School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia.
Health Soc Care Community. 2022 Nov;30(6):e4095-e4102. doi: 10.1111/hsc.13803. Epub 2022 Mar 25.
The Child Dental Benefits Schedule (CDBS) is an ongoing scheme administered through the Australian Government providing eligible children funding for clinical dental treatment. This study aimed to investigate the access of dental services across children's early childhood and examine whether the CDBS has improved access to dental care. The longitudinal study of Australian children is an ongoing cross-sequential cohort study with a representative sample of Australian children recruited in 2004. Birth (0-1 year) and kindergarten (4-5 years) cohorts were recruited through Medicare enrolment information at baseline and were representative of the Australian child population. Population-weighted longitudinal mixed effects Poisson models with individual identifiers as a random effect were used to assess the effect of Medicare dental schedules on reported dental attendance. Prior to the implementation of the CDBS for both cohorts, the birth cohort reported the lowest attendance rate at age 4-5. The introduction of the CDBS increased the rate of dental attendance for the low household income group by 8% (95% CI: 1%, 15%) after adjusting for confounders. The model provides evidence that dental attendance increased with age and the Indigenous population have 31% (95% CI: 4%, 55%) lower attendance rate after adjustment. The increase in reported access to dental services and favourable visiting patterns in low-income households during the operation of the CDBS provides some evidence that the schedule's primary aims to improve access to care in the child population are being met. Access to healthcare is multifaceted and the underutilisation of the schedule in the population warrants review of the schedule performance using other patient-centred indicators.
儿童牙科福利计划(CDBS)是澳大利亚政府管理的一项持续计划,为符合条件的儿童提供临床牙科治疗资金。本研究旨在调查儿童整个幼儿期的牙科服务获得情况,并探讨 CDBS 是否改善了儿童的牙科护理获得情况。澳大利亚儿童的纵向研究是一项正在进行的横断面队列研究,对 2004 年招募的澳大利亚具有代表性的儿童样本进行研究。在基线时,通过医疗保险登记信息招募了出生队列(0-1 岁)和幼儿园队列(4-5 岁),该队列代表了澳大利亚儿童人口。使用具有个体标识符作为随机效应的加权纵向混合效应泊松模型来评估医疗保险牙科时间表对报告的牙科就诊率的影响。在为两个队列实施 CDBS 之前,出生队列在 4-5 岁时报告的就诊率最低。调整混杂因素后,CDBS 的引入使低收入家庭组的牙科就诊率提高了 8%(95%CI:1%,15%)。该模型提供的证据表明,随着年龄的增长,牙科就诊率增加,调整后土著人口的就诊率降低了 31%(95%CI:4%,55%)。在 CDBS 运行期间,报告的获得牙科服务的机会增加,低收入家庭的就诊模式有利,这为该计划的主要目标是改善儿童人群的护理获得情况提供了一些证据。医疗保健的获得是多方面的,该计划在人群中的利用率较低,因此需要使用其他以患者为中心的指标来审查该计划的绩效。