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Lin C, Mella-Velazquez A, Braund WE, Tu P. Disparities in Healthcare-Seeking Behavior and Decision Preference Among Hispanics: A Comparative Study Across Races/Ethnicities, SES, and Provider Types. J Multidiscip Healthc 2024; 17:3849-3862. [PMID: 39139698 PMCID: PMC11319094 DOI: 10.2147/jmdh.s476285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose Hispanics, the largest minority in America, have increased risk of several medical issues and face noteworthy health disparities. This study compares care-seeking behaviors and choice experience among Hispanics, Asians, Blacks, and Whites, considering SES (income, education, and insurance status) and across five healthcare provider (HCP) types. Concurrent analysis provides a comprehensive view of how and where inequity manifests in healthcare. Methods A cross-sectional online survey assessed 1485 adults (Hispanic=314, Asian=313, Black=316, White=542, recruited through a panel agency) of the frequency of visiting primary care providers, dentists, optometrists, gynecologists, and specialists for chronic conditions. Participants also rated the importance of self-selecting a HCP and difficulty in finding one. Results Whites visited each HCP most regularly. Compared to Asians, more Hispanics saw specialists regularly (45.1% vs 56.5%, p=0.042), and Blacks saw dentists less (47.0% vs 38.3%, p=0.028) and gynecologists more often (21.2% vs 33.1%, p=0.024). No other frequency differences were observed among minorities. Low-income participants across four races saw dentists and gynecologists with comparable infrequency. Hispanics and Asians assigned similarly significantly lower self-choice importance and experienced more difficulty relative to Whites or Blacks. Participants with lower income or education visited HCPs less regularly yet perceived the same choice importance as higher-SES peers (p>0.05). Notably, discrepancies in visit frequency between Whites and minorities were more pronounced in higher-SES than lower-SES group. Differences in experiencing care-seeking difficulty were associated with income (p=0.029) and insurance type (p=0.009) but not education (p>0.05). Conclusion Higher income and education increase healthcare utilization; however, racial disparities persist, particularly among higher-SES groups. Despite similarities among minorities, the extent of disparities varied by SES and provider type. The findings help explain evident inequity in healthcare access and health outcomes. Tailored patient education, culturally-specific navigation support, and more inclusive services are needed to address barriers faced by minorities and disadvantaged populations.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC, USA
| | | | | | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC, USA
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Baker L, Munnich EL, Kranz AM. Medicaid Managed Care and Pediatric Dental Emergency Department Visits. JAMA HEALTH FORUM 2024; 5:e241472. [PMID: 38874960 PMCID: PMC11179125 DOI: 10.1001/jamahealthforum.2024.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Millions of economically disadvantaged children depend on Medicaid for dental care, with states differing in whether they deliver these benefits using fee-for-service or capitated managed care payment models. However, there is limited research examining the association between managed care and the accessibility of dental services. Objective To estimate the association between the adoption of managed care for dental services in Florida's Medicaid program and nontraumatic dental emergency department visits and associated charges. Design, Setting, and Participants This cohort study used an event-study difference-in-differences design, leveraging Florida Medicaid's staggered adoption of managed care to examine its association with pediatric nontraumatic dental emergency department visits and associated charges. This study included all Florida emergency department visits from 2010 to 2014 in which the patient was 17 years or younger, the patient was a Florida resident, Medicaid paid for the visit, and a primary or secondary International Classification of Diseases, Ninth Revision, code was used to classify a nontraumatic dental condition. Analyses were conducted between May 2023 and April 2024. Exposure The county of residence transitioning Medicaid dental services from fee-for-service to a fully capitated managed care program managed by a dental plan. Main Outcomes and Measures The rate of nontraumatic dental emergency department visits per 100 000 pediatric Medicaid enrollees and the associated mean charges per visit. Nontraumatic dental emergency department visits are a well-documented proxy for access to dental care. Data on emergency department visit counts came from the Florida Agency for Health Care Administration. Medicaid population denominators were derived from the American Community Survey's 5-year estimates. Results Among the 34 414 pediatric nontraumatic dental emergency department visits that met inclusion criteria across Florida's 67 counties, the mean (SD) age of patients was 8.11 (5.28) years, and 50.8% of patients were male. Of these, 10 087 visits occurred in control counties and 24 327 in treatment counties. Control counties generally had lower rates of NTDC ED visits per 100 000 enrollees compared with treatment counties (123.5 vs 132.7). Over the first 2.5 years of implementation, the adoption of managed care was associated with an 11.3% (95% CI, 4.0%-18.4%; P = .002) increase in nontraumatic dental emergency department visits compared with pre-implementation levels. There was no evidence that the average charge per visit changed. Conclusions and Relevance In this cohort study, Florida Medicaid's adoption of managed care for pediatric dental services was associated with increased emergency department visits for children, which could be associated with decreased access to dental care.
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Affiliation(s)
- Lawrence Baker
- RAND Corporation, Boston, Massachusetts
- Pardee RAND Graduate School, Santa Monica, California
| | - Elizabeth L Munnich
- Department of Economics, University of Louisville College of Business, Louisville, Kentucky
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Lyu W, Wehby GL. The effects of Medicaid expansions on dental services at federally qualified health centers. J Am Dent Assoc 2023; 154:215-224.e10. [PMID: 36635206 DOI: 10.1016/j.adaj.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/27/2022] [Accepted: 11/12/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Federally qualified health centers (FQHCs) have become safety-net providers of dental services for low-income patients. The authors examined the effects of the Patient Protection and Affordable Care Act Medicaid expansions, according to level of dental benefits, on the number of visits for dental services at FQHCs. METHODS The authors used publicly available facility-level data on 1,400 FQHCs across the United States from the 2011 through 2019 Uniform Data System. The authors used an event-study difference-in-difference design to examine the effects of expanding Medicaid in 2014, according to the level of dental benefits, compared with nonexpansion states. Outcomes included the number of dental visits for any dental service and separately for preventive and other services. Regression models adjusted for the demographic characteristics of the FQHC's patient population, county-level factors, and center and year fixed effects. RESULTS Expanding Medicaid with extensive dental benefits has increased the number of dental visits provided at FQHCs in 2014 through 2019 from 2013 by 1,329 to 7,647 visits per FQHC on average compared with FQHCs in nonexpansion states. There was an increase in visits for both preventive and other dental services. In contrast, there was no evidence of such an increase from expanding Medicaid with limited or emergency-only dental benefits. CONCLUSIONS Expanding Medicaid eligibility with extensive dental benefits has increased the number of dental visits at FQHCs, including for both preventive and other dental services. PRACTICAL IMPLICATIONS As safety-net providers, FQHCs might be able to provide more oral health care for low-income patients after Medicaid expansions that offer extensive dental benefits.
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Lee H, Marsteller JA, Wenzel J. Dental care utilization during pregnancy by Medicaid dental coverage in 26 states: Pregnancy risk assessment monitoring system 2014-2015. J Public Health Dent 2022; 82:61-71. [PMID: 34904236 DOI: 10.1111/jphd.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the association between Medicaid dental coverage for adult pregnant women with dental care utilization during pregnancy. METHODS Pregnancy risk assessment monitoring system (PRAMS) data (2014-2015) and the Medicaid-SCHIP state dental association (MSDA) national profiles (2014-2015) were used in this study. The study sample included 16,612 Medicaid-enrolled women, for a weighted number of 965,046 women from 26 states and New York City. State Medicaid dental coverage was categorized into (1) no coverage for the dental cleaning, (2) coverage for dental cleaning and fillings, (3) extended dental coverage. The adjusted prevalence ratios (aPR) for dental visits for cleaning during pregnancy were examined by Medicaid dental coverage level. RESULTS Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). Compared with women in state without dental coverage, Medicaid-enrolled women in states with extended dental coverage (aPR = 1.20, 95% CI [1.16-1.23]) and women in states with limited coverage (aPR = 1.10, 95% CI [1.06-1.14]) were more likely to visit dentists for cleaning during pregnancy when adjusted for other sociodemographic variables and adequacy of prenatal care. A similar pattern of association was observed for a dental visit to address dental problems during pregnancy. CONCLUSIONS This study highlights the importance of Medicaid dental coverage for adult pregnant women related to dental service utilization during pregnancy.
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Affiliation(s)
- Hyewon Lee
- Mount Sinai Hospital, Department of Dentistry, New York, New York, USA
| | - Jill A Marsteller
- Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Akinlotan MA, Ferdinand AO. Emergency department visits for nontraumatic dental conditions: a systematic literature review. J Public Health Dent 2020; 80:313-326. [DOI: 10.1111/jphd.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/24/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Marvellous A. Akinlotan
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
| | - Alva O. Ferdinand
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
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Ranade A, Young G, Garcia R, Griffith J, Singhal A, McGuire J. Changes in Dental Benefits and Use of Emergency Departments for Nontraumatic Dental Conditions in Massachusetts. Public Health Rep 2020; 135:571-577. [PMID: 32795220 DOI: 10.1177/0033354920946788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Research examining the effect of changes in Medicaid dental benefits on emergency department (ED) use for dental conditions has had mixed results. We examined the effect of changes in Medicaid dental benefits on ED use for nontraumatic dental conditions (NTDCs) among adults in Massachusetts before and after Medicaid dental benefits for adults were eliminated (July 2010) and partially restored (January 2013). METHODS We used 2009-2013 data from the Massachusetts All-Payer Claims Database. The study population included Medicaid enrollees aged ≥21 who made a visit to the ED for an NTDC that was paid for by Medicaid during the study period. We used an interrupted time-series study design and segmented regression model to assess the effect of the policy changes on ED use for NTDCs. We also conducted a subanalysis by patient age, sex, and geographic location. RESULTS During the study period, 21 731 Medicaid enrollees aged ≥21 made 35 660 NTDC ED visits. Eliminating comprehensive dental benefits led to a significant increase in the use of EDs for NTDCs. This increase occurred over time (11% increase at 15 months after elimination of comprehensive dental benefits; estimate, 0.64 [95% CI, 0.07-1.21]; P = .03) rather than immediately after the policy change took effect. The partial restoration of certain dental benefits led to a significant decrease in the rate of ED visits for NTDCs over time (15.7% decrease at 5 months after partial restoration of certain dental benefits; estimate, -0.97 [95% CI, -1.83 to -0.11]; P = .03). CONCLUSION Strengthening dental coverage policies for adult Medicaid enrollees could decrease their reliance on EDs for NTDCs.
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Affiliation(s)
- Ashwini Ranade
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.,1825 Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Gary Young
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.,1848 D'Amore-McKim School of Business, Northeastern University, Boston, MA, USA.,1848 Center for Health Policy and Healthcare Research, Northeastern University, Boston, MA, USA
| | - Raul Garcia
- 1846 Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - John Griffith
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Astha Singhal
- 1846 Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Jean McGuire
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Huang SS. Should Medicaid include adult coverage for preventive dental procedures? What evidence is needed? J Am Dent Assoc 2020; 151:607-613. [PMID: 32718490 PMCID: PMC7392117 DOI: 10.1016/j.adaj.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medicaid programs may have a salient financial incentive to provide adult coverage for cost-effective preventive dental procedures because they face responsibility for catastrophic costs of dental disease. Whether there is sufficient evidence to support adult Medicaid coverage of preventive dental services is unclear. METHODS Using an optimal insurance model, the author examines what evidence there is to support coverage of cost-effective preventive dental services in Medicaid and what evidence gaps remain. RESULTS There is insufficient evidence to support adult Medicaid coverage for preventive dental procedures. CONCLUSIONS More research is needed to identify preventive dental procedures that are cost-effective from a Medicaid perspective, quantify the impact dental prevention has on dental-related health care costs and overall health care costs, and quantify the impact patient-side and provider-side financial incentives have on take-up of specific preventive dental treatments. PRACTICAL IMPLICATIONS Although Medicaid programs may have an interest in preventing catastrophic costs of dental disease (that is, dental-related emergency department visits), there is insufficient evidence for Medicaid programs to provide coverage for preventive dental procedures.
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Zivkovic N, Aldossri M, Gomaa N, Farmer JW, Singhal S, Quiñonez C, Ravaghi V. Providing dental insurance can positively impact oral health outcomes in Ontario. BMC Health Serv Res 2020; 20:124. [PMID: 32066434 PMCID: PMC7027064 DOI: 10.1186/s12913-020-4967-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. Methods We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013–2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada’s most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. Results Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9–19.8 vs. ME lowest: 27.2; 95% CI: 25.0–29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: − 13.2 to − 9.9 vs. ME lowest: -27.2; 95% CI: − 29.5 to − 24.8). Conclusions Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.
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Affiliation(s)
- Nevena Zivkovic
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
| | - Musfer Aldossri
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Noha Gomaa
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Julie W Farmer
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Carlos Quiñonez
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, England
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9
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Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness. Am J Prev Med 2018; 55:470-479. [PMID: 30126670 DOI: 10.1016/j.amepre.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/31/2018] [Accepted: 05/02/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. METHODS Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). RESULTS Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. CONCLUSIONS Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.
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Abdus S, Decker SL. Association between Medicaid adult nonemergency dental benefits and dental services use and expenditures. J Am Dent Assoc 2018; 150:24-33. [PMID: 30266300 DOI: 10.1016/j.adaj.2018.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Only some states provide coverage of nonemergency dental services for adult Medicaid enrollees. This study examined the association between coverage of Medicaid adult nonemergency dental services and dental services use and expenditures. METHODS The authors analyzed data from the 2000 through 2015 Medical Expenditure Panel Survey Household Component for adults 21 years or older enrolled in Medicaid. The authors examined a range of outcomes such as dental visits, preventive and 5 other types of dental services, and total and out-of-pocket dental expenditures. Multivariate regression models were used to estimate the differences in outcomes for Medicaid enrollees between states that provided coverage of nonemergency dental services and states that did not, controlling for potentially confounding factors. RESULTS Compared with Medicaid enrollees in states that did not provide coverage, enrollees in states that provided coverage of nonemergency dental services were approximately 9 percentage points more likely to have a dental visit, approximately 7 percentage points more likely to have any preventive dental service, and more likely to have all other types of dental services except oral surgery services. Among enrollees with any visit, out-of-pocket share of dental expenditures was approximately 19 percentage points lower among those in covered states than those in uncovered states. CONCLUSIONS Medicaid adult nonemergency dental benefits were associated with higher use of preventive and other types of dental services and lower out-of-pocket share of dental costs. PRACTICAL IMPLICATIONS Our results may help inform policy makers as they consider ways of improving dental health of adults through Medicaid.
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Baicker K, Allen HL, Wright BJ, Taubman SL, Finkelstein AN. The Effect of Medicaid on Dental Care of Poor Adults: Evidence from the Oregon Health Insurance Experiment. Health Serv Res 2017; 53:2147-2164. [PMID: 28884818 DOI: 10.1111/1475-6773.12757] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. DATA SOURCES Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery. STUDY DESIGN We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. DATA COLLECTION Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646). PRINCIPAL FINDINGS Medicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p < .001) or having unmet dental care needs (-13.5 percentage points, p < 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending. CONCLUSIONS Expansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services.
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Affiliation(s)
- Katherine Baicker
- Harris School of Public Policy, University of Chicago, Chicago, IL.,National Bureau of Economic Research, Cambridge, MA.,Jameel Poverty Action Lab, Cambridge, MA.,Harvard T. H. Chan School of Public Health, Boston, MA
| | - Heidi L Allen
- School of Social Work, Columbia University, New York, NY
| | - Bill J Wright
- Center for Outcomes Research and Education, Providence Health and Services, Portland, OR
| | | | - Amy N Finkelstein
- National Bureau of Economic Research, Cambridge, MA.,Jameel Poverty Action Lab, Cambridge, MA.,Massachusetts Institute of Technology, Cambridge, MA
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12
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Shane DM, Wehby G. The Impact of the Affordable Care Act's Dependent Coverage Mandate on Use of Dental Treatments and Preventive Services. Med Care 2017; 55:841-847. [PMID: 28719488 PMCID: PMC5568688 DOI: 10.1097/mlr.0000000000000775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate. OBJECTIVES To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults. DATA 2006-2013 Medical Expenditure Panel Surveys. STUDY DESIGN We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women. CONCLUSIONS Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.
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Affiliation(s)
- Dan M Shane
- Assistant Professor, University of Iowa College of Public Health, Department of Health Management and Policy, 145 N. Riverside Drive, N244 CPHB, Iowa City, IA 52242
| | - George Wehby
- Associate Professor, University of Iowa College of Public Health, Department of Health Management and Policy, 145 N. Riverside Drive, Iowa City, IA 52242
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13
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Mohamed A, Alhanti B, McCullough M, Goodin K, Roling K, Glickman L. Temporal association of implementation of the Arizona Health Care Cost Containment System (AHCCCS) with changes in dental-related emergency department visits in Maricopa County from 2006 to 2012. J Public Health Dent 2017; 78:49-55. [DOI: 10.1111/jphd.12238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Kate Goodin
- Public Health, Maricopa County; Phoenix AZ USA
| | - Kirsten Roling
- California Oral Health Coalition for the Aging & Developmentally Disabled; San Diego CA USA
| | - Larry Glickman
- Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette IN USA
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14
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Doan L, Tiwari T, Brunson D, Carey CM. Medicaid Adult Dental Benefit Impact on Dental Utilization: A University Clinic Setting. Front Public Health 2017; 5:147. [PMID: 28725642 PMCID: PMC5495854 DOI: 10.3389/fpubh.2017.00147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction In 2014, the state of Colorado initiated new dental coverage benefits for adults in the Colorado Medicaid program. The goal of this study was to investigate the utilization and impact of this new dental coverage at the University of Colorado School of Dental Medicine. The utilization of dental services delivered and the numbers of patients in this program were compared before and after the implementation of the benefit. Materials and methods This retrospective study compared the utilization of services provided 2 years prior and 2 years after the Medicaid adult benefit was made available. Through the University of Colorado School of Dental Medicine (CU-SODM) electronic dental record, all adult Medicaid dental patients’ (ages 21+) charts were extracted for zip code, CDT dental procedure codes, with a focus on tooth extraction compared to tooth saving procedures. Graphical analysis and Pearson’s chi-squared tests were applied to assess the statistical significance of procedure utilization changes over time. Results After implementation of the Medicaid adult benefit, the number of patients seen at the school under this program increased by a factor of 4.5. The geographic range (zip code) increased with some patients coming from further distances to receive dental care. The number of patients from local zip codes increased by as much as 235%. There was a 51% increase in tooth saving procedures, which was statistically significant (P = 0.0013). Additionally, there was a 22% decrease in extractions, while not statistically significant (P = 0.0992), a downward trend was clear. Discussion The focus was on the utilization of Medicaid adult benefits at the dental school, which was only a small proportion of the state-wide Medicaid population. Therefore, these data are not generalizable for statewide assessments of the program. However, based on the findings at the school clinics, more adult patients utilized the benefits; and chose to receive more tooth saving procedures and less extractions after implementation of the Medicaid adult benefit. This Medicaid study conducted at the CU-SODM 2 years after the adult dental coverage can be used as a baseline for future studies.
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Affiliation(s)
- Lynn Doan
- University of Colorado School of Dental Medicine, Aurora, CO, United States
| | - Tamanna Tiwari
- Department of Applied Dentistry, University of Colorado School of Dental Medicine, Aurora, CO, United States
| | - Diane Brunson
- Department of Applied Dentistry, University of Colorado School of Dental Medicine, Aurora, CO, United States
| | - Clifton M Carey
- Department of Craniofacial Biology, University of Colorado School of Dental Medicine, Aurora, CO, United States
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15
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Laniado N, Badner VM, Silver EJ. Expanded Medicaid dental coverage under the Affordable Care Act: an analysis of Minnesota emergency department visits. J Public Health Dent 2017; 77:344-349. [DOI: 10.1111/jphd.12214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nadia Laniado
- Department of Dentistry, Jacobi Medical Center; Albert Einstein College of Medicine, Bronx; NY USA
| | - Victor M. Badner
- Department of Dentistry, Jacobi Medical Center; Albert Einstein College of Medicine, Bronx; NY USA
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Singhal A, Caplan DJ, Jones MP, Momany ET, Kuthy RA, Buresh CT, Isman R, Damiano PC. Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs. Health Aff (Millwood) 2016; 34:749-56. [PMID: 25941275 DOI: 10.1377/hlthaff.2014.1358] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations.
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Affiliation(s)
- Astha Singhal
- Astha Singhal is a PhD candidate in the Department of Preventive and Community Dentistry, College of Dentistry, and a research assistant at the Public Policy Center, both at the University of Iowa, in Iowa City
| | - Daniel J Caplan
- Daniel J. Caplan is a professor and department executive officer in the Department of Preventive and Community Dentistry, College of Dentistry, at the University of Iowa
| | - Michael P Jones
- Michael P. Jones is a professor in the Department of Biostatistics, College of Public Health, at the University of Iowa
| | - Elizabeth T Momany
- Elizabeth T. Momany is an associate research scientist at the Public Policy Center, University of Iowa
| | - Raymond A Kuthy
- Raymond A. Kuthy is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, at the University of Iowa
| | - Christopher T Buresh
- Christopher T. Buresh is an associate professor in the Department of Emergency Medicine, College of Medicine, at the University of Iowa
| | - Robert Isman
- Robert Isman is a dental program consultant in the Medi-Cal Dental Services Division of the California Department of Health Care Services, in Sacramento
| | - Peter C Damiano
- Peter C. Damiano is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, and director of the Public Policy Center, both at the University of Iowa
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MacDougall H. Dental Disparities among Low-Income American Adults: A Social Work Perspective. HEALTH & SOCIAL WORK 2016; 41:208-210. [PMID: 29206952 PMCID: PMC4985883 DOI: 10.1093/hsw/hlw026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/12/2015] [Indexed: 06/07/2023]
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Dillender M, Mulligan K. The Effect of Medicare Eligibility on Spousal Insurance Coverage. HEALTH ECONOMICS 2016; 25:591-605. [PMID: 25762207 DOI: 10.1002/hec.3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 12/15/2014] [Accepted: 02/13/2015] [Indexed: 06/04/2023]
Abstract
A majority of married couples in the USA take advantage of the fact that employers often provide health insurance coverage to spouses. When older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of younger spouses. We find that spousal eligibility for Medicare results in younger spouses no longer having employers pay for their insurance and being less likely to have employer-sponsored coverage. Instead, younger spouses switch to privately purchased coverage, which tends to be worse than what they had before their spouses became eligible for Medicare. We also find suggestive evidence that younger spouses are less likely to use health care services after their older spouses become eligible for Medicare.
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Affiliation(s)
- Marcus Dillender
- W.E. Upjohn Institute for Employment Research, Kalamazoo, MI, USA
| | - Karen Mulligan
- Department of Economics and Finance, Middle Tennessee State University, Murfreesboro, TN, USA
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Abstract
OBJECTIVE The authors conducted a study to measure the gap in dental care utilization between poor and nonpoor adults at the state level and to show how the gap has changed over time. METHODS The authors collected data from the 2002, 2004, 2006, 2008 and 2010 Behavioral Risk Factor Surveillance System prevalence and trends database maintained by the Centers for Disease Control and Prevention to measure differences in dental care utilization between poor and nonpoor adults. Poor adults are defined as those at or below the federal poverty threshold. The authors estimated a series of linear probability models to measure the dental care utilization gap between poor and nonpoor adults, while controlling for potentially confounding covariates. RESULTS In 12 states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Nebraska, Ohio, Oklahoma, South Carolina, Texas and Washington), the gap in dental care utilization between poor and nonpoor adults grew from 2002 through 2010. The remaining states had a stable utilization gap from 2002 through 2010. The study results show that four states (Alaska, Massachusetts, Minnesota, New York) and the District of Columbia had a smaller gap in dental care utilization in 2010 than that in other states. CONCLUSIONS At the state level, poor adults face greater access barriers to dental care than do nonpoor adults. As states limit dental coverage through Medicaid, poor adults are at greater risk of experiencing poor oral health outcomes. Practical Implications In states that are experiencing increasing inequality in dental care utilization between poor and nonpoor adults, policymakers may wish to explore alternative approaches that could address this situation.
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Decker SL, Lipton BJ. Do Medicaid benefit expansions have teeth? The effect of Medicaid adult dental coverage on the use of dental services and oral health. JOURNAL OF HEALTH ECONOMICS 2015; 44:212-225. [PMID: 26519908 PMCID: PMC6758545 DOI: 10.1016/j.jhealeco.2015.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 07/17/2015] [Accepted: 08/30/2015] [Indexed: 06/05/2023]
Abstract
This article examines the effect of Medicaid adult dental coverage on use of dental care and dental health outcomes using state-level variation in dental coverage during 2000-2012. Our findings imply that dental coverage is associated with an increase in the likelihood of a recent dental visit, with the size of the effect increasing with Medicaid payment rates to dentists, and a reduction in the likelihood of untreated dental caries. We are among the first to detect an effect of Medicaid coverage on a clinical health outcome other than mortality. These findings may have implications for states expanding Medicaid coverage to adults with incomes of up to 138% of the federal poverty threshold under the Affordable Care Act as most of these states offer an adult dental benefit.
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Affiliation(s)
- Sandra L Decker
- National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, United States
| | - Brandy J Lipton
- National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, United States.
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21
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Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders. J Autism Dev Disord 2015; 45:1396-407. [PMID: 25374135 DOI: 10.1007/s10803-014-2298-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0% (children) and 2.1% (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR 0.39; 95% CI 0.29, 0.52; p < 0.001) but incurred significantly greater mean costs for NTDC-related ED visits (p < 0.006) than did adults without ASD.
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Shane DM, Ayyagari P. Spillover Effects of the Affordable Care Act? Exploring the Impact on Young Adult Dental Insurance Coverage. Health Serv Res 2015; 50:1109-24. [PMID: 25483853 PMCID: PMC4545349 DOI: 10.1111/1475-6773.12266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess whether the Affordable Care Act's (ACA) dependent coverage health insurance mandate had a spillover impact on young adult dental insurance coverage and whether any observed effects varied by household income. DATA Medical Expenditure Panel Surveys from 2006 through 2011. STUDY DESIGN We employed a difference-in-difference regression approach comparing changes in insurance rates for young adults ages 19-25 years to changes in insurance rates for adults ages 27-30 years. Separate regressions were estimated by categories of household income as a percentage of the Federal Poverty Level (FPL) to understand whether the mandate had heterogeneous spillover effects. RESULTS Private dental insurance increased by 6.7 percentage points among young adults compared to a control group of 27-30-year olds. Increases were concentrated at middle-income levels (125-400 percent FPL). CONCLUSIONS The dependent coverage mandate provision of the Affordable Care Act has not only increased health insurance rates among young adults but also dental insurance coverage rates.
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Affiliation(s)
- Dan M Shane
- Padmaja Ayyagari, Ph.D., is also with the Department of Health Management and Policy, University of Iowa, Iowa City, IA
| | - Padmaja Ayyagari
- Padmaja Ayyagari, Ph.D., is also with the Department of Health Management and Policy, University of Iowa, Iowa City, IA
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Wides C, Alam SR, Mertz E. Shaking up the dental safety-net: elimination of optional adult dental Medicaid benefits in California. J Health Care Poor Underserved 2015; 25:151-64. [PMID: 24583494 DOI: 10.1353/hpu.2014.0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In July 2009, California eliminated funding for most adult non-emergency Medicaid dental benefits (Denti-Cal). This paper presents the findings from a qualitative assessment of the impacts of the Denti-Cal cuts on California's oral health safety-net. Interviews were conducted with dental safety-net providers throughout the state, including public health departments, community health centers, dental schools, Native American health clinics, and private providers, and were coded thematically using Atlas.ti. Safety-net providers reported decreased utilization by Denti-Cal-eligible adults, who now primarily seek emergency dental services, and reported shifting to focus on pediatric and privately-insured patients. Significant changes were reported in safety-net clinic finances, operations, and ability to refer. The impact of the Denti-Cal cuts has been distributed unevenly across the safety-net, with private providers and County Health Departments bearing the highest burden.
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Phillips E, Gwozdek AE, Shaefer HL. Safety Net Care and Midlevel Dental Practitioners: A Case Study of the Portion of Care That Might Be Performed Under Various Setting and Scope-of-Practice Assumptions. Am J Public Health 2015; 105:1770-6. [PMID: 26180959 DOI: 10.2105/ajph.2015.302715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine the proportion of dental care provided at safety net-type clinics that might be performed by midlevel practitioners. METHODS Data were obtained on 157,328 procedures performed in 2012 at the clinics associated with a Midwestern dental school. Based on procedure codes, we determined the overall proportion, as well as the proportion of visits and patients' care, that could have been performed by 3 types of practitioners. RESULTS Overall, 48% to 66% of all procedures could have been performed by a midlevel dental practitioner. Nearly half of all visits, and roughly a third of all patients, could have been entirely cared for by a practitioner trained in prophylaxis and with evaluation capabilities. Such practitioners could handle roughly 80% of the visits at the community-based clinic and more than half of the visits at the hospital-based clinic. CONCLUSIONS A midlevel practitioner with training in prophylaxis has the potential to alleviate much of the burden on the dental safety net because much of the need among vulnerable populations falls well within their scope of practice.
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Affiliation(s)
- Elizabeth Phillips
- Elizabeth Phillips and H. Luke Shaefer are with the School of Social Work, University of Michigan, Ann Arbor. Anne E. Gwozdek is with the Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan
| | - Anne E Gwozdek
- Elizabeth Phillips and H. Luke Shaefer are with the School of Social Work, University of Michigan, Ann Arbor. Anne E. Gwozdek is with the Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan
| | - H Luke Shaefer
- Elizabeth Phillips and H. Luke Shaefer are with the School of Social Work, University of Michigan, Ann Arbor. Anne E. Gwozdek is with the Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan
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Sun BC, Chi DL, Schwarz E, Milgrom P, Yagapen A, Malveau S, Chen Z, Chan B, Danner S, Owen E, Morton V, Lowe RA. Emergency department visits for nontraumatic dental problems: a mixed-methods study. Am J Public Health 2015; 105:947-55. [PMID: 25790415 DOI: 10.2105/ajph.2014.302398] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. METHODS We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. RESULTS Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. CONCLUSIONS Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.
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Affiliation(s)
- Benjamin C Sun
- Benjamin C. Sun, Annick Yagapen, Susan Malveau, and Ben Chan are with Department of Emergency Medicine, Oregon Health and Science University (OHSU), Portland. Robert A. Lowe is with the Department of Medical Informatics and Clinical Epidemiology, OHSU. Donald L. Chi and Peter Milgrom are with Department of Oral Health Sciences, University of Washington, Seattle. Eli Schwarz is with School of Dentistry, OHSU. Zunqui Chen is with Department of Public Health and Preventive Medicine, OHSU. Sankirtana Danner is with Oregon Rural Practice-Based Research Network, OHSU. Erin Owen is with Slocum Research and Education Foundation, Eugene, OR. Vickie Morton is with Financial Services, OHSU
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Nasseh K, Vujicic M. Health reform in Massachusetts increased adult dental care use, particularly among the poor. Health Aff (Millwood) 2014; 32:1639-45. [PMID: 24019370 DOI: 10.1377/hlthaff.2012.1332] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
States frequently expand or limit dental benefits for adults covered by Medicaid. As part of statewide health reform in 2006, Massachusetts expanded dental benefits to all adults ages 19-64 whose annual income was at or below 100 percent of the federal poverty level. We examined the impact of this reform and found that it led to an increase in dental care use among the Massachusetts adult population, driven by gains among poor adults. Compared to the prereform period, dental care use increased by 2.9 percentage points among all nonelderly adults in Massachusetts, relative to all nonelderly adults in eight control states. For poor Massachusetts adults, the effect was larger-an eleven-percentage-point increase in dental care use above the increase among the state's nonpoor residents. The Massachusetts experience provides evidence that providing dental benefits to poor adults through Medicaid can improve dental care access and use. Our results imply that the lack of expanded dental coverage for low-income adults under the Affordable Care Act is a missed opportunity to improve access to oral care.
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Chi DL, Masterson EE, Wong JJ. U.S. emergency department admissions for nontraumatic dental conditions for individuals with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:193-204. [PMID: 24937745 PMCID: PMC4097187 DOI: 10.1352/1934-9556-52.3.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults age 18 years or older. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 0.91, 1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (OR = 0.49; 95% CI = 0.44, 0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions, whereas adults with IDDs are at significantly reduced odds.
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Wiener RC, Shockey AT. Oral Health Knowledge and Dental Visits in Community Living Older Adults in Rural Appalachia-West Virginia: A Cross-Sectional Analysis. JOURNAL OF STUDIES IN SOCIAL SCIENCES 2014; 8:1-14. [PMID: 25530938 PMCID: PMC4269834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship between oral health knowledge and dental visits of older adults in an Appalachian county. METHODS A cross-sectional study design was used. Surveys were returned from 205 older adults (50 years and above) from an Appalachian county. Questions were asked about oral health, last dental visit and sociodemographics. RESULTS The variable of interest, oral health knowledge, was associated with dental visit. Having low oral health knowledge increased odds of having delayed a dental visit beyond a year (unadjusted odds ratio: 2.99; 95% Confidence interval: 1.70, 5.28). Even after considering the number of existing teeth, and controlling for age, sex, education and smoking, the association remained positive and independently significant (adjusted odds ratio: 2.25; 95% Confidence interval: 1.05, 4.82). Education was the only sociodemographic variable associated with last dental visit. CONCLUSION The surveyed older adults have a need for increasing dental visits within the previous year. Increasing dental knowledge was associated with odds of increased dental visits. Improving dental knowledge may be a strategy to improve the number of older adults having a dental visit within the year.
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Affiliation(s)
- R Constance Wiener
- Dental Practice and Rural Health, School of Dentistry, Department of Epidemiology, School of Public Health, West Virginia University, 104A Health Sciences Center Addition PO Box 9448, Morgantown, WV 26506
| | - Alcinda Trickett Shockey
- Department of Periodontics; Division of Dental Hygiene, West Virginia University, Health Sciences Center, Morgantown, WV 26506
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Cohen LA. Expanding the physician's role in addressing the oral health of adults. Am J Public Health 2013; 103:408-12. [PMID: 23327256 PMCID: PMC3673507 DOI: 10.2105/ajph.2012.300990] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 12/30/2022]
Abstract
Many disadvantaged adults visit physicians or hospital emergency departments to receive relief from dental pain. Physicians also see patients with general questions or concerns about their oral health. Unfortunately, because physicians generally have received little oral health training, patients often do not receive comprehensive emergency services or appropriate counseling. This situation has begun to change, as there has been a growing sentiment among the dental and medical communities that better integration and coordination between medicine and dentistry would be beneficial. Reports from the Institute of Medicine and professional associations and foundations reflect the need for better integration. I have outlined the rationale for and progress toward expanding the physician's role in addressing the oral health of adults.
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Affiliation(s)
- Leonard A Cohen
- Division of Dental Public Health, University of Maryland Dental School, Baltimore, MD 21201, USA.
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Lee HH, Lewis CW, Saltzman B, Starks H. Visiting the emergency department for dental problems: trends in utilization, 2001 to 2008. Am J Public Health 2012; 102:e77-83. [PMID: 22994252 DOI: 10.2105/ajph.2012.300965] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the hypothesis that between 2001 and 2008, Americans increasingly relied upon emergency departments (EDs) for dental care. METHODS Data from 2001 through 2008 were collected from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Population-based visit rates for dental problems, and, for comparison, asthma, were calculated using annual US Census Bureau estimates. As part of the analysis, we described patient characteristics associated with large increases in ED dental utilization. RESULTS Dental visit rates increased most dramatically for the following subpopulations: those aged 18 to 44 years (7.2-12.2 per 1000, P < .01); Blacks (6.0-10.4 per 1000, P < .01); and the uninsured (9.5-13.2 per 1000, P < .01). Asthma visit rates did not change although dental visit rates increased 59% from 2001 to 2008. CONCLUSIONS There is an increasing trend in ED visits for dental issues, which was most pronounced among those aged 18 to 44 years, the uninsured, and Blacks. Dental visit rates increased significantly although there was no overall change in asthma visit rates. This suggests that community access to dental care compared with medical care is worsening over time.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, University of Washington, Seattle, WA, USA.
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Hall JP, Chapman SLC, Kurth NK. Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities. J Public Health Dent 2012; 73:79-82. [PMID: 22881988 DOI: 10.1111/j.1752-7325.2012.00359.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To inform policy with better information about the oral health-care needs of a Medicaid population that engages in employment, that is, people ages 16 to 64 with Social Security-determined disabilities enrolled in a Medicaid Buy-In program. METHODS Statistically test for significant differences among responses to a Medicaid Buy-In program satisfaction survey that included oral health questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the Oral Health Impact Profile (OHIP) to results for the state's general population and the US general population. RESULTS All measures of dental care access and oral health were significantly worse for the study population as compared with a state general population or a US general population. Differences were particularly pronounced for the OHIP measure for difficulty doing one's job due to dental problems, which was almost five times higher for the study population. CONCLUSIONS More comprehensive dental benefits for the study population could result in increased oral and overall health, and eventual cost savings to Medicaid as more people work, have improved health, and pay premiums for coverage.
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Affiliation(s)
- Jean P Hall
- Division of Adult Studies, University of Kansas, Lawrence, KS 66045, USA.
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Pajewski NM, Okunseri C. Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid. J Public Health Dent 2012; 74:34-41. [PMID: 22882075 DOI: 10.1111/j.1752-7325.2012.00364.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED). METHODS This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist. RESULTS We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 to <50 years) and enrollees living in counties with a lower supply of dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit. CONCLUSIONS Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions.
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Affiliation(s)
- Nicholas M Pajewski
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA School of Dentistry, Department of Clinical Services, Marquette University, Milwaukee, WI, USA
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Wall T. Recent trends in dental emergency department visits in the United States:1997/1998 to 2007/2008. J Public Health Dent 2012; 72:216-20. [PMID: 22536892 DOI: 10.1111/j.1752-7325.2012.00339.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The author focused on recent national trends in dental emergency department (ED) visits. Patients who presented at an ED for a dental condition are described and the author look at the extent to which these patients have changed over time. METHODS This study was based on the National Ambulatory Medical Care Survey, a national probability survey of hospital ED visits. A dental ED visit was defined using International Classification of Diseases, Ninth Edition, Clinical Modification diagnostic codes. RESULTS Between 1997/1998 and 2007/2008, dental ED visits increased from 1.15 to 1.87 percent of total ED visits. The largest increase in the number of dental ED visits per 1,000 persons was found for young adults 20-34 years old. Primary payer, a measure of insurance status, suggests that patients from all income levels participated in the increase. CONCLUSIONS Although dental-related ED visits account for a relatively small percentage of total ED visits, both the number and the percentage of such visits grew from 1997/1998 to 2007/2008. Young adults 20-34 years old were most likely to present at an ED with a dental problem.
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Affiliation(s)
- Thomas Wall
- Health Policy Resources Center, American Dental Association, Chicago, IL 60611-2678, USA.
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USING EMERGENCY DEPARTMENTS: Authors' response. J Am Dent Assoc 2011. [DOI: 10.14219/jada.archive.2011.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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