North Carolina physician-based preventive oral health services improve access and use among young Medicaid enrollees

Abstract

To combat disparities in oral health and access to dental care among infants and toddlers, most state Medicaid programs now reimburse physician-based preventive oral health services such as fluoride varnish applications. We used geospatial data to examine the distribution of dental and medical Medicaid providers of pediatric oral health services throughout North Carolina to determine if these services have improved access to care for Medicaid enrollees younger than age three. We then used claims data to examine the association between distance from these practices and use of dental services for a cohort of approximately 1,000 young children. Among one hundred counties, four counties had no physician-based preventive oral health services, and nine counties had no dental practice. While children who lived farther from the nearest dental practice were less likely to make dental visits, distance from physician-based preventive oral health services did not predict utilization. For young Medicaid enrollees, oral health services provided in medical offices can improve access and increase utilization.

Keywords: Access To Care; Children’s Health; Disparities; Medicaid; Oral Health Care.

EXHIBIT 1

Location Of Medical Practices Providing Physician-Based Preventive Oral Health Services And The Number Of County-Level Dental Practices Per 1,000 Children Ages Five Years Or Younger In North Carolina, 2009–10 Sources: Five-year estimates from the 2006–10 American Community Survey and practice addresses from the North Carolina Division of Medical Assistance during 2009.

EXHIBIT 2

Location Of Dental Practices And Medical Practices Providing Physician-Based Preventive Oral Health Services And The County-Level Percent of Population Younger Than 18 Years Of Age Living in Poverty In North Carolina, 2009–10 Source: Five-year estimates from the 2006–10 American Community Survey and practice addresses from the North Carolina Division of Medical Assistance during 2009.

EXHIBIT 4

Effects Of Distance To Care On Probability Of Physician-Based Preventive Oral Health Services Among Infants And Toddlers Enrolled In North Carolina Medicaid, 2008–10 Source: Combination of national survey data, survey data from the Carolina Oral Health Literacy cohort study, and North Carolina Medicaid claims data, 2008–10. NOTES. Whisker marks represent 95% confidence intervals.

EXHIBIT 5

Effects Of Distance To Care On Probability Of Dental Visit Among Infants And Toddlers Enrolled In North Carolina Medicaid, 2008–10 Source: Combination of national survey data, survey data from the Carolina Oral Health Literacy cohort study, and North Carolina Medicaid claims data, 2008–10. NOTES. Whisker marks represent 95% confidence intervals.