Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
JAMA. 2011 Jul 13;306(2):187-93. doi: 10.1001/jama.2011.956.
Although Medicaid removes most financial barriers to receipt of dental care among children and adolescents, Medicaid recipients may not be able to access dental care if dentists decline to participate in Medicaid because of low payment levels or other reasons.
To describe the association between state Medicaid dental fees in 2 years (2000 and 2008) and children's receipt of dental care.
DESIGN, SETTING, AND PARTICIPANTS: Data on Medicaid dental fees in 2000 and 2008 for 42 states plus the District of Columbia were merged with data from 33,657 children and adolescents (aged 2-17 years) in the National Health Interview Survey (NHIS) for the years 2000-2001 and 2008-2009. Logit models were used to estimate the probability that children and adolescents had seen a dentist in the past 6 months as a function of the Medicaid prophylaxis fee and control variables including age group, race, poverty status, and state and year effects. The effect of fees on children with Medicaid relative to a control group, privately insured counterparts, served to separate Medicaid's effect on access to care from any correlation between the Medicaid fee or changes in fees by state and other attributes of states.
Whether a child or adolescent had seen a dentist in the past 6 months.
On average, Medicaid dental payment levels did not change significantly in inflation-adjusted terms between 2000 and 2008, although a difference existed for some states, including in 5 states plus the District of Columbia, where payments increased at least 50%. In 2008-2009, more children and adolescents covered by Medicaid (55%, 95% confidence interval [CI], 53%-57%) had seen a dentist in the past 6 months than did uninsured children (27%, 95% CI, 24%-30%), but fewer than children covered by private insurance (68%, 95% CI, 67%-70%). Changes in state Medicaid dental payment fees between 2000 and 2008 were positively associated with use of dental care among children and adolescents covered by Medicaid. For example, a $10 increase in the Medicaid prophylaxis payment level (from $20 to $30) was associated with a 3.92 percentage point (95% CI, 0.54-7.50) increase in the chance that a child or adolescent covered by Medicaid had seen a dentist.
Higher Medicaid payment levels to dentists were associated with higher rates of receipt of dental care among children and adolescents.
尽管医疗补助计划消除了儿童和青少年接受牙科护理的大部分经济障碍，但如果牙医因低报酬或其他原因拒绝参与医疗补助计划，那么医疗补助计划的受助人可能无法获得牙科护理。
描述在两年内（2000 年和 2008 年）州医疗补助牙科费用与儿童获得牙科护理之间的关系。
设计、地点和参与者：将 42 个州和哥伦比亚特区的医疗补助牙科费用数据与全国健康访谈调查（NHIS）中 33657 名 2-17 岁儿童和青少年（2000-2001 年和 2008-2009 年）的数据进行合并。使用逻辑回归模型来估计过去 6 个月内儿童和青少年看牙医的概率作为医疗补助预防费的函数，并控制变量包括年龄组、种族、贫困状况以及州和年份效应。与对照组（私人保险儿童）相比，医疗补助对儿童的影响有助于将医疗补助对获得护理的影响与医疗补助费用或各州之间费用的变化以及各州的其他属性之间的任何相关性分开。
儿童或青少年在过去 6 个月内是否看过牙医。
平均而言，以通胀调整后的术语衡量，2000 年至 2008 年间，医疗补助牙科支付水平并未显著变化，尽管一些州存在差异，包括在 5 个州和哥伦比亚特区，这些州的支付至少增加了 50%。在 2008-2009 年，更多接受医疗补助的儿童和青少年（55%，95%置信区间[CI]，53%-57%）在过去 6 个月内看过牙医，而未参保的儿童（27%，95%CI，24%-30%），但低于私人保险覆盖的儿童（68%，95%CI，67%-70%）。2000 年至 2008 年间，州医疗补助牙科支付费用的变化与接受医疗补助的儿童和青少年使用牙科护理呈正相关。例如，医疗补助预防支付水平增加 10 美元（从 20 美元增加到 30 美元）与接受医疗补助的儿童和青少年看牙医的机会增加 3.92 个百分点（95%CI，0.54-7.50）相关。
向牙医支付更高的医疗补助费用与儿童和青少年获得牙科护理的比例增加有关。
