Division of Health Management and Policy, School of Public Health, San Diego State University, California.
Center for Health Economics and Policy Studies, San Diego State University, California.
JAMA Health Forum. 2022 Sep 2;3(9):e223041. doi: 10.1001/jamahealthforum.2022.3041.
Although all state Medicaid programs cover children's dental services, less than half of publicly insured children receive recommended care.
To evaluate the association between the ratio of Medicaid payment rates to dentist charges for an index of services (fee ratio) and children's preventive dental visits, oral health, and school absences.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a difference-in-differences analysis was conducted between September 2021 and April 2022 of 15 738 Medicaid-enrolled children and a control group of 16 867 privately insured children aged 6 to 17 years who participated in the 2016-2019 National Survey of Children's Health. Exploratory subgroup analyses by sex and race and ethnicity were also performed. A 2-sided P < .05 was considered significant.
Past-year preventive dental visits (at least 1 and at least 2), parent-reported excellent oral health, and number of days absent from school (at least 4 days and at least 7 days).
The Medicaid-enrolled sample included a weighted estimate of 51.20% boys and 48.80% girls (mean age, 11.24 years; Black, 21.65%; Hispanic, 37.75%; White, 31.45%). By weighted baseline estimates, 87% and 48% of Medicaid-enrolled children had at least 1 and at least 2 past-year dental visits, respectively, and 29% had parent-reported excellent oral health. Increasing the fee ratio by 1 percentage point was associated with percentage point increases of 0.18 in at least 1 dental visit (95% CI, 0.07-0.30), 0.27 in at least 2 visits (95% CI, 0.04-0.51), and 0.19 in excellent oral health (95% CI, 0.01-0.36). Increases in at least 2 visits were larger for Hispanic children than for White children. By weighted baseline estimates, 28% and 15% of Medicaid-enrolled children had at least 4 and at least 7 past-year school absences, respectively. Regression estimates for school absences were not statistically significant for the full sample but were estimated to be significantly reduced among girls.
This cross-sectional study found that more generous Medicaid payment policies were associated with significant but modest increases in children's preventive dental visits and excellent oral health. Further research is needed to understand the potential association between policies that improve access to dental care and children's academic success.
尽管所有州的医疗补助计划都涵盖儿童的牙科服务，但只有不到一半的公共保险儿童接受了推荐的护理。
评估医疗补助支付率与牙医收费指数（费用比率）之间的关系与儿童预防牙科就诊、口腔健康和缺课天数的关系。
设计、地点和参与者：在这项 2021 年 9 月至 2022 年 4 月期间进行的横断面研究中，对参加了 2016-2019 年全国儿童健康调查的 15738 名医疗补助受保儿童和 16867 名私人保险儿童的对照组进行了差异-差异分析。还按性别和种族和民族进行了探索性亚组分析。双侧 P <.05 被认为具有统计学意义。
过去一年的预防牙科就诊（至少 1 次和至少 2 次）、家长报告的良好口腔健康状况以及缺课天数（至少 4 天和至少 7 天）。
医疗补助受保样本包括 51.20%的男孩和 48.80%的女孩（平均年龄为 11.24 岁；黑人，21.65%；西班牙裔，37.75%；白人，31.45%）。根据加权基线估计，87%和 48%的医疗补助受保儿童过去一年至少有 1 次和至少有 2 次牙科就诊，29%的儿童家长报告口腔健康状况良好。费用比率每增加 1 个百分点，至少有 1 次就诊的百分比就会增加 0.18（95%CI，0.07-0.30），至少有 2 次就诊的百分比增加 0.27（95%CI，0.04-0.51），口腔健康状况良好的百分比增加 0.19（95%CI，0.01-0.36）。西班牙裔儿童的至少 2 次就诊增加幅度大于白人儿童。根据加权基线估计，28%和 15%的医疗补助受保儿童过去一年分别至少有 4 天和 7 天缺课。回归估计显示，对于全样本来说，学校缺勤的情况没有统计学意义，但在女孩中估计会显著减少。
这项横断面研究发现，更慷慨的医疗补助支付政策与儿童预防牙科就诊和口腔健康状况的显著但适度改善有关。需要进一步研究以了解改善获得牙科护理的政策与儿童学业成功之间的潜在关联。
