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最不需要的领域之一。牙科保险是与儿童使用牙科服务有关的一个重要因素。高未满足的需求，鼓励大多数国家SCHIP计划，包括牙科福利，但是，鲜为人知的是获得护理和成本的计划的影响。爱荷华州的结合SCHIP和医疗补助计划提供了一个自然的实验，以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。三种不同类型的牙科保险计划在S-SCHIP计划中运作（赔偿，开放式访问面板和封闭式面板HMO），一种在M-SCHIP和医疗补助计划中运作（医疗补助收费服务）。本研究的具体目的包括：（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）确定与未满足的牙科需求相关的因素（即，不符合年度牙科检查的专业指南），（3）确定与“自我报告”未满足的儿童牙科需求相关的因素，以及（4）确定与在爱荷华州的SHIP和Medicaid计划中为儿童提供牙科护理相关的成本，以及是否存在对牙科护理的压抑需求。这些目标将使用来自SHIP和Medicaid计划的管理数据以及来自计划注册者的调查数据进行评估。中心假设是，牙科保险计划的类型将显着相关的获得牙科保健和传统的收费服务医疗补助和封闭面板HMO模式的程序将有较低的获得护理由于更有限的提供者面板。其他诱发因素（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。方案费用将通过对服务的使用适用计划偿还率来评估。被压抑的需求将通过确定（1）当SHIP计划首次开始时，牙科护理费用是否较高，以及（2）当儿童首次加入SHIP或医疗补助时，个人费用是否较高来评估。长期目标是提高决策者对牙科保健费用的理解，并为他们提供可以增加牙科保健的信息。研究结果将有助于实现2010年健康人的目标，即改善低收入儿童和青少年的牙科服务。

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.