University of Iowa Public Policy Center, Iowa City, IA, USA.
University of Iowa College of Dentistry, Iowa City, IA, USA.
BMC Oral Health. 2019 May 24;19(1):89. doi: 10.1186/s12903-019-0771-z.
In Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population. The programs differed with respect to reimbursement, administration, and benefit structure. This study explored differences in patterns and predictors of dentist participation in the two programs.
Authors sent a survey to all private practice dentists in Iowa (n = 1301) 2 years after DWP implementation. Descriptive, bivariate, and logistic regression analyses were used to examine patterns and predictors of dentist participation in Medicaid and DWP.
Overall rates of dentists' acceptance of new Medicaid and DWP patients were 45 and 43%, respectively. However, Medicaid participants were much more likely than DWP participants to place limits on patient acceptance. Adjusting for other factors, practice busyness was the only significant predictor of DWP participation, and practice location was the only significant predictor of Medicaid participation. Dentists who were not busy enough were more than twice as likely to participate in DWP compared to others, and dentists in rural areas were almost twice as likely to participate in Medicaid compared to dentists in urban areas.
Dentist participation in Medicaid is an ongoing concern for states aiming to ensure access to dental care for low-income populations. We found distinct participation patterns and predictors between a traditional Medicaid dental program and the DWP, suggesting different motivations for participation between the two programs.
2014 年至 2017 年，爱荷华州为参加医疗补助计划的成年人提供了两项独立的公共牙科福利计划：一项是针对医疗补助扩大人群的“牙科健康计划”（DWP），另一项是针对传统、非扩大的成年医疗补助人群的计划。这两个项目在报销、管理和福利结构方面存在差异。本研究探讨了这两个项目中牙医参与模式和预测因素的差异。
作者在 DWP 实施两年后，向爱荷华州所有私人执业牙医发送了一份调查。采用描述性、双变量和逻辑回归分析来检查牙医参与 Medicaid 和 DWP 的模式和预测因素。
总体而言，牙医接受新 Medicaid 和 DWP 患者的比例分别为 45%和 43%。然而，与 DWP 参与者相比， Medicaid 参与者更有可能对患者接受设置限制。调整其他因素后，业务繁忙程度是 DWP 参与的唯一显著预测因素，而实践地点是 Medicaid 参与的唯一显著预测因素。不够繁忙的牙医参与 DWP 的可能性是其他牙医的两倍多，而农村地区的牙医参与 Medicaid 的可能性几乎是城市地区牙医的两倍。
对于旨在确保低收入人群获得牙科护理的州来说，牙医参与 Medicaid 仍然是一个持续存在的问题。我们发现传统 Medicaid 牙科计划和 DWP 之间存在明显的参与模式和预测因素，表明两个计划之间的参与动机不同。
