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SURVEY OF DEPENDENT DENTAL CARE

INTRODUCTION

BACKGROUND

In 1956, with Congressional passage of the Dependent Medical Care Act, a major advance was recorded in the realm of military compensation. This initial groundbreaking provision of care

in civilian hospitals for the dependents of military personnel was subsequently expanded, most notably a decade later, in the form of the Military Medical Benefits Amendments. These amendments expanded coverage significantly to include outpatient and other types of care, extended to retirees and their dependents care from civilian sources, and established a new program of financial aid for the care of mentally retarded and physically handicapped children.

Since civilian dental care had not been an integral component of any previous medical care program for dependents, Chairman Rivers of the House Armed Services Committee appointed a Special Subcommittee, early in the Ninetieth Congress, charged with a broad mandate to consider all the ramifications of the problem. One specific item for consideration was an examination of the ability of military families, particularly those of men in the lower pay grades, to handle the burden of dental bills.

In his testimony before the Special Subcommittee, the then

Assistant Secretary of Defense (Manpower), Thomas D. Morris, put forth the Department of Defense position that each fringe benefit program for military personnel should be considered with an eye to its bearing on the entire military compensation package. He further stated that "where there are economic penalties resulting from conditions of service, there must be a compensating advantage in the benefits extended to mili

tary personnel."

REQUIREMENT

Dental care for military dependents at government expense is available at this time only in certain prescribed hardship situations. Notably, routine dental care in uniformed service facilities is authorized by law, on a space available basis, for all dependents located in areas outside the United States. Similar dental care for dependents is authorized at installations in "remote areas" of CONUS where it has been determined that adequate civilian dental facilities are unavailable. It was not known, at the time of the Secretary's testimony whether and to what extent, a military dependent residing in CONUS, not at an installation in a designated "remote area", might be generally disadvantaged, vis-a-vis a civilian counterpart, in having equal access to qualified dental services at reasonable cost. In this connection the Assistant Secretary

of Defense for Manpower directed that a survey be initiated to reveal the experience with civilian dental care for dependents of a representative cross-section of military families as compared to a civilian counterpart population.

PROCEDURE

Considering the dimensions of the requirement and time constraints for completion of the survey, it was determined that maximum results would be obtained with minimum expenditure of resources by administering a structured objective-response type questionnaire to a sample of military and Federal civilian personnel at DoD installations in continental United States. This procedure would not only facilitate the collection of data, but would also enhance the efficiency of the survey as a result of the control that was possible centrally, and provide an opportunity to conduct the survey without trained representatives in the field, as well as to reduce the burden on

field commands.

Separate questionnaires were used for military and civilian respondents. Each was designed to be self-administered and completely anonymous. The primary thrust of the questions required responses concerning dental care received by dependents during the last year in terms of number of visits,

type of care, cost and availability of dental facilities. Certain questions were asked which developed the demographic characteristics of the individual respondent and his dependents. Finally, the respondent was given an opportunity for expressing personal remarks concerning dependent dental care.

The sampling procedure initially divided the continental United States into nine geographic areas following the classification utilized in surveys conducted by the Bureau of the Census1 and American Dental Association.2 Within these regional areas, major military installations which had not been previously designated as in a "remote area" under criteria established by the Uniformed Services Health Benefits Program directive of February 1967 (Army Regulation 40-121) for purposes of dependent dental care were included for participation in the survey. A further condition for the selection of installations was the

stratification of installations into locations which were

representative of rural areas, small civilian communities, or large urban areas. Fifty such installations (see Appendix A) were selected for a nationally representative mix regardless of service affilation.

1 U.S. Bureau of the Census Statistical Abstract of the

2

United States: 1967, (88th edition) Washington, D.C., 1957.

American Dental Association, Bureau of Economic Research

and Statistics.

Survey of Recds for Dental Care, 1965.

Chicago, 1965.

It is conceiveable that every military and civilian employec at these fifty installations could have been surveyed. How

ever, such an ennumeration would have been inefficient in terms of time and money in studying a defined population. It is well recognized that a relatively small number of carefully selected individuals may represent the total population within useful limits of error when selected in a statistically

valid manner.

However, in order to possess reliability of

results from such a sample, it is essential that the sampling procedures for selection of respondents be so controlled as to guarantee random selection. That is to say, the actual persons

who constitute the sample are chosen in an unbiased manner and in such a way that each person in the total population has an equal chance to be selected.

It was initially determined that the number of participants in the survey should not exceed 6,000 military and 6,000 civilians in order to satisfy certain technical considerations and to fulfill the requirements of expediency. The military sample was stratified by the size and pay grade of the installation military population. The civilian sample, however, was stratified only by size of civilian population at each installation, since no information was immediately available on grade distri

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