance, and caregiver education and dental utilization history were associated with whether or not a child had a past year dental visit. Ensuring child dental coverage and caregiver access to dental care may promote regular dental utilization by children.

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Resumo Este estudo de abordagem qualitativa teve como objetivo compreender as relações e conflitos entre operadoras odontológicas, beneficiários e prestadores, além da interface com a Agência Nacional de Saúde Suplementar (ANS) e com o Sistema Único de Saúde (SUS). A coleta de dados foi realizada mediante a aplicação de questionários aos representantes das operadoras, seguida de análise documental e de entrevistas semiestruturadas. A análise por meio da triangulação dos dados permitiu observar como principais resultados: que a lógica de redução de custos orienta as ações das operadoras e se reflete nas relações com beneficiários, prestadores e ANS; que é frágil a interface com o SUS; que há resistência à ampliação de coberturas; e que o crescimento do mercado é acompanhado de grande concentração. Não se pode ignorar a pujança da saúde suplementar na odontologia, mas é preciso discutir criticamente o papel do Estado, tanto como regulador deste mercado, quanto como indutor de um modelo de atenção à saúde bucal com maior qualidade e resolutividade.

Abstract This study of a qualitative approach aimed to understand the relationships and conflicts between dental insurance companies, beneficiaries, and providers, as well as the interface with the National Supplementary Health Agency (ANS) and the Unified Health System (SUS). Data was collected through questionnaires applied to representatives of selected companies, documentary analysis and semi-structured interviews. The analysis through data triangulation enabled to observe as main results: cost control mechanisms guides the companies' activities and also perpetrate the relations with beneficiaries, providers and the ANS; there is a poor relation with the SUS; the companies tend to avoid the extending of dental insurance coverage; and the dental insurance market comes with huge concentration. We cannot ignore the strength of the dental health insurance sector in Brazil, but it is necessary to critically discuss the role of the State, both as regulating the private insurance sector as encouraging a dental care approach with improved quality and resolutivity.

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Objetivo: Verificar se os valores pagos por operadoras de planos odontológicos na cidade de Maceió (AL), aos profissionais credenciados, estão condizentes com os preconizados pelo Conselho Federal de Odontologia (CFO) em sua tabela de Valores de Referência para Procedimentos Odontológicos (VRPO). Materiais e Métodos: Utilizaram-se três tabelas de honorários profissionais, de procedimentos de dentística, de planos odontológicos na cidade de Maceió (AL). Como grupo de controle para comparação dos valores discriminados nas tabelas dos planos, adotou-se a tabela VRPO do CFO. Foram analisados comparativamente os valores dos procedimentos pagos pelos planos de acordo com os materiais restauradores (amálgama, resina e ionômero) e de outros (clareamento dentário, restauração temporária/tratamento expectante), sendo calculado o valor percentual de acréscimo ou defasagem em relação à VRPO. Resultados: Os maiores descontos aplicados sobre os preços sugeridos pelo CFO foram observados para procedimentos restauradores de resina fotopolimerizável (81 a 87%, em média). Conclusão: A remuneração oferecida pelos três planos odontológicos na cidade de Maceió (AL), nos procedimentos que constam da especialidade de dentística restauradora, está aquém dos valores definidos na tabela VRPO-CFO.

Objective: To determine whether the amounts paid for dental care plan operators from Maceió, the accredited professionals are consistent with those recommended by the Federal Council of Dentistry (CFO) in his table of reference values for Dental Procedures (VRPO). Materials and Methods: three tables of professional fees, dentistry procedures, dental care plans from Maceió (AL). As a control group for comparison of the amounts shown in the tables of the plans it has used the VRPO table. In this work, were analyzed the comparative values of procedures paid by the plans according to the restorative materials (amalgam, resin and ionomer) and others (tooth whitening, temporary restoration / expectant treatment); calculating the percentage difference to the VRPO. Results: The highest discounts applied on prices suggested by the CFO were observed for light-cured resin restorative procedures (81-87% on average). Conclusion: The remuneration offered by the three dental plans of the city of Maceio (AL), involving the specialty of restorative dentistry, it is less than the values defined in Table VRPO-CFO.

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O objetivo do presente estudo foi a partir de uma abordagem indutiva, utilizando um questionário fechado nos consultórios dentários que atendem a convênios odontológicos no município de Duque de Caxias (RJ), fazer o levantamento do perfil de relacionamento técnico-profissional entre esses profissionais e as empresas de Planos de Saúde Odontológicos. Dos 74 questionários respondidos, observou-se uma distribuição homogênea de 20% quanto ao tempo de formado, em cada faixa de tempo. O atendimento a mais de um plano de saúde se mostrou mais comum (88% da amostra). O aumento de volume de pacientes se destacou entre os pontos positivos (81%) e falta de clareza, quanto a valores diferenciados entre colegas (89%) e falta de reajuste financeiro e ou pagamento não compatível com o mercado (52%) como principais pontos negativos.

The aim of this study was an inductive approach through a close questionnaire applied in private dental offices that offer dental pre-payment assistance, in order to analyse the working relationship between dentists and private dental insurances in the City of Duque de Caxias (RJ). A sample of 74 questionnaires, were equally distributed (20% each), by graduation time. The attendance to more than one pre-payment oral health company insurance was the most common (88% of the sample). From the positive aspects, the patients increase were most mentioned (81%) and the lack of clarity about the different values paid between colleagues (89%) and lack of financial adjustment or payment not compatible with the market (52%) as the main negative points.

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