Comparative analysis of dental procedure mix in public and private dental benefits programs.
Medicaid
claims data
prevention
procedure type
Journal
Journal of the American Dental Association (1939)
ISSN: 1943-4723
Titre abrégé: J Am Dent Assoc
Pays: England
ID NLM: 7503060
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
05
03
2021
revised:
21
07
2021
accepted:
21
07
2021
pubmed:
8
10
2021
medline:
20
1
2022
entrez:
7
10
2021
Statut:
ppublish
Résumé
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). 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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 34615607
pii: S0002-8177(21)00482-7
doi: 10.1016/j.adaj.2021.07.024
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
59-66Informations de copyright
Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.