文章基本信息

标题：Effects of Cuts in Medicaid on Dental-Related Visits and Costs at a Safety-Net Hospital
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作者：Martha Neely ; Judith A. Jones ; Sharron Rich 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：6
页码：e13-e16
DOI：10.2105/AJPH.2014.301903
语种：English
出版社：American Public Health Association
摘要：We used data from Boston Medical Center, Massachusetts, to determine whether dental-related emergency department (ED) visits and costs increased when Medicaid coverage for adult dental care was reduced in July 2010. In this retrospective study of existing data, we examined the safety-net hospital’s dental-related ED visits and costs for 3 years before and 2 years after Massachusetts Health Care Reform. Dental-related ED visits increased 2% the first and 14% the second year after Medicaid cuts. Percentage increases were highest among older adults, minorities, and persons receiving charity care, Medicaid, and Medicare. Emergency department (ED) visits in the United States rose by 32% from 1993 to 2006. 1 In the 2010 National Hospital Ambulatory Medical Care Survey, 2 there were 42.8 ED visits for every 100 people. Almost one third, 31.4%, of the 2010 ED visits were by people dependent on Medicaid or State Children’s Health Insurance Program, 2 17.7% were by people with Medicare, and 16.6% were uninsured. 2 Cohen et al. 3 examined ED use for the treatment of dental problems at the University of Maryland Medical System in 1995. They analyzed dental-related ED use before and after a change in coverage status for poor adults took place (in an attempt to reduce costs, in February 1993, the state of Maryland eliminated Medicaid reimbursement for dental care). After the policy change, the rate of dental visits to the ED by Medicaid recipients increased by 21.8%. Because definitive treatment is not provided in the ED, use of EDs for dental care and associated costs may be repeated because patients are forced to return for treatment of the unresolved condition. The magnitude of this problem is unknown. Lewis et al. 4 reported that patients in the United States made about 3 million ED visits for complaints of tooth pain or tooth injury during the 4-year period from 1997 to 2000. Similarly, in a national study based on the National Ambulatory Medical Care Survey, Wall 5 found that dental-related ED visits increased from 1.15% to 1.87% between 1997–1998 and 2007–2008. In New Hampshire, overall ED use has been increasing among all age, racial, and ethnic groups. Between 2001 and 2007, Anderson et al. 6 found a 14% increase in total ED visits overall and a 47% increase in the visits associated with the nontraumatic dental conditions. Thus, use of EDs for dental care points to an inappropriate use of resources and lack of continuity of dental care. Lowe et al. 7 evaluated the effect of the Oregon Health Plan changes on ED use in a representative sample of Oregon EDs before and after the Oregon Health Plan cutbacks in February and March 2003. Multivariate analyses showed that the March 2003 policy change was followed by a 20% (95% confidence interval [CI] = 13%, 28%) increase in the number of uninsured ED visits per month, after they adjusted for seasonal variation and for a secular trend showing an additional increase of 7% per year (95% CI = 4%, 10%). The Massachusetts Medicaid program (MassHealth) reduced its dental coverage for adults in July 2010. The purpose of this study was to analyze the rate of adults (aged 21 years or older) who used the ED at an urban safety-net hospital, Boston Medical Center (BMC) in Massachusetts, for dental problems 3 years before and 2 years after Massachusetts Health Care Reform (July 1, 2007–June 30, 2012).