Implications of CHIPRA: Utilization of Dental Services among Young Children
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Transcript of Implications of CHIPRA: Utilization of Dental Services among Young Children
Smiles Across America Webinar Series
Date: 12/10/2015
Implications of CHIPRA: Utilization of
Dental Services among Young Children
/Oral Health America @Smile4Health
Connect with OHA!
/Oral Health America @Smile4Health
HOUSEKEEPING INFORMATION
• Please remember to MUTE your phone.
• Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions.• Questions will be accepted in writing through the control
panel on the upper right hand of your screen.
• Submit questions at any time; we will address them at the end of the presentation.
• Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org
• Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
CE Credit Available
OUR MISSION
Oral Health America’s mission is to change lives by
connecting communities
with resources to drive access to care, increase
health literacy, and advocate for policies that
improve overall health through better oral health for
all Americans, especially those most vulnerable.
OHA PRIORITIES
ADVOCACYHEALTH
LITERACYACCESS
OHA’s Programs and Campaigns are designed to improve
access to care, oral health literacy and policies that
prioritize the impact of oral health on the overall health of all
Americans – particularly those most vulnerable.
Campaigns for Oral Health Equity
Educate the public, including policy makers, about the importance of oral health for overall health
Emphasize the need to prioritize oral disease alongside other serious health conditions
Advocate for policies that positively impact programs and stakeholders
Current campaigns include:
toothwisdom.org Demonstration
Projects
Professional
Symposia
Advocacy Health Education &
Communications
Technical Assistance
Product Donation
Grant Funding
IMPLICATIONS OF CHIPRA:
Utilization of dental services among young children
Nicole Thurlow Zautra, MPH
Indiana University, Bloomington
PRESENTATION OUTLINE
1. Introduction
2. Method
3. Results
4. Discussion
5. Conclusion
INTRODUCTION
DENTAL CARIESPrevalence, severity, and treatment cost
increase with age and duration of delay
Good oral health in childhood means better oral health
for life.
ORAL HEALTH IN CHILDHOOD
REDUCING DENTAL DISEASE
Prevention of tooth decay requires a comprehensive, integrated approach that addresses many factors including:
• Environment (e.g., access to community water fluoridation and number of dental providers);
• Economic (e.g., payment for dental services and dental insurance);
• Personal or social norms/behaviors (e.g., health literacy, diet, oral hygiene care and transmission of disease);
• Political (e.g., funding, support for community water fluoridation and scope of dental practice).
Greatest unmet
healthcare need
among low-income
children under five
DENTAL CARE
CHILDREN’S HEALTH INSURANCE PROGRAM
REAUTHORIZATION ACT (CHIPRA)
Goal: to motivate states to develop mechanisms for
increasing enrollment of eligible children in
Medicaid/CHIP
Dental health components:
1. Federally established dental benefit parameters
2. Prenatal and early childhood dental education for
parents
METHOD
FISHER-OWENS MODEL
OF CHILDREN’S ORAL HEALTH
(Fisher-Owens et al., 2007)
ADAPTED
STUDY
MODEL
Community-Level
Influences
Family-Level Influences
Child-Level Influences
Oral Health
Dental care
system
characteristics
Health care
system
characteristics
Socioeconomic
status
Use of dental
careDental
insurance
STUDY DESIGN
Retrospective time-series
DV’s: 1) dental visit, and 2) total dental
expenditure
IV’s: Based on Fisher-Owens et al. model
Child: age, sex, race/ethnicity, insurance
status
Family: income level
Year: 2009-2012
STUDY HYPOTHESES
1. The implementation of CHIPRA
was associated with an increase in
child dental service utilization.
2. The implementation of CHIPRA
was associated with a decrease in
the total Medicaid expenditures for
child dental services.
DATA SOURCE
Medical Expenditure Panel Survey,
household component
Years 2009-2012
STUDY CRITERIA
INCLUSION
• 0-5 years of age
• Continuous Medicaid/CHIP enrollment (experimental group) or uninsured (control group) during survey period
EXCLUSION
• >5 years of age
• Privately insured or non-
continuous
Medicaid/CHIP
enrollment during survey
period
ANALYSIS METHOD
Heckman’s 2-Step procedure
1. Logistic regression of dental visit by
predictors
1. Linear regression of dental
expenditure by predictors
Mill’s ratio generated in step 1
Inverse Mill’s ratio included in step 2
RESULTS
CHILD CHARACTERISTICS
0
5000000
10000000
15000000
20000000
25000000
Age Category
Age
0-1 years 2-3 years 4-5 years
Female50%
Male50%
Sex
CHILD CHARACTERISTICS
0
2000000
4000000
6000000
8000000
10000000
12000000
14000000
16000000
18000000
20000000
Race/Ethnicity Category
Race/Ethnicity
Non-Hispanic White Non-Hispanic Black
Hispanic Other
Medicaid/SCHIP64%
Uninsured36%
Insurance Status
FAMILY CHARACTERISTICS
0
2000000
4000000
6000000
8000000
10000000
12000000
14000000
16000000
18000000
20000000
Family Income Level
200925%
201027%
201124%
201224%
Year
Weighted Odds Ratios of Dental Visit by Logistic Regression
1. Child characteristics Odds Ratio 95% Confidence Interval
Age: 0-1 years 0.03** (0.02, 0.04)
2-3 years 0.13** (0.10, 0.17)
4-5 years --- ---
Sex: Female ---
Male 0.92 (0.79, 1.07)
Race/ethnicity: Non-Hispanic white --- ---
Non-Hispanic black 1.27* (1.04, 1.56)
Hispanic 1.41** (1.18, 1.69)
Other 1.33 (0.99, 1.79)
Insurance status: Medicaid/SCHIP 1.60** (1.34, 1.91)
Uninsured --- ---
2. Family characteristics
Family income level: Poor/negative 1.11 (0.89, 1.39)
Near poor 1.09 (0.79, 1.50)
Low income 1.03 (0.80, 1.33)
Middle income ---
High income 1.03 (0.73, 1.44)
3. Year
2009 0.99 (0.81, 1.22)
2010 ---
2011 1.21 (0.98, 1.50)
2012 1.2 (0.97, 1.49)
Note: N=41,370,241; *p<0.05; **p<0.01
Data source: 2009-2012 Medical Expenditure Panel Survey
Weighted Linear Regression of Dental Expenditure ( ≥ 1 dental visit)
1. Child characteristics β SE p-value
Age: 0-1 years -231.13 50.14 <.001**
2-3 years -97.59 20.34 <.001**
4-5 years ---
Sex: Female ---
Male -1.98 8.12 0.81
Race/ethnicity: Non-Hispanic white ---
Non-Hispanic black -9.77 11.32 0.39
Hispanic 15.25 12.36 0.22
Other 32.54 17.48 0.06
Insurance status: Medicaid/SCHIP 110.69 12.92 <.001**
Uninsured ---
2. Family characteristics
Family income level: Poor/negative -14.87 17.92 0.41
Near poor -31.76 17.68 0.07
Low income -15.25 17.43 0.38
Middle income ---
High income -9.25 15.36 0.55
3. Year
2009 -3.28 11.83 0.78
2010 ---
2011 29.91 8.3 0.01**
2012 -2.49 8.3 0.76
Note: N=24,665,641; *p<0.05; **p<0.01
Data source: 2009-2012 Medical Expenditure Panel Survey
DISCUSSION
STUDY SIGNIFICANCE
Child age remains a barrier to dental care
No observed impact on dental utilization
CHIPRA may have contributed to increased frequency of dental service utilization among those already accessing services
STUDY HYPOTHESES
1. The implementation of CHIPRA
was associated with an increase in
child dental service utilization.
2. The implementation of CHIPRA
was associated with a decrease in
the total Medicaid expenditures for
child dental services.
POLICY IMPLICATIONS
CHIPRA requires improvement
Suggestions:
1. Increase dental service
reimbursements
2. Reduce administrative burden on
providers
CONCLUSION
CONCLUSIONS
Future study of CHIPRA is necessary
It’s too soon!
New policies specific to dental care are
needed
Dr. Hsien-Chang Lin
Question and Answer Session
• Questions are welcome! This session may last for 10-15 minutes.
• Write your questions in your control panel on the upper right hand of your screen.
• Submit questions at any time.
CE Credit Available