Abstract
Since the current national health insurance in Japan only covers treatments for existing diseases and injuries, there is little incentive for regular preventive dental visits or preventive interventions in dental practice. In order to provide basic data to evaluate these preventive activities for future dental practices, the trends in dental utilization and dental practice were investigated using some national surveys. 1. In adults, the prevalence of dental caries was more than 40 percent, and from 20 to 30 percent of people consulted a dentist for dental caries in the past year. As for periodontal diseases, the prevalence was more than 80 percent, and the dental visit rate was just a few percent. The number of outpatients was comparatively close to that for people with oral symptoms. It seems that people mainly consult a dentist only after they realize the symptoms. 2. During the past 15 years, the dental visit rate for people aged 54 and under decreased, but increased among those aged 70 and over. Visits for dental caries or pulpitis decreased and those for periodontal diseases increased. However, most dental visits were for treatments of dental caries or prosthodontics. Visits for dental check-ups were less than 1% of total visits. 3. The transition of fees per dental claim from 1985 through 2002, excluding the influence of the revision on dental treatment fee points, revealed that the "Restoration and Prosthodontics fee" had plateaued and the "Treatment and Surgery fee" and the "Diagnostic Test and Radiology fee" had decreased since the second half of the 1990's. On the contrary, the "Instruction fee", mostly consisring of fees for oral health instructions and disease preventions, has increased remarkably. 4. According to a regression model analysis using panel data by age groups from 1994 to 2002, I estimated that 1% of the "Total fee" and the "Instruction fee" change in the previous year affected the "Instruction fee" in the following year by 0.04% and 0.98%, respectively. Therefore the "Instruction fee" has been promoted by the increase of the "Instruction fee" in the previous year, rather than by the change of the "Total fee" in the previous year. This implies that receiving and giving preventive instruction has been established and become accustomed to over the same period. I also found that the raise of the co-payment rate of the employed in September 1997 caused a 27.5% reduction of the "Instruction fee". These findings show that the instructions for prevention, mainly for periodontal diseases, have been provided for more in dental practice. This means that the recent remuneration policy has induced more preventive interventions, even under the current health insurance system. Meanwhile, there is a disparity between the number of people with oral diseases and that of people who realize their symptoms. I conclude that dental practitioners should encourage their patients to have routine dental check-ups, and consultations at an early stage should be recommended for those who have not yet realized their symptoms.
