1. Enrollment and Effect of the TRICARE Dental Plan Among the Military Reserve Component Andrew K. York, CAPT, DC, USN David L. Moss, LTC, USA, DC Susan W. Mongeau, Lt Col, USAF, DC Tri-Service Center for Oral Health Studies Uniformed Services University of the Health Sciences Bethesda, MD February 2003

2. Table of Contents Background2 Methods3-4 Dental Insurance Enrollment by Service5 Percent Who Received Dental Treatment Within 12 Months by Insurance Status6 Dental Classification Distribution by Insurance Status7 Dental Procedures Needed per 100 Reservists by Insurance Status8 1

3. Background Prior to this study, the dental treatment need among Military Reserve Components was largely unknown. Anecdotal accounts from Operation Desert Storm (1991) reported poor dental health and large amounts of dental treatment need. In October 2001, the largest reserve component mobilization in a decade began with the onset of Operation Noble Eagle/Enduring Freedom. This presented a unique opportunity to assess the dental condition of this group. The Tri-Service Center for Oral Health Studies (TSCOHS) was tasked and funded by the DoD Health Affairs, TRICARE Management Activity (TMA) to develop and implement a scientific protocol to assess and document the oral health status and treatment needs of these mobilized reservists. The protocol was also designed to capture information regarding dental insurance status including TRICARE Dental Plan (TDP) and other dental insurance enrollment. In October 2001, the Navy, Army, and Air Force Dental Corps Chiefs tasked all military Dental Commands to collect and submit data, according to the protocol provided by TSCOHS, for all mobilized reservists receiving dental care in their dental treatment facilities (DTF). This report focuses on the insurance status of mobilized reservists and their related oral health status and dental treatment needs. Detailed individual service analyses of oral health status and dental treatment needs will be reported separately. 2

4. Methods 1. Data Collection Mobilized reservist dental records are reviewed by dental personnel upon initial access to dental treatment facilities. This review determines whether or not a dental examination is required, based upon the individual’s DoD Dental Classification. Military dentistry captures the results of patient dental exams and tracks their individual treatment needs using standard forms 603/603A. All dental facilities were tasked to send TSCOHS a copy of the most recent SF603/603A from the dental record of each mobilized reservist receiving care at their facility. If a new dental examination was performed, a copy of that new SF603/603A was collected. If a new dental examination was not required, a copy of the most recent SF603/603A in the patient’s record was collected. In addition, a questionnaire was completed by dental personnel for each reservist. The questionnaire captured answers to the following questions: 1. Date of last type 2 examination prior to the current examination ______ 2. Dental classification prior to the current examination classification ______ 3. Are you currently enrolled in the TRICARE Dental Plan (TDP)? Yes No 4. Are you currently enrolled in another dental insurance program? Yes No 5. Have you received dental care (other than examination) within the past 12 months? Yes No All data was received by TSCOHS via US mail in postage paid, pre-addressed envelopes. 2. Computer Data Entry / Analysis TSCOHS dental personnel manually transferred the treatment needs from the SF603/603As and the questionnaires for 10,293 reservists into a customized computer data entry screen designed using Microsoft Access® 2000. This data was then converted into a SPSS ® 11.0 database for statistical analysis. 3

5. 3. Study Sample The data collection period ran from October 2001 through March 2002 for Navy and Marine Corps, and from January 2002 through August 2002 for Army and Air Force. TSCOHS received data from 19 Navy/Marine Corps dental treatment facilities (DTF), 24 Army DTF, and 44 Air Force DTF. Table 1 shows the number of records analyzed and the estimated percentage of mobilized reservists captured for each service. The representative strength of the sample is bolstered by the natural randomization resulting from data collection at many geographically disbursed data collection sites. No indications of systematic bias were found. Analysis results shown in figures 2, 3, and 4 are combined service estimates calculated after weighting the study database to reflect the service distribution of all military reservists obtained from the Defense Manpower Data Center, March 2002. NavyMarine Corps ArmyAir Force Estimated Total Reservists Mobilized9,827 (Oct 01-Mar 02) 4,467 (Oct 01-Mar 02) 12,910 (Jan 02-Aug02) 12,504 (Jan 02-Aug02) Total Records Analyzed5,4321,5761,1412,066 Percent of Reservists Captured5535916 Table 1 4 Methods

6. Figure 1 provides the status of dental insurance enrollment reported by mobilized reservists in our sample. When the service data is combined, a greater percentage of reservists reported having “other dental insurance” (42.1%) compared to being enrolled in TDP (32.4%). Overall, 63.7% are enrolled in some type of dental insurance plan. 5

7. Those reservists with “no dental insurance” are significantly less likely to have received dental treatment within the 12 months prior to their mobilization compared to those with some type of dental insurance. Reservists with “Other Dental Insurance” are significantly more likely to have received dental treatment compared to reservists with TDP as there only type of insurance. 6 * Statistically different compared to the “TDP Only” group

8. The DoD Dental Classification distribution does not differ significantly between reservists with “TDP Only” and those with “No Dental Insurance”. Reservists that report enrollment in a dental insurance program other than TDP demonstrate significantly higher Class 1 levels and lower Class 3 levels compared to the “No Dental Insurance” and “TDP Only” groups (Figure 3). 7 * Statistically different compared to the “TDP Only” group

9. Figure 4 shows the number of dental procedures treatment planned (from the SF603/603A) per 100 reservists, by insurance status. Reservists with “TDP Only” need significantly less operative treatment compared to those with “No Dental Ins”. However, those with “Other Dental Insurance” have significantly less treatment need in all clinical categories compared to the “TDP Only” group. 8