Jean Mitchell Ph.D., Professor, Georgetown University Public Policy Institute, 3600 N Street, N.W., 2nd Floor Washington, DC 20007 mitchejm@georgetown.edu
Abstract
Tooth decay is the most common chronic childhood disease (Edelstein et al, 1995). Recent evidence indicates that nearly half of children aged 5 to 17 have decayed, missing, or filled tooth surfaces and teeth (Kaste, 1996). Low Income, minority children are disproportionately affected and are more likely to go untreated. Other evidence shows that few children covered by Medicaid receive the preventive dental care recommended under the Early and Periodic Screening, Diagnosis and Treatment program (DHHS, 1996). The reasons are complex. For dentists who operate independently the access problems can be attributed to low fees, burdensome paperwork, reimbursement delays, aversion to managed care and unkept appointments. For low income families, preventive dental care may be a low priority, and they may not be aware of the importance of good dental hygiene. Access to dental care for low income children has become more acute due to the financial constraints linked to Medicaid managed care. Research examining children's use of and access to dental care under Medicaid managed care arrangements is sparse.
This proposed research will address this gap in knowledge. The investigators will first analyze Medicaid eligibility, claims and encounter data for children with special health care needs enrolled in the DC Medicaid program to evaluate the effects of plan choice (managed care versus fee-for-service) on use of dental care services. Second, the investigators will evaluate the effect of plan choice on access to dental services. To evaluate access to dental care, recently conducted interviews with parents of 1,088 children with special health care needs enrolled in the DC Medicaid program will be used. Baseline and follow-up interviews with parents have been conducted so access to dental services can be evaluated over time.
