医疗补助管理式医疗中牙科医疗服务和支付创新对儿童和青少年的影响。

Impacts of innovation in dental care delivery and payment in Medicaid managed care for children and adolescents.

机构信息

Department of Health Services, School of Public Health, University of Washington, Box 357660, Seattle, WA, USA.

Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA.

出版信息

BMC Health Serv Res. 2021 Jun 8;21(1):565. doi: 10.1186/s12913-021-06549-3.

DOI:10.1186/s12913-021-06549-3

PMID:34103017

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8188686/

Abstract

BACKGROUND

We evaluated a 14-county quality improvement program of care delivery and payment of a dental care organization for child and adolescent managed care Medicaid beneficiaries after 2 years of implementation.

METHODS

Counties were randomly assigned to either the intervention (PREDICT) or control group. Using Medicaid administrative data, difference-in-difference regression models were used to estimate PREDICT intervention effects (formally, "average marginal effects") on dental care utilization and costs to Medicaid, controlling for patient and county characteristics.

RESULTS

Average marginal effects of PREDICT on expected use and expected cost of services per patient (child or adolescent) per quarter were small and insignificant for most service categories. There were statistically significant effects of PREDICT (p < .05), though still small, for certain types of service: (1) Expected number of diagnostic services per patient-quarter increased by .009 units; (2) Expected number of sealants per patient-quarter increased by .003 units, and expected cost by $0.06; (3) Total expected cost per patient-quarter for all services increased by $0.64. These consistent positive effects of PREDICT on diagnostic and certain preventive services (i.e., sealants) were not accompanied by increases in more costly service types (i.e., restorations) or extractions.

CONCLUSION

The major hypothesis that primary dental care (selected preventive services and diagnostic services in general) would increase significantly over time in PREDICT counties relative to controls was supported. There were small but statistically significant, increases in differential use of diagnostic services and sealants. Total cost per beneficiary rose modestly, but restorative and dental costs did not. The findings suggest favorable developments within PREDICT counties in enhanced preventive and diagnostic procedures, while holding the line on expensive restorative and extraction procedures.

摘要

背景

我们评估了一个为期两年的口腔护理组织提供的 14 个县的医疗保健服务改善计划和支付情况，该计划针对儿童和青少年管理式医疗 Medicaid 受益人。

方法

各县被随机分配到干预组（PREDICT）或对照组。使用 Medicaid 管理数据，通过差异-差异回归模型，控制患者和县级特征，估计 PREDICT 干预对每季度每位（儿童或青少年）患者的牙科护理利用率和 Medicaid 成本的影响（正式来说，是“平均边际效应”）。

结果

PREDICT 对每季度每位患者（儿童或青少年）预期服务使用量和预期服务成本的平均边际效应在大多数服务类别中都较小且无统计学意义。尽管较小，但 PREDICT 对某些类型的服务仍具有统计学上的显著影响（p<0.05）：（1）每季度每位患者的预期诊断服务数量增加了 0.009 个单位；（2）每季度每位患者的预期窝沟封闭数量增加了 0.003 个单位，预期成本增加了 0.06 美元；（3）所有服务的每位患者每季度的总预期成本增加了 0.64 美元。PREDICT 对诊断和某些预防性服务（即窝沟封闭）的这些一致的积极影响并没有伴随着更昂贵服务类型（即修复和拔牙）的增加。

结论

主要假设，即初级牙科保健（一般选择的预防性服务和诊断服务）在 PREDICT 县相对于对照组将随着时间的推移显著增加，得到了支持。在诊断服务和窝沟封闭的使用上，出现了较小但具有统计学意义的增加。每位受益人的总成本略有上升，但修复和牙科费用没有增加。这些发现表明，在 PREDICT 县，预防性和诊断性程序得到了有利的发展，同时控制了昂贵的修复和拔牙程序。