Department of Health Care Organization and Policy, University of Alabama, Birmingham, AL, USA.
Pediatrics. 2013 Jun;131(6):1107-13. doi: 10.1542/peds.2012-2586. Epub 2013 May 27.
Although preventive dental visits are considered important for maintaining pediatric oral health, there is relatively little research showing that they reduce subsequent nonpreventive dental visits or costs. At least 1 study seemed to find that early preventive dental care is associated with more restorative and emergency visits. Previous studies are limited by their inability to account for unmeasurable factors that may lead children to "select" into using both more preventive and nonpreventive dental care. We used econometric techniques that minimize selection bias to assess the effectiveness of preventive dental care in reducing subsequent nonpreventive dental service utilization among children.
Using data from Alabama's Children's Health Insurance Program (CHIP), 1998-2010., a cohort study of children's dental service utilization was conducted. Outcomes were 1-year lagged nonpreventive dental care and expenditures, and overall dental and medical expenditures. Children who were continuously enrolled for at least 3 years were included. Separate models were estimated for children aged <8 years (n = 14 972) and those aged ≥8 years (n = 21 833).
More preventive visits were associated with fewer subsequent nonpreventive dental visits and lower nonpreventive dental expenditures for both groups. However, more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures.
Preventive dental visits can reduce subsequent nonpreventive visits and expenditures for children continuously enrolled in CHIP. However, they may not reduce overall program costs. Effective empirical research in this area must continue to address unobserved confounders and selection issues.
尽管预防性牙科就诊被认为对维持儿童口腔健康很重要，但几乎没有研究表明它们可以减少后续的非预防性牙科就诊次数或费用。至少有一项研究似乎表明，早期预防性牙科护理与更多的修复和急诊就诊有关。以前的研究受到限制，因为它们无法解释可能导致儿童“选择”更多预防性和非预防性牙科护理的不可测量因素。我们使用了最小化选择偏差的计量经济学技术，来评估预防性牙科护理在减少儿童后续非预防性牙科服务利用方面的效果。
利用来自阿拉巴马州儿童健康保险计划（CHIP）的 1998-2010 年数据，对儿童牙科服务利用情况进行了队列研究。结果是 1 年滞后的非预防性牙科护理和支出，以及整体牙科和医疗支出。连续至少 3 年入组的儿童被纳入研究。分别为年龄<8 岁（n=14972）和年龄≥8 岁（n=21833）的儿童估计了单独的模型。
对于两个年龄组的儿童，更多的预防性就诊与随后的非预防性牙科就诊次数减少和非预防性牙科支出降低有关。然而，预防性就诊并不能降低整体牙科或医疗（包括牙科）支出。
持续参加 CHIP 的儿童的预防性牙科就诊可以减少后续的非预防性就诊次数和支出。然而，它们可能不会降低整体计划成本。在这一领域需要继续进行有效的实证研究，以解决未观察到的混杂因素和选择问题。
