Health Care, RAND Corporation, Arlington, Virginia, USA.
Health Care, RAND Corporation, Boston, Massachusetts, USA.
Health Serv Res. 2022 Oct;57(5):1175-1181. doi: 10.1111/1475-6773.13995. Epub 2022 May 10.
To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive.
Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018).
We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid.
DATA COLLECTION/EXTRACTION METHODS: Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics.
Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers.
Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.
研究私人医疗保险在医疗环境下支付氟化物涂料应用费用的价格差异，氟化物涂料是一种新报销的服务，但很少有儿童接受。
康涅狄格州、缅因州、新罕布什尔州和罗得岛州（2016-2018 年）的私人保险医疗索赔。
我们检查了私人保险公司支付的氟化物涂料价格，并将其与医疗补助计划支付的价格进行了比较。
数据收集/提取方法：儿童年龄在 1-5 岁之间，在医疗就诊期间进行的氟化物涂料私人索赔。从儿科学会获得了氟化物涂料的州医疗补助计划费率。
私人保险公司支付的氟化物涂料价格在各州内部和之间存在差异，从不到 5 美元到 50 美元不等。在四个州中的三个州，中位数价格紧随医疗补助计划费率。在覆盖医疗就诊期间一整套氟化物涂料加其他预防性口腔健康服务的州，综合医疗补助计划费率几乎是私人保险公司支付的中位数价格的两倍。
氟化物涂料是一种推荐的服务，但很少有儿童接受。价格差异可能导致该服务的低使用率。确保足够的医疗补助和私人保险费率可以增加医疗环境中氟化物涂料的应用，从而改善口腔健康。
