Association of payment method on orthodontic treatment completion and duration

Background: A greater number of adolescent patients need orthodontic treatment than receive treatment in Iowa for patients with state-insurance. This is due, in-part, to low participation in public insurance amongst orthodontists. There are many reasons why orthodontists choose not to participate in public insurance. One assumption is that patients with public insurance are less likely to keep appointments and have poorer treatment compliance than those with private insurance. This study aimed to compare orthodontic treatment completion and treatment duration rates of adolescent patients with public insurance to those with private insurance and self-payment.

Materials and Methods: The data source was electronic health records from the University of Iowa Orthodontic Residency Clinic. To be included in the study, patients had to be ages 8-18 years who underwent comprehensive orthodontic treatment between July 2009 and June 2019. This study compared payment method, treatment completion, and treatment duration with patient compliance, initial malocclusion severity, final malocclusion severity, distance travelled to the University dental clinic, and urbanicity. Data analyses were performed.

Results: The vast majority of patients included in this study completed orthodontic treatment, and the average treatment length was 23.4 months. Patients who failed or late-cancelled more appointments were less likely to complete treatment and more likely to have longer treatment duration. Patients with good oral hygiene were more likely to complete treatment than those with poor hygiene. Patients with a class I malocclusion were the most likely to complete treatment and have the shortest duration of treatment. Payment method was not significantly associated with either treatment completion or treatment duration. Patients with public insurance did fail more appointments and have worse oral hygiene than their privately insured and self-pay counterparts. Patients with public insurance had the most severe initial malocclusions of the payment groups as well as less acceptable treatment outcomes. However, all payment groups saw significant reduction in severity of malocclusion after completion of orthodontic treatment.

Conclusions: Patient compliance was associated with rate of completion of comprehensive orthodontic treatment but not length of treatment. Initial malocclusion severity was not associated with treatment completion rates but was associated with length of treatment. Distance travelled and urbanicity were not associated with treatment completion rates, but urbanicity was associated with length of treatment.