Dental hygiene therapy service reimbursement delays and preventive care visit discontinuation in Namibian private clinics: a discrete-time survival analysis of claims lapse

Namibian private dental hygiene practices bill medical aid schemes for preventive visits, and the interval between claim submission and reimbursement is widely reported to vary across schemes and across procedures. The framework treats each patient-month between successive preventive visits as a discrete time interval, models the hazard of discontinuation as a function of the reimbursement delay experienced on the preceding claim, and accommodates right-censoring, scheme-level clustering and procedure-level heterogeneity. Because no claims data were available for the present analysis, the paper is methodological and conceptual: it specifies the estimand, the likelihood, the identification assumptions and the reporting standard that a Namibian claims-lapse study would require, and it illustrates the framework with a real DHS Program indicator on the percentage of injections given by a health care provider across 14 African countries (2021-2025; N = 14; mean 91.964; SD 12.468; range 60.90 in Malawi to 99.70 in Kenya) to show how the same discrete-time logic is reported when data are available. The contribution is a transferable analytic template that makes reimbursement delay a measurable exposure in dental hygiene services research rather than an anecdotal complaint.