Child/Adolescent Health

Design of the public insurance plan can reduce the time to a child's first dental visit after enrollment

Historically, an inadequate supply of participating dentists, in part due to low payments, have made it difficult for children covered by public health insurance to find participating dentists and make appointments soon after enrollment. Letting a covered child go to any dentist and paying the dentist's full charges reduces the time between when the child becomes covered and the first covered visit to the dentist, according to a new study.

Peter C. Damiano, D.D.S., M.P.H., and his colleagues at the University of Iowa compared the time from enrollment in public insurance and the first visit to a dentist or for a dental cleaning. Medicaid accounted for 74 percent of Iowa children with public insurance. Iowa counties typically offered one of three separate State Children's Health Insurance Program (SCHIP) plans in addition to Medicaid, with only eight counties offering a choice of two SCHIP plans. SCHIP plans 1 and 2 each accounted for 7 percent of publicly insured children, while SCHIP plan 3 accounted for 12 percent. The SCHIP plans differed in the numbers of participating dentists and the amounts that dentists were paid relative to their fee-for-service charges.

Of the children enrolled in SCHIP 2, which allowed children to see any dentist and paid the dentist's full fee-for-service charges, 36 percent had a dental visit within 6 months of enrollment and 88 percent by 3 years after enrollment. This compares with 23 percent at 6 months and 73 percent at 3 years after enrollment for Medicaid enrollees, and between 21–30 percent at 6 months and 80–82 percent at 3 years for enrollees in the other two SCHIP plans that had smaller panels of participating dentists and limited the amount paid for dental services. The study was funded in part by the Agency for Healthcare Research and Quality (HS13410).

More details are in "Time to first dental visit after initially enrolling in Medicaid and S-SCHIP," by Peter C. Damiano, D.D.S., M.P.H., Elizabeth T. Momany, Ph.D., Knute D. Carter, B.Sc., and others, in the December 2008 Medical Care 46(12), pp. 1234-1239.

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