儿童特殊健康护理需求者的州医疗补助资格标准及未满足的预防性牙科护理需求

State Medicaid Eligibility Criteria and Unmet Preventive Dental Care Need for CSHCN.

作者信息

McManus Beth M, Chi Donald, Carle Adam

机构信息

Department of Health Systems, Management and Policy, Colorado School of Public Health and Children's Outcomes Research Group, Children's Hospital Colorado, 13001 E. 17th Place, MS B117, Aurora, CO, 80045, USA.

Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.

出版信息

Matern Child Health J. 2016 Feb;20(2):456-65. doi: 10.1007/s10995-015-1843-6.

DOI:10.1007/s10995-015-1843-6

PMID:26520157

Abstract

OBJECTIVE

To determine if Medicaid eligibility is associated with unmet preventive dental care need for Medicaid-enrolled CSHCN.

METHODS

We analyzed the 2009-2010 National Survey of CSHCN and focused on Medicaid-enrolled children ages 3-17. The outcome measure was parent-reported unmet need for preventive dental care. The predictor variable was state Medicaid eligibility criteria, categorized as broad [>250 % Federal Poverty Level (FPL)], moderate (200-249 % FPL), and narrow (<200 % FPL). Multiple variable multilevel logistic regression models estimated the association between state-level eligibility criteria and variability in unmet need.

RESULTS

The multilevel models indicated no significant association between Medicaid eligibility criteria and unmet preventive dental care need. CSHCN with more severe chronic health conditions had significantly greater odds of unmet need (OR 1.52; 95 % CI 1.28, 1.82) and CSHCN with a medical home had significantly lower odds (OR 0.61; 95 % CI 0.50, 0.75).

CONCLUSIONS FOR PRACTICE

There is significant state variability in unmet need for preventive dental care for Medicaid-enrolled CSHCN. Broadening Medicaid eligibility criteria alone is not likely to address the preventive dental care needs of CSHCN, which has policy implications for improving oral health disparities for publicly-insured CSHCN.

摘要

目的

确定医疗补助资格是否与参加医疗补助的儿童特殊医疗需求群体（CSHCN）未满足的预防性牙科护理需求相关。

方法

我们分析了2009 - 2010年全国CSHCN调查，并重点关注年龄在3 - 17岁、参加医疗补助的儿童。结果指标是家长报告的未满足的预防性牙科护理需求。预测变量是州医疗补助资格标准，分为宽泛（>250%联邦贫困水平[FPL]）、中等（200 - 249% FPL）和狭窄（<200% FPL）。多变量多水平逻辑回归模型估计了州级资格标准与未满足需求的变异性之间的关联。

结果

多水平模型表明，医疗补助资格标准与未满足的预防性牙科护理需求之间无显著关联。患有更严重慢性健康状况的CSHCN未满足需求的几率显著更高（比值比[OR] 1.52；95%置信区间[CI] 1.28，1.82），而有医疗之家的CSHCN未满足需求的几率显著更低（OR 0.61；95% CI 0.50，0.75）。