Home Dental Radiology Comparative analysis of dental procedure mix in public and private dental benefits programs

Comparative analysis of dental procedure mix in public and private dental benefits programs

by adminjay


There is little published research on whether public and private dental benefits plans
affect the types of oral health care procedures patients receive. This study compares
the dental procedure mix by age group (children, working-age adults, older adults),
dental benefits type (Medicaid and Children’s Health Insurance Program, private),
and level of Medicaid dental benefits by state (emergency only, limited, extensive).


The authors extracted public dental benefits claims data from the 2018 Transformed
Medicaid Statistical Information System. To compare procedure mix with beneficiaries
who had private dental benefits, the authors used claims data from the 2018 IBM MarketScan
dental database. The authors categorized dental procedures into specific service categories
and calculated the share of procedures performed within each category. They analyzed
procedure mix by age, plan type (fee-for-service, managed care), and adult Medicaid
benefit level.


Aside from orthodontic services, the dental procedure mix among children with public
and private benefits is similar. Among adults with public benefits, surgical interventions
make up a higher share of dental procedures than routine preventive services.


Children with public benefits have a procedure mix comparable with those with private
benefits. There are substantial differences in procedure mix between publicly and
privately insured adults. Even in states that provide extensive dental benefits in
Medicaid, those programs primarily finance invasive surgical treatment as opposed
to preventive treatment.

Practical Implications

There is a need to assess best practices in publicly funded programs for children
and translate those attributes to programs for adults for more equitable benefit design
and care delivery across public and private insurers.

Source link

Related Articles