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Managed care and the receipt of dent...

Chang, Chun-Lan.

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Managed care and the receipt of dental services for children on Medicaid.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Managed care and the receipt of dental services for children on Medicaid./
Author:	Chang, Chun-Lan.
Description:	229 p.
Notes:	Adviser: Stephen Metraux.
Contained By:	Dissertation Abstracts International68-04B.
Subject:	Health Sciences, Dentistry. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3261757

Managed care and the receipt of dental services for children on Medicaid.
Chang, Chun-Lan.

Managed care and the receipt of dental services for children on Medicaid. - 229 p.

Adviser: Stephen Metraux.

Thesis (Ph.D.)--University of the Sciences in Philadelphia, 2007.

Tooth decay is the most common pediatric health problem. The epidemic of tooth decay disproportionately occurs in indigent children. The Medicaid program, started in 1965, has become the major public force to provide health coverage for indigent children. Dental care is included in the mandatory benefits through the Early Periodically Screening Diagnosis and Treatment (EPSDT) program. However, the underuse of dental services in Medicaid has been a long-standing problem. As state governments have gradually transformed their Medicaid programs from fee-for-service to managed care models, it has become necessary to update the understanding of pediatric dental utilization in Medicaid. In addition, dental utilization and care delivery in an urban Medicaid environment may be different from those in rural areas, and is rarely studied. Therefore, this research used Philadelphia children aged 3--20 in a Medicaid managed care organization (MMCO) as a study case (1) to update data on dental services utilization; (2) to examine if geographic mismatch between dentists and children exists in an urban setting; (3) to explore possible factors such as patient relevant characteristics affecting the use of dental care; (4) to assess the regular use of preventive dental services. The descriptive analysis with dental claims found that, over the four-year study period, 72% of the study children received preventive dental services. However, only 37% received preventive dental services annually. For those children with four-year continuous enrollment, regular use of preventive services was even less common. About six percent of the children with four-year continuous enrollment received preventive dental services annually. From the perspective of a Medicaid managed care provider, geographic information showed that there is little evidence to support a severe geographic mismatch between major dental providers and the majority of the study children. However, the geographic mismatch still affects the likelihood of dental care use in a small proportion of the study children, who had no available major dental providers in their residential areas. Analysis with logistic regression showed that several patient relevant characteristics, such as available "major" dental providers, poverty in residential areas, co-morbidity/frequent medical attention, and race/ethnicity, were related to the use of dental care. Possible explanations were provided for the relationship between patient relevant characteristics and the likelihood of dental care use. To improve the use of dental care, especially preventive care, those identified characteristics can be used to devise strategies targeting those who underuse dental care, and promote the importance of oral hygiene and dental check-up. Also, efforts to provide medical care and dental care in partnership may also help in increasing dental care use.Subjects--Topical Terms:

1019378
Health Sciences, Dentistry.

Managed care and the receipt of dental services for children on Medicaid.
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100 1 $a Chang, Chun-Lan. $3 1271052
245 1 0 $a Managed care and the receipt of dental services for children on Medicaid.
300 $a 229 p.
500 $a Adviser: Stephen Metraux.
500 $a Source: Dissertation Abstracts International, Volume: 68-04, Section: B, page: 2230.
502 $a Thesis (Ph.D.)--University of the Sciences in Philadelphia, 2007.
520 $a Tooth decay is the most common pediatric health problem. The epidemic of tooth decay disproportionately occurs in indigent children. The Medicaid program, started in 1965, has become the major public force to provide health coverage for indigent children. Dental care is included in the mandatory benefits through the Early Periodically Screening Diagnosis and Treatment (EPSDT) program. However, the underuse of dental services in Medicaid has been a long-standing problem. As state governments have gradually transformed their Medicaid programs from fee-for-service to managed care models, it has become necessary to update the understanding of pediatric dental utilization in Medicaid. In addition, dental utilization and care delivery in an urban Medicaid environment may be different from those in rural areas, and is rarely studied. Therefore, this research used Philadelphia children aged 3--20 in a Medicaid managed care organization (MMCO) as a study case (1) to update data on dental services utilization; (2) to examine if geographic mismatch between dentists and children exists in an urban setting; (3) to explore possible factors such as patient relevant characteristics affecting the use of dental care; (4) to assess the regular use of preventive dental services. The descriptive analysis with dental claims found that, over the four-year study period, 72% of the study children received preventive dental services. However, only 37% received preventive dental services annually. For those children with four-year continuous enrollment, regular use of preventive services was even less common. About six percent of the children with four-year continuous enrollment received preventive dental services annually. From the perspective of a Medicaid managed care provider, geographic information showed that there is little evidence to support a severe geographic mismatch between major dental providers and the majority of the study children. However, the geographic mismatch still affects the likelihood of dental care use in a small proportion of the study children, who had no available major dental providers in their residential areas. Analysis with logistic regression showed that several patient relevant characteristics, such as available "major" dental providers, poverty in residential areas, co-morbidity/frequent medical attention, and race/ethnicity, were related to the use of dental care. Possible explanations were provided for the relationship between patient relevant characteristics and the likelihood of dental care use. To improve the use of dental care, especially preventive care, those identified characteristics can be used to devise strategies targeting those who underuse dental care, and promote the importance of oral hygiene and dental check-up. Also, efforts to provide medical care and dental care in partnership may also help in increasing dental care use.
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650 4 $a Health Sciences, Health Care Management. $3 1017922
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