Dental Access & Costs for Children in a SCHIP Program

描述(由申请人提供)：牙科护理是低收入儿童未得到满足需求最高的领域之一。牙科保险是影响儿童使用牙科服务的一个重要因素。较高的未得到满足的需求鼓励了大多数州的SCIP计划包括牙科福利，然而，人们对该计划对获得护理的机会和成本的影响知之甚少。爱荷华州的SCIP和医疗补助计划相结合，为评估不同类型的牙科保险模式对这些计划中儿童服务的使用和成本的影响提供了一个自然的实验。三种不同类型的牙科保险计划在S-斯奇普计划中运作(赔偿、开放准入小组和封闭式小组医疗保险)，一种在M-斯奇普计划和医疗补助计划中(医疗补助服务费)。这项研究的具体目标包括：(1)确定爱荷华州SHIP和医疗补助计划中儿童的牙科服务利用率，(2)确定与儿童的牙科需求未得到满足(即未满足年度牙科检查的专业指南)相关的因素，(3)确定与“自我报告的”未得到满足的儿童牙科需求相关的因素，以及(4)确定与在爱荷华州SHIP和医疗补助计划中为儿童提供牙科护理相关的成本，以及是否存在被压抑的牙科护理需求。这些目标将使用SHIP和Medicaid计划的管理数据以及计划参与者的调查数据进行评估。核心假设是，牙科保险计划的类型将与获得牙科护理的机会密切相关，而传统的按服务收费的医疗补助和封闭小组HMO模式计划由于提供者小组更有限，获得医疗服务的机会将较低。其他易感因素(例如，年龄、儿童报告的健康状况、没有牙科保险的时间)也将按照健康行为模型作为分析的概念基础进行评估。将通过对服务利用适用计划偿还率来评估方案费用。被压抑的需求将通过确定(1)当SHIP计划第一次开始时牙科护理成本是否更高，以及(2)当儿童第一次加入SHIP或医疗补助时个人成本是否更高来评估。长期目标是提高政策制定者对牙科保健成本的理解，并向他们提供能够增加获得牙科保健的信息。这一成果应有助于实现2010年健康人目标，即改善低收入儿童和青少年获得牙科的机会。

DESCRIPTION (provided by applicant): Dental care is among the areas of highest unmet need for lower-income children. Dental insurance is an important factor related to the use of dental services by children. High unmet need has encouraged most state SCHIP programs to include dental benefits, however, little is known about program effects on access to care and costs. Iowa's combination SCHIP and Medicaid programs provide a natural experiment for evaluating the effect of different types of dental insurance models on the use and costs of services for children in these programs. Three different types of dental insurance plans operate in the S-SCHIP program (indemnity, open access panel and closed panel HMO) and one in the M-SCHIP and Medicaid programs (Medicaid fee-for-service). The specific aims of this study include: (1) determine dental services utilization for children in the Iowa SHIP and Medicaid programs, (2) determine the factors related to unmet dental need (i.e., not meeting professional guidelines for an annual dental check-up) for children, (3) determine the factors related to 'self-reported' unmet dental need for children, and (4) determine the costs associated with providing dental care for children in Iowa's SHIP and Medicaid programs and whether there is pent-up demand for dental care. These aims will be evaluated using administrative data from the SHIP and Medicaid programs and survey data from program enrollees. The central hypothesis is that the type of dental insurance plan will be significantly related to access to dental care and that the traditional fee-for-service Medicaid and closed panel HMO model programs will have lower access to care due to more limited provider panels. Other predisposing factors (e.g., age, child's reported health status, time without dental insurance) will also be evaluated following the Health Behavior Model as the conceptual basis for the analyses. Programmatic costs will be evaluated by applying plan reimbursement rates to utilization of services. Pent-up demand will be evaluated by determining (1) if dental care costs were higher when the SHIP program first began, and (2) if individual costs were higher when children first joined SHIP or Medicaid. The long-range goal is to improve policymakers' understanding of dental care costs and to provide them with information that can increase access to dental care. The results should help to realize the Healthy People 2010 goal of improving dental access to low-income children and adolescents.