Arthur Tania, Rozier R Gary
NYU Lutheran Department of Dental Medicine, Dental Public Health Residency Program, Brooklyn, New York; and
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Pediatrics. 2016 Feb;137(2):e20153436. doi: 10.1542/peds.2015-3436. Epub 2016 Jan 22.
Aims of this study are to determine (1) the association of oral health services (OHS) provided by nontraditional providers with the percentage of Medicaid children 0 to 5 years of age who receive ≥1 preventive services from all provider types in the United States; and (2) characteristics of state Medicaid policies associated with provision of OHS.
We conducted a time-series cross-sectional study of preventive services provided by nontraditional (OHS) and dental (PDS) providers for Medicaid-enrolled children from birth to 5 years of age in all states during 2010 to 2013 (204 observations). We applied panel data multiple regression analysis techniques to exploit year and state variation in aggregate data available in Centers for Medicare and Medicaid Services reports (form CMS-416). Total preventive dental services (TPDS =OHS + PDS) was predicted by months since state enactment of a policy to reimburse medical providers for OHS.
The 44 states with a policy reported 4.3% of children per state per year with any OHS. For all states, an average of 30.1% received PDS and 34.5% TPDS. The delivery of OHS was associated with a small increase in percentage with TPDS. One year of Medicaid OHS availability was associated with an increase of 1.5% in the percentage of children with TPDS per state per year.
Implementation of policies by Medicaid programs to support integration of OHS into primary care is associated with increases in overallTPDS use, but efforts are needed to improve implementation in practice to achieve national impact on access.
本研究旨在确定：（1）非传统医疗服务提供者所提供的口腔健康服务（OHS）与美国0至5岁接受医疗补助儿童中从所有医疗服务提供者类型接受≥1次预防性服务的儿童百分比之间的关联；以及（2）与提供OHS相关的州医疗补助政策特征。
我们对2010年至2013年期间所有州为参加医疗补助的出生至5岁儿童提供的非传统（OHS）和牙科（PDS）医疗服务提供者的预防性服务进行了时间序列横断面研究（204次观察）。我们应用面板数据多元回归分析技术，利用医疗保险和医疗补助服务中心报告（CMS - 416表）中汇总数据的年份和州差异。自州颁布一项为医疗服务提供者报销OHS的政策以来的月份数可预测总预防性牙科服务（TPDS = OHS + PDS）。
报告有该政策的44个州每年每个州有4.3%的儿童接受任何OHS。对于所有州，平均有30.1%的儿童接受PDS，34.5%的儿童接受TPDS。OHS的提供与TPDS百分比的小幅增加相关。医疗补助OHS可获得性一年与每个州每年接受TPDS的儿童百分比增加1.5%相关。
医疗补助计划实施支持将OHS纳入初级保健的政策与总体TPDS使用增加相关，但需要努力在实践中改进实施，以实现对可及性的全国性影响。
