Provider Payment & Dentistry for Poor Pregnant Women

Project Number: R40 MC 05501-03
Project Date: 09/01/2005
Grantee: University of Washington
Department/Center: Dental Public Health Sciences

Final Report

Pending

Principal Investigator

Peter Milgrom DDS,
Professor, University of Washington Dental Public Health Sciences,
Box 357475
Seattle, WA 98195-7475
dfrc@u.washington.edu

Abstract

Increasing recent evidence suggests that maternal oral infection is one factor in prematurity and growth restriction. At the same time, it has been known for at least two decades that untreated mothers are the source of oral infection in their children and that treating the mother greatly reduces the transmission of the disease to the child. Nevertheless the restriction of Medicaid dental benefits to pregnant women is increasing and Medicaid has failed to adapt to the "paradigm shift" that may be happening within dentistry - shifting from a focus on disease in the child to a medical model where the mother is treated to prevent problems with the offspring. Beyond the humanitarian and ethical issues, the State has an interest in this problem because low income women and children are more likely to have both of these conditions (caries and periodontal disease) and because low income children are legally entitled to medical and dental care for which the State must bear a major part of the cost. Research from four States (other than Oregon) shows that even among women with reported mouth symptoms, utilization of dental is relatively low. Using analysis of Medicaid claims and a dental provider survey, the specific aims of this proposal are then: 1) To describe the utilization of dental care provided for pregnant and non-pregnant low-income women 18 - 35 years old in Oregon (N=3400 in 2003, Medicaid covered women in Oregon saw a dentist); 2) To ascertain the attitudes and knowledge of general dentists in Oregon (N=1700) regarding dental care for pregnant and non-pregnant women; and 3) To determine the impact of the method of provider payment (fee-for-service v. managed care/capitation) and provider knowledge and attitudes on access, use and cost of dental services. This research addresses MCHB Strategic Research Issue II: MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations, and III: Services and systems to assure quality of care for MCH populations.

Publications

Pending

Keywords

Oral health, prenatal care, prematurity, preventive health care, Medicaid, Oregon