School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.
Department of Prevention and Public Health Sciences, College of Dentistry, University of Illinois, Chicago, Illinois, USA.
J Public Health Dent. 2023 Mar;83(1):60-68. doi: 10.1111/jphd.12551. Epub 2022 Oct 11.
This study evaluates the dentists' availability to deliver preventive dental care to children in schools and the impact of school-based programs on access.
The study population included Florida elementary-school children, differentiated by dental insurance (Medicaid, CHIP, private, or none). We considered the implementation of school-based programs using optimization modeling to (re)allocate the dentists' caseload to schools to meet demand for preventive care under resource constraints. We considered multiple settings for school-based program implementation: (i) school prioritization; and (ii) dentists' participation in public insurance. Statistical inference was used to identify communities to improve access and reduce disparities.
School-based programs reduced unmet demand (3%-12%), being more efficient if prioritizing schools in communities targeted to improve access. The access improvement varied by insurance status and geography. Uninsured urban children benefited most from school-based programs, with 15%-75% unmet need reduction. The percentage of urban communities targeted to improve access decreased by 12% against no-school program. Such percentage remained large for suburban (15%-100%) and rural (50%-100%) communities. Disparity in access for public-insured vs. private-insured children persisted under school-based programs (32%-84% identified communities).
School-based programs improve dental care access; the improvement was however different by insurance status, with uninsured children benefiting the most. Accounting to the dentists' availability in prioritizing schools resulted in effective resource allocation to school-based programs. Access disparities between public and private-insured children did not improve; school-based programs shifted resources from public-insured to uninsured. School-based programs are effective in addressing access barriers to those children experiencing them most.
本研究评估了牙医为学校儿童提供预防牙科保健的能力以及基于学校的计划对获得服务的影响。
研究人群包括佛罗里达州的小学生，按牙科保险（医疗补助、儿童健康保险计划、私人保险或无保险）进行区分。我们考虑了通过优化模型实施基于学校的计划，以（重新）将牙医的病例分配到学校，以在资源限制下满足预防保健需求。我们考虑了多种实施基于学校的计划的方案：（一）学校优先级排序；（二）牙医参与公共保险。统计推断用于确定需要改善获得服务机会和减少差异的社区。
基于学校的计划减少了未满足的需求（3%-12%），如果优先考虑目标是改善获得服务机会的社区的学校，则更有效率。获得服务机会的改善因保险状况和地理位置而异。无保险的城市儿童从基于学校的计划中受益最多，未满足需求减少了 15%-75%。没有基于学校的计划，目标是改善获得服务机会的城市社区比例减少了 12%。对于郊区（15%-100%）和农村（50%-100%）社区，这一比例仍然很大。在基于学校的计划下，公共保险和私人保险的儿童之间的获得服务机会的差异仍然存在（确定的社区为 32%-84%）。
基于学校的计划改善了牙科保健的获得服务机会；然而，这种改善因保险状况而异，无保险儿童受益最大。在优先考虑学校的牙医资源分配方面，基于学校的计划实现了有效的资源分配。公共保险和私人保险的儿童之间的获得服务机会差异没有改善；基于学校的计划将资源从公共保险转移到无保险。基于学校的计划对于那些最需要的儿童来说是解决获得服务障碍的有效方法。
