Insurer Views on Reimbursement of Preventive Services in the Dental Setting: Results From a Qualitative Study
Insurer Views on Reimbursement of Preventive Services in the Dental Setting: Results From a Qualitative Study
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DOI：
10.2105/ajph.2013.301825
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发表时间：
2014-05-01
影响因子：
12.7
通讯作者：
Metsch, Lisa R.
中科院分区：
文献类型：
--
作者：
Feinstein-Winitzer, Rebecca T.;Pollack, Harold A.;Metsch, Lisa R.
目标。我们探讨了保险公司对口腔快速艾滋病毒检测和牙科护理期间其他预防性筛查报销障碍的看法。方法。我们在 2010 年 4 月至 10 月期间对 13 家牙科保险公司高管和顾问进行了半结构化访谈，这些公司的累计市场份额超过了美国雇主牙科保险市场的 50%。参与者代表了牙科保险行业大部分人士的观点。结果。一些预防性筛查，例如口腔癌筛查，得到了保险公司的广泛支持和报销。其他项目，例如基于人群的艾滋病毒筛查，似乎在保险报销方面面临许多障碍。主要障碍是雇主要求最低、牙科环境特定的有效性和投资回报证据有限、实施和组织限制、缺乏提供者培训以及患者缺乏接受度。结论。牙科环境是预防性筛查的一个有前景的场所，解决此类服务的保险报销障碍是公共卫生政策的一个关键挑战。
Objectives. We explored insurers' perceptions regarding barriers to reimbursement for oral rapid HIV testing and other preventive screenings during dental care.Methods. We conducted semistructured interviews between April and October 2010 with a targeted sample of 13 dental insurance company executives and consultants, whose firms' cumulative market share exceeded 50% of US employer-based dental insurance markets. Participants represented viewpoints from a significant share of the dental insurance industry.Results. Some preventive screenings, such as for oral cancer, received widespread insurer support and reimbursement. Others, such as population-based HIV screening, appeared to face many barriers to insurance reimbursement. The principal barriers were minimal employer demand, limited evidence of effectiveness and return on investment specific to dental settings, implementation and organizational constraints, lack of provider training, and perceived lack of patient acceptance.Conclusions. The dental setting is a promising venue for preventive screenings, and addressing barriers to insurance reimbursement for such services is a key challenge for public health policy.