Johnson Ben, Serban Nicoleta, Griffin Paul M, Tomar Scott L
School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA.
Community Dent Oral Epidemiol. 2017 Dec;45(6):522-528. doi: 10.1111/cdoe.12315. Epub 2017 Jun 21.
We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia.
We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes.
Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by <1% and cost over $38 million. Given one parameter set, SBSPs could serve over 27 000 children with an intervention cost between $500 000 and $1.3 million with a potential cost saving of $1.1 million. Loan repayment could serve almost 13 000 children for a cost of $400 000 and a potential cost saving of $176 000.
The three interventions all improved met need for preventive dental care. Raising the reimbursement rate alone would marginally affect utilization of Medicaid services but would not substantially increase acceptance of Medicaid by providers. Both loan repayment programmes and amending supervision requirements are potentially cost-saving interventions. Loan repayment programmes provide complete care to targeted areas, while amending supervision requirements of dental hygienists could provide preventive care across the state.
我们评估了贷款偿还计划、修订医疗补助服务收费标准以及改变牙科保健员监管要求对佐治亚州儿童获得预防性牙科护理的影响。
在扣除干预成本后，我们估算了这三项针对幼儿预防性护理干预措施所节省的成本。我们使用回归模型来评估改变医疗补助报销率的影响。通过比较学校牙科防龋项目中的一般监管和直接监管来评估监管的影响。
与提高医疗补助报销率相比，向牙医提供的联邦贷款偿还以及学校防龋项目（SBSPs）的干预成本更低（潜在成本节省更高）。在实施SBSP时，一般监管的成本比牙科保健员的直接监管低56%。将医疗补助报销率提高10个百分点将使利用率提高不到1%，且成本超过3800万美元。在给定一组参数的情况下，SBSPs可为超过27000名儿童提供服务，干预成本在50万美元至130万美元之间，潜在成本节省为110万美元。贷款偿还可为近13000名儿童提供服务，成本为40万美元，潜在成本节省为17.6万美元。
这三项干预措施均改善了对预防性牙科护理需求的满足情况。仅提高报销率只会对医疗补助服务的利用率产生轻微影响，但不会大幅增加提供者对医疗补助的接受度。贷款偿还计划和修订监管要求都是潜在的节省成本的干预措施。贷款偿还计划为目标地区提供全面护理，而修订牙科保健员的监管要求可为全州提供预防性护理。
