Knowledge of dental care costs and coverage in the context of health literacy

Objectives: This preliminary analysis introduces a knowledge-based measure of oral health literacy and describes its performance among adult patients presenting to university dental clinics in Baltimore and Los Angeles.

Methods: Data came from the Multi-Site Assessment of Health Literacy and Oral Health, an investigation of the relationships between health literacy, informed healthcare decision making, and oral health. The new measure assessed having correct knowledge of dental care costs and safety-net dental coverage. Outcome variables of interest included utilization of healthcare services, beliefs and attitudes, and oral health status. Other measures of health literacy (e.g., word recognition, reading comprehension, numeracy, and conceptual knowledge) were also included in the investigation. Available sociodemographic covariates included age, sex, race/ethnicity, and education level.

Results: More than half of respondents did not know the correct costs of three common dental procedures (cleaning, filling, and extraction). More than 60% of adults did not know whether Medicaid and Medicare offered dental benefits. Correct knowledge of costs and coverage was mixed, dependent on sociodemographic group and outcome measure. For instance, adults who incorrectly estimated the cost of an extraction were significantly more likely to have visited an emergency room for a dental problem during their lifetime. Younger adults were significantly less likely to know that Medicare does not cover dental procedures.

Discussion: Health literacy is moving from measurement to interventions however most established instruments provide little guidance down this path. Knowledge-based instruments offer an opportunity to isolate topics that might benefit from targeted educational initiatives in the future.