Serban Nicoleta, Ma Simin, Yu Jiaxi, Anderson Annalea, Pospichel Katrine, Solipuram Shalini R, Tomar Scott L
Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Northwest Georgia, USA.
Department of Prevention and Public Health Sciences, College of Dentistry, University of Illinois, Chicago, Illinois, USA.
J Public Health Dent. 2024 Dec;84(4):351-361. doi: 10.1111/jphd.12635. Epub 2024 Jul 16.
To evaluate access to dental care for children in the United States.
The study population included children in 48 states and the District of Columbia. Using multiple data sources, dental care access was estimated at the community level by matching dental care supply and demand using mathematical modeling accounting for access constraints. Outcome measures included percent-met demand, travel distance, and percentage of underserved and unserved communities. Multiple scenarios to improve Medicaid/CHIP participation of dentists were evaluated.
Medicaid-insured and CHIP-insured children exhibited lower access compared to those privately insured. The percent-met demand was lower than 50% for Medicaid-insured children and CHIP-insured children for 42 and 34 states, respectively. Percent-met demand was higher than 50% for private-insured children except for Texas and West Virginia. Increasing Medicaid/CHIP participation of dentists resulted in improving access for public-insured children. At 100% Medicaid/CHIP participation, all states exhibited different degrees of percent-met demand increase for publicly insured children, from 7% to 46%. The percent-met demand across all children ranged in 23.8%-82.9% under 70% participation rate versus 22%-83% under 100% participation rate. No single participation rate improved access for all children uniformly across all states.
This study found that dental care access was lower for children with public insurance than those with private access across all states, although states responded differently to changes in Medicaid/CHIP participation. Increasing access for children with public insurance would reduce disparities, but overall children's access to dental care would be better improved by expanding the oral health workforce.
评估美国儿童获得牙科护理的情况。
研究人群包括48个州和哥伦比亚特区的儿童。利用多个数据源，通过使用考虑到获取限制的数学模型匹配牙科护理的供需情况，在社区层面估计牙科护理的可及性。结果指标包括需求满足百分比、出行距离以及服务不足和未服务社区的百分比。评估了多种提高牙医参与医疗补助/儿童健康保险计划（Medicaid/CHIP）的方案。
与私人保险儿童相比，参加医疗补助和儿童健康保险计划的儿童获得牙科护理的机会较低。在42个州，参加医疗补助的儿童需求满足百分比低于50%；在34个州，参加儿童健康保险计划的儿童需求满足百分比低于50%。除德克萨斯州和西弗吉尼亚州外，私人保险儿童的需求满足百分比高于50%。提高牙医参与医疗补助/儿童健康保险计划的比例可改善公共保险儿童获得牙科护理的机会。当牙医参与医疗补助/儿童健康保险计划的比例达到100%时，所有州的公共保险儿童需求满足百分比均有不同程度的提高，增幅在7%至46%之间。在参与率低于70%时，所有儿童的需求满足百分比在23.8%至82.9%之间；在参与率达到100%时，该比例在22%至83%之间。没有单一的参与率能在所有州统一改善所有儿童获得牙科护理的机会。
本研究发现，在所有州，参加公共保险的儿童获得牙科护理的机会低于参加私人保险的儿童，尽管各州对医疗补助/儿童健康保险计划参与率变化的反应不同。增加参加公共保险儿童获得牙科护理的机会将减少差距，但通过扩大口腔卫生人力，总体上儿童获得牙科护理的情况将得到更好改善。
