Association Between Medicaid Dental Payment Policies and Children's Dental Visits, Oral Health, and School Absences.
Association Between Medicaid Dental Payment Policies and Children's Dental Visits, Oral Health, and School Absences.
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医疗补助牙科支付政策与儿童牙科访问，口腔健康和学校缺勤之间的关联。
DOI：
10.1001/jamahealthforum.2022.3041
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发表时间：
2022-09-02
期刊：
影响因子：
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通讯作者：
Manski, Richard J
中科院分区：
文献类型：
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作者：
Lipton, Brandy J;Decker, Sandra L;Stitt, Brittney;Finlayson, Tracy L;Manski, Richard J
医疗补助支付率与牙医收费的比率的增加是否与儿童结局的改善有关？这项横断面研究使用差异分析来评估15，738名参加医疗补助的儿童和16，867名参加2016-2019年全国儿童健康调查的6至17岁的私人保险儿童。增加医疗补助费用比率与儿童牙科就诊和口腔健康的显着但适度的改善有关，与缺课没有显着关联。更慷慨的医疗补助牙科支付政策与儿童结果的改善有关。这项横断面研究使用全国儿童健康调查数据来评估医疗补助牙科支付率增加与儿童牙科就诊，口腔健康和缺课的关系。尽管所有州医疗补助计划都涵盖儿童牙科服务，但只有不到一半的公共保险儿童获得推荐的护理。评估医疗补助支付率与牙医收费的服务指数（费用比率）和儿童预防性牙科就诊，口腔健康和学校缺勤之间的关系。在这项横断面研究中，对2021年9月至2022年4月期间参加2016-2019年全国儿童健康调查的15738名参加医疗补助的儿童和16867名6至17岁的私人保险儿童进行了差异分析。还按性别、人种和种族进行了探索性亚组分析。双侧P <0.05被认为是显著的。过去一年的预防性牙科检查（至少1次和至少2次），父母报告的良好口腔健康，以及缺课天数（至少4天和至少7天）。医疗补助登记的样本包括51.20%的男孩和48.80%的女孩（平均年龄，11.24岁;黑人，21.65%;西班牙裔，37.75%;白色，31.45%）的加权估计。通过加权基线估计，87%和48%的医疗补助登记儿童分别至少有1次和至少2次去年牙科就诊，29%的父母报告口腔健康状况良好。费用比率增加1个百分点与至少1次牙科就诊增加0.18个百分点（95%CI，0.07-0.30），至少2次就诊增加0.27个百分点（95%CI，0.04-0.51），口腔健康良好增加0.19个百分点（95%CI，0.01-0.36）相关。西班牙裔儿童至少2次访视的增加幅度大于白色儿童。根据加权基线估计，28%和15%的医疗补助注册儿童分别有至少4次和至少7次上一年的缺课。对整个样本的缺勤率的回归估计在统计上并不显著，但估计女孩的缺勤率显著减少。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性牙科就诊和良好口腔健康的显着但适度的增加有关。需要进一步的研究来了解改善牙齿护理的政策与儿童学业成功之间的潜在联系。
Are increases in the ratio of Medicaid payment rates to dentist charges for an index of services associated with improvements in children’s outcomes? This cross-sectional study used a difference-in-differences analysis to evaluate 15 738 Medicaid-enrolled and 16 867 privately insured children aged 6 to 17 years who participated in the 2016-2019 National Survey of Children’s Health. Increasing the Medicaid fee ratio was associated with significant but modest improvements in children’s dental visits and oral health and had no significant association with school absences. More generous Medicaid dental payment policies are associated with improvements in children’s outcomes. This cross-sectional study used National Survey of Children’s Health data to evaluate the association of increased Medicaid dental payment rates with children’s dental visits, oral health, and school absences. 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. 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.