Dataset Information

The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.

ABSTRACT: OBJECTIVE: To examine changes in children's receipt of well-child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt. DATA SOURCES: The 2004-2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky. STUDY DESIGN: Logistic and hazard pre-post regression models, controlling for age, gender, race/ethnicity, and eligibility category. DATA EXTRACTION METHODS: Claims and enrollment data were de-identified and merged. PRINCIPAL FINDINGS: Increased reimbursement had a small, positive association with well-child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well-child care and quicker receipt of well-child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care. CONCLUSIONS: Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.

SUBMITTER: Kenney GM

PROVIDER: S-EPMC3037784 | biostudies-literature | 2011 Feb

REPOSITORIES: biostudies-literature

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The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.

Kenney Genevieve M GM Marton James J Klein Ariel E AE Pelletier Jennifer E JE Talbert Jeffery J

Health services research 20101105 1 Pt 2

<h4>Objective</h4>To examine changes in children's receipt of well-child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt.<h4>Data sources</h4>The 2004-2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky.<h4>Study design</h4>Logistic and hazard pre-post regression models, controlling for age, gender, race/ethnicity, and eligibility category.<h4>Data extraction ...[more]

PMID: 21054374

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Project description:ImportanceThere is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it.ObjectiveTo investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees.Design, setting, and participantsHigh-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use.ExposuresChildren receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care.Main outcome and measuresTwo-part models estimated caries-related treatment and expenditures.ResultsAmong 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by $40.77 per child per year (95% CI, $30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures.Conclusions and relevanceChildren with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.

Project description:BACKGROUND: Latinos are the largest minority group in the United States and experience persistent disparities in access to and quality of health care. OBJECTIVES: (1) To determine the relationship between nativity/immigration status and self-reported quality of care and preventive care. (2) To assess the impact of a usual source of health care on receipt of preventive care among Latinos. DESIGN: Using cross-sectional data from the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative telephone survey of 4,013 Latino adults, we compared US-born Latinos with foreign-born Latino citizens, foreign-born Latino permanent residents and undocumented Latinos. We estimated odds ratios using separate multivariate ordered logistic models for five outcomes: blood pressure checked in the past 2 years, cholesterol checked in the past 5 years, perceived quality of medical care in the past year, perceived receipt of no health/health-care information from a doctor in the past year, and language concordance. RESULTS: Undocumented Latinos had the lowest percentages of insurance coverage (37% vs 77% US-born, P < 0.001), usual source of care (58% vs 79% US-born, P < 0.001), blood pressure checked (67% vs 87% US-born, P < 0.001), cholesterol checked (56% vs 83% US-born, P < 0.001), and reported excellent/good care in the past year (76% vs 80% US-born, P < 0.05). Undocumented Latinos also reported the highest percentage receiving no health/health-care information from their doctor (40% vs 20% US-born, P < 0.001) in the past year. Adjusted results showed that undocumented status was associated with lower likelihood of blood pressure checked in the previous 2 years (OR = 0.60; 95% CI, 0.43-0.84), cholesterol checked in the past 5 years (OR = 0.62; 95% CI, 0.39-0.99), and perceived receipt of excellent/good care in the past year (OR = 0.56; 95% CI, 0.39-0.77). Having a usual source of care increased the likelihood of a blood pressure check in the past 2 years and a cholesterol check in the past 5 years. CONCLUSION: In this national sample, undocumented Latinos were less likely to report receiving blood pressure and cholesterol level checks, less likely to report having received excellent/good quality of care, and more likely to receive no health/health-care information from doctors, even after adjusting for potential confounders. Our study shows that differences in nativity/immigration status should be taken into consideration when we discuss perceived quality of care among Latinos.

Dataset Information

The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.

Publications

The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.

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