Comparative analysis of dental procedure mix in public and private dental benefits programs
Comparative analysis of dental procedure mix in public and private dental benefits programs
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DOI：
10.1016/j.adaj.2021.07.024
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发表时间：
2022-01-04
影响因子：
3.9
通讯作者：
Vujicic, Marko
中科院分区：
文献类型：
--
作者：
Nasseh, Kamyar;Fosse, Chelsea;Vujicic, Marko
背景资料。关于公共和私人牙科福利计划是否会影响患者接受的口腔保健程序的类型，发表的研究很少。这项研究比较了按年龄组(儿童、工作年龄成人、老年人)、牙科福利类型(医疗补助和儿童健康保险计划，私人)以及按州(仅限紧急、有限、广泛)医疗补助牙科福利水平的牙科手术组合。方法：研究方法。作者从2018年改造后的医疗补助统计信息系统中提取了公共牙科福利索赔数据。为了将手术组合与享有私人牙科福利的受益人进行比较，作者使用了2018年IBM MarketScan牙科数据库中的索赔数据。作者将牙科手术归类为特定的服务类别，并计算了在每一类别中进行的程序所占份额。他们分析了按年龄、计划类型(服务费、管理式医疗)和成人医疗补助福利水平进行的程序组合。结果。除了正畸服务，拥有公共和私人福利的儿童的牙科手术组合也是相似的。在有公共福利的成年人中，手术干预在牙科手术中所占的比例高于常规预防服务。结论。有公共福利的孩子的手术组合与那些有私人福利的孩子的程序组合相当。在公共保险和私人保险的成年人之间，程序组合有很大的不同。即使在医疗补助计划中提供广泛牙科福利的州，这些计划也主要为侵入性手术治疗提供资金，而不是预防性治疗。具有实际意义。有必要评估公共资助的儿童方案的最佳做法，并将这些属性转化为成人方案，以便在公共和私营保险公司之间更公平地设计福利和提供护理。
Background. There is little published research on whether public and private dental benefits plans affect the types of oral health care procedures patients receive. This study compares the dental procedure mix by age group (children, working-age adults, older adults), dental benefits type (Medicaid and Children's Health Insurance Program, private), and level of Medicaid dental benefits by state (emergency only, limited, extensive). Methods. The authors extracted public dental benefits claims data from the 2018 Transformed Medicaid Statistical Information System. To compare procedure mix with beneficiaries who had private dental benefits, the authors used claims data from the 2018 IBM MarketScan dental database. The authors categorized dental procedures into specific service categories and calculated the share of procedures performed within each category. They analyzed procedure mix by age, plan type (fee-for-service, managed care), and adult Medicaid benefit level. Results. Aside from orthodontic services, the dental procedure mix among children with public and private benefits is similar. Among adults with public benefits, surgical interventions make up a higher share of dental procedures than routine preventive services. Conclusions. Children with public benefits have a procedure mix comparable with those with private benefits. There are substantial differences in procedure mix between publicly and privately insured adults. Even in states that provide extensive dental benefits in Medicaid, those programs primarily finance invasive surgical treatment as opposed to preventive treatment. Practical Implications. There is a need to assess best practices in publicly funded programs for children and translate those attributes to programs for adults for more equitable benefit design and care delivery across public and private insurers.