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Cariology, Restorative Sciences, and Endodontics

Health Services and Outcomes Research (HSOR)

Statement of the research objectives

The purpose of this project is to measure and monitor the effects of the Healthy Kids Dental (HKD) program and to compare these effects to the conventional Medicaid dental program, and compare both of these to Delta Dental’s commercial programs.  Dimensions to be evaluated include access to care, the type and quantity of care provided, and the participation of dentists in each program.  These comparisons will be made for the current year and trends in these patterns will be compared through time.

Background

Historically, virtually every state has had and continues to have difficulty is assuring desirable levels of access to their Medicaid-eligible child populations.  There has been a widespread resistance by dentists to accept these patients into their practices.  Reasons for this problem have consistently centered on complaints about low reimbursement levels, atypical administrative requirements, and poor compliance on the part of patients and their families.  The Healthy Kids Dental program in Michigan was started in Michigan in May of 2000, in an effort to determine whether a conversion form the conventional Medicaid program to a commercially-administered program that closely resembled a conventional commercial program would affect access.  The result after only 12 months showed increases in access, and those gains in access have continued through the first five years of operation.

Methods and materials

This evaluation project will monitor the utilization of dental care in Michigan children in order to evaluate the effectiveness of the Healthy Kids Dental program in reducing disparities in access to and utilization of dental care. Evidence from many sources demonstrate a wide disparity in utilization of dental care that is associated with the socioeconomic status of children. Disparities exist as measured by both visits for care as well as untreated oral disease. Dental insurance claims data will be used to demonstrate historical patterns of utilization and the disparities between privately-insured and Healthy Kids Dental (HKD)- eligible children. Data from both the privately-insured child population in Michigan and from the HKD program in Michigan will be used to assess the ability of this method of payment and administration to reduce the historical disparities in dental care utilization. Performance measures to be evaluated are: 1) the difference in the percent of children with at least one dental visit per year, between children with Medicaid, HKD, or private insurance coverage, 2) the difference in the mix of services received, between children with Medicaid, HKD, or private insurance coverage, 3) the difference in the participation of dentists between children with Medicaid, HKD, or private insurance coverage, and 4) the difference in the distance traveled to receive care, between children with Medicaid, HKD, or private insurance coverage.

Performance measures to be assessed are:

Separately for HKD, conventional Medicaid, MiChild, and Delta Dental commercial groups:

  • The percent of the enrolled population, by age, with at least one visit in a calendar year. Subsets based on length of enrollment will also be reported.
  • The proportion of treated children who receive preventive services in a calendar year within each coverage group.
  • The number and proportion of dentists, by county, who treat children in each coverage group.
  • The number of children per dentist treated in each coverage group.
  • The patterns of treatment received by children in each coverage group.
  • The utilization and costs of treatment (distribution of services and ayments per user) for select major procedure groupings.

Longitudinal assessments across years since 2000, for treatment patterns in children who have multi-year enrollment will be made to determine whether regular visits result in similar treatment patterns in future years, regardless of coverage type.