BACKGROUND: To increase receipt of preventive oral health services (POHS), all state Medicaid programs have enacted policies to encourage nondental providers to deliver POHS in medical offices. This study examined if these Medicaid policies improved oral health, as measured by reductions in dental visits with treatment and preventable emergency department (ED) visits for nontraumatic dental conditions (NTDC). METHODS: Using data on children aged 6 months to up to 6 years from 38 state Medicaid programs during 2006-2014, we used a generalized difference-in-differences estimation approach to examine the probability of a child having, in a year, any dental visits with caries-related treatment and any ED visits for NTDC, conditional on length of policy enactment. Models included additional child-level and county-level characteristics, state and year fixed effects, probability weights, and clustered standard errors. RESULTS: Among a weighted sample of 45,107,240 child/year observations, 11.7% had any dental visits with treatment and 0.2% had any ED visits for NTDC annually. Children in states with and without medical POHS policies had similar odds of having any dental visits with treatment, regardless of length of policy enactment. Children in states with medical POHS policies enacted for one or more years had significantly greater odds of having any ED visits for NTDC (P<0.05). CONCLUSIONS: State policies making POHS available in medical offices did not affect rates of dental visits with caries-related treatment, but were associated with increased rates of potentially avoidable ED visits for NTDC. Findings suggest that many young Medicaid-enrollees lack access to dentists.
BACKGROUND: To increase receipt of preventive oral health services (POHS), all state Medicaid programs have enacted policies to encourage nondental providers to deliver POHS in medical offices. This study examined if these Medicaid policies improved oral health, as measured by reductions in dental visits with treatment and preventable emergency department (ED) visits for nontraumatic dental conditions (NTDC). METHODS: Using data on children aged 6 months to up to 6 years from 38 state Medicaid programs during 2006-2014, we used a generalized difference-in-differences estimation approach to examine the probability of a child having, in a year, any dental visits with caries-related treatment and any ED visits for NTDC, conditional on length of policy enactment. Models included additional child-level and county-level characteristics, state and year fixed effects, probability weights, and clustered standard errors. RESULTS: Among a weighted sample of 45,107,240 child/year observations, 11.7% had any dental visits with treatment and 0.2% had any ED visits for NTDC annually. Children in states with and without medical POHS policies had similar odds of having any dental visits with treatment, regardless of length of policy enactment. Children in states with medical POHS policies enacted for one or more years had significantly greater odds of having any ED visits for NTDC (P<0.05). CONCLUSIONS: State policies making POHS available in medical offices did not affect rates of dental visits with caries-related treatment, but were associated with increased rates of potentially avoidable ED visits for NTDC. Findings suggest that many young Medicaid-enrollees lack access to dentists.
Authors: Jill Boylston Herndon; Scott L Tomar; Frank A Catalanotto; W Bruce Vogel; Elizabeth A Shenkman Journal: Health Serv Res Date: 2014-07-09 Impact factor: 3.402