Smiles Across America Webinar Series

Date: 12/10/2015

Implications of CHIPRA: Utilization of

Dental Services among Young Children

/Oral Health America @Smile4Health

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/Oral Health America @Smile4Health

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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

Contact Information

•Nicole Thurlow Zautra–ntz@Indiana.edu

•Tyler Brown -tyler.brown@oralhealthamerica.org