Health care utilization and cost among health maintenance organization members with temporomandibular disorders

Aims: Little has been reported on the use of health care services and conse quent costs among persons with temporomandibular disorders (TMD). This proj ect compared the use and cost of medical and dental care services for TMD p atients and matched comparison subjects. Methods: Patients were continuousl y enrolled members of Kaiser Permanente Northwest Division who had at least 1 TMD Clinic visit or TMD-related procedure between January 1990 and Decem ber 1995 (n = 8,801). An equal number of comparison subjects were identifie d electronically and matched on 14 variables, including age and gender. Uti lization and cost estimates were determined and compared for selected medic al and dental services. Results: For both groups, the mean age was about 40 .5 years, and approximately 80% were female. The TMD subjects used signific antly more services than did comparison subjects and had mean costs that we re 1.6 times higher for all services. Outpatient visits accounted fro about 40% of the difference in mean costs. About 10% of TMD subjects and compari son subjects accounted fro about 40% and 47% of the costs in each group, re spectively. Female TMD subjects and comparison subjects had higher costs th an their male counterparts, and male TMD subjects had higher costs than fem ale comparison subjects. Conclusion: Patients with TMD used more of all typ es of services and had higher costs. A small proportion of the subjects acc ounted for a large proportion of the costs. Gender was an important factor in utilization and cost. Utilization and cost differences were consistent o ver a wide range of service categories and could not be explained by TMD al one.