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Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010–2012

      Abstract

      Objective

      To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010–2012.

      Methods

      Nationally representative data from the Medical Expenditure Panel Survey (2010–2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care.

      Results

      Overall, 41.9% of US children reported an annual dental office–based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families.

      Conclusions

      Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017.

      Keywords

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      References

        • US Surgeon General
        Oral Health in America: A Report of the Surgeon General.
        US Department of Health and Human Services; National Institute of Dental and Craniofacial Research; National Institues of Health, Rockville, Md2000
        • Nasseh K.
        • Vujicic M.
        Dental care utilization rate highest ever among children, continues to decline among working-age adults.
        Health Policy Institute Research Brief. American Dental Association, 2014 (Available at:) (Accessed October 1, 2015)
        • Flores G.
        • Lin H.
        Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: has anything changed over the years?.
        Int J Equity Health. 2013; 12: 10
        • Isong I.A.
        • Soobader M.J.
        • Fisher-Owens S.A.
        • et al.
        Racial disparity trends in children's dental visits: US National Health Interview Survey, 1964–2010.
        Pediatrics. 2012; 130: 306-314
        • Edelstein B.L.
        • Chinn C.H.
        Update on disparities in oral health and access to dental care for America's children.
        Acad Pediatr. 2009; 9: 415-419
        • Kenney M.K.
        Oral health care in CSHCN: state Medicaid policy considerations.
        Pediatrics. 2009; 124: S384-S391
        • Chi D.L.
        • Raklios N.A.
        The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study.
        BMC Oral Health. 2012; 12: 28
        • Lewis C.W.
        Dental care and children with special health care needs: a population-based perspective.
        Acad Pediatr. 2009; 9: 420-426
        • Krol D.M.
        • Section on Oral Health
        Maintaining and improving the oral health of young children.
        Pediatrics. 2014; 134: 1224-1229
        • Dye B.A.
        • Thorton-Evans Li X.
        • Iafolla T.J.
        Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS Data Brief 191.
        United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md2015
        • Lin M.
        • Sappenfield W.
        • Hernandez L.
        • et al.
        Child- and state-level characteristics associated with preventive dental care access among US children 5–17 years of age.
        Matern Child Health J. 2012; 16: 320-329
        • Manski R.J.
        • Cooper P.F.
        Dental care use: does dental insurance truly make a difference in the US?.
        Community Dent Health. 2007; 24: 205-212
        • Howell E.M.
        • Kenney G.M.
        The impact of the Medicaid/CHIP expansions on children: a synthesis of the evidence.
        Med Care Res Rev. 2012; 69: 372-396
        • Edelstein B.L.
        Putting teeth in CHIP: 1997–2009 retrospective of Congressional action on children's oral health.
        Acad Pediatr. 2009; 9: 467-475
        • Beil H.
        • Rozier R.G.
        • Preisser J.S.
        • et al.
        Effects of early dental office visits on dental caries experience.
        Am J Public Health. 2014; 104: 1979-1985
        • Samnaliev M.
        • Wijeratne R.
        • Kwon E.G.
        • et al.
        Cost-effectiveness of a disease management program for early childhood caries.
        J Public Health Dent. 2015; 75: 24-33
        • McCormick M.C.
        • Kass B.
        • Elixhauser A.
        • et al.
        Annual report on access to and utilization of health care for children and youth in the United States, 1999.
        Pediatrics. 2000; 105: 219-230
        • McCormick M.C.
        • Weinick R.M.
        • Elixhauser A.
        • et al.
        Annual report on access to and utilization of health care for children and youth in the United States—2000.
        Ambul Pediatr. 2001; 1: 3-15
        • Elixhauser A.
        • Machlin S.R.
        • Zodet M.W.
        • et al.
        Health care for children and youth in the United States: 2001 annual report on access, utilization, quality and expenditures.
        Ambul Pediatr. 2002; 2: 419-437
        • Simpson L.
        • Zodet M.W.
        • Chevarley F.M.
        • et al.
        Health care for children and youth in the United States: 2002 report on trends in access, utilization, quality and expenditures.
        Ambul Pediatr. 2004; 4: 131-153
        • Simpson L.
        • Owens P.L.
        • Zodet M.W.
        • et al.
        Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by income.
        Ambul Pediatr. 2005; 5: 6-44
        • Chevarley F.M.
        • Owens P.L.
        • Zodet M.W.
        • et al.
        Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by a county level of urban influence.
        Ambul Pediatr. 2006; 6: 241-264
        • Owens P.L.
        • Zodet M.W.
        • Berdahl T.
        • et al.
        Annual report on health care for children and youth in the United States: focus on injury-related emergency department utilization and expenditures.
        Ambul Pediatr. 2008; 8: 219-240.e17
        • Berdahl T.
        • Owens P.L.
        • Dougherty D.
        • et al.
        Annual report on health care for children and youth in the United States: racial/ethnic and socioeconomic disparities in children's health care quality.
        Acad Pediatr. 2010; 10: 95-118
        • Friedman B.
        • Berdahl T.
        • Simpson L.A.
        • et al.
        Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality.
        Acad Pediatr. 2011; 11: 263-279
        • Berdahl T.A.
        • Friedman B.S.
        • McCormick M.C.
        • et al.
        Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002–2009.
        Acad Pediatr. 2013; 13: 191-203
        • Torio C.M.
        • Encinosa W.
        • Berdahl T.
        • et al.
        Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions.
        Acad Pediatr. 2015; 15: 19-35
        • Hudson J.L.
        • Abdus S.
        Coverage and care consequences for families in which children have mixed eligibility for public insurance.
        Health Aff. 2015; 34: 1340-1348
        • Hudson J.L.
        • Selden T.M.
        Children's eligibility and coverage: recent trends and a look ahead.
        Health Aff. 2007; 26: w618-w629
        • Brown E.
        • Manski R.
        Dental Services: Use, Expenditures, and Sources of Payment, 1996–2000.
        Agency for Healthcare Research and Quality, Rockville, Md2004
        • Manski R.J.
        • Vargas C.M.
        • Brown E.
        • et al.
        Dental procedures among children age birth to 20, United States, 1999 and 2009.
        J Public Health Dent. 2015; 75: 10-16
        • Abdus S.
        • Selden T.M.
        Adherence with recommended well-child visits has grown, but large gaps persist among various socioeconomic groups.
        Health Aff. 2013; 32: 508-515
        • Selden T.M.
        Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000–2002.
        Pediatrics. 2006; 118: e1766-e1778
      1. Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents. American Academy of Pediatric Dentistry, Chicago, Ill2013
        • Behrens D.
        • Lear J.G.
        Strengthening children's oral health: views from the field.
        Health Aff. 2011; 30: 2208-2213
        • Beil H.A.
        • Rozier R.G.
        Primary health care providers' advice for a dental checkup and dental use in children.
        Pediatrics. 2010; 126: e435-e441
        • Romaire M.A.
        • Bell J.F.
        • Grossman D.C.
        Health care use and expenditures associated with access to the medical home for children and youth.
        Med Care. 2012; 50: 262-269
        • Lee J.Y.
        • Rozier R.G.
        • Norton E.C.
        • et al.
        The effects of the Women, Infants, and Children's Supplemental Food Program on dentally related Medicaid expenditures.
        J Public Health Dent. 2004; 64: 76-81
        • Brickhouse T.H.
        • Haldiman R.R.
        • Evani B.
        The impact of a home visiting program on children's utilization of dental services.
        Pediatrics. 2013; 132: S147-S152
        • Mertz E.
        • Mouradian W.E.
        Addressing children's oral health in the new millennium: trends in the dental workforce.
        Acad Pediatr. 2009; 9: 433-439
        • Guarnizo-Herreno C.C.
        • Wehby G.L.
        Dentist supply and children's oral health in the United States.
        Am J Public Health. 2014; 104: e51-e57
        • Fisher-Owens S.A.
        • Isong I.A.
        • Soobader M.J.
        • et al.
        An examination of racial/ethnic disparities in children's oral health in the United States.
        J Public Health Dent. 2013; 73: 166-174
        • Chi D.L.
        • McManus B.M.
        • Carle A.C.
        Caregiver burden and preventive dental care use for US children with special health care needs: a stratified analysis based on functional limitation.
        Matern Child Health J. 2014; 18: 882-890
        • Wall T.P.
        • Brown L.J.
        • Manski R.J.
        The funding of dental services among US children 2 to 17 years old: recent trends in expenditures and sources of funding.
        J Am Dent Assoc. 2002; 133: 474-482
        • Newacheck P.W.
        • Pearl M.
        • Hughes D.C.
        • et al.
        The role of Medicaid in ensuring children's access to care.
        JAMA. 1998; 280: 1789-1793
        • Dubay L.
        • Kenney G.M.
        Health care access and use among low-income children: who fares best?.
        Health Aff. 2001; 20: 112-121
        • Decker S.L.
        Medicaid payment levels to dentists and access to dental care among children and adolescents.
        JAMA. 2011; 306: 187-193
        • Nasseh K.
        • Vujicic M.
        • O'Dell A.
        Affordable Care Act expands dental benefits for children but does not address critical access to dental care issues.
        Health Policy Resources Center Research Brief. American Dental Association, 2013 (Available at:)
        • Watson M.R.
        • Manski R.J.
        • Macek M.D.
        The impact of income on children's and adolescents' preventive dental visits.
        J Am Dent Assoc. 2001; 132: 1580-1587
        • Wall T.
        • Nasseh K.
        • Vujicic M.
        Fewer Americans forgoing dental care due to cost.
        Health Policy Institute Research Brief. American Dental Association, 2014 (Available at:)
        • Wall T.
        • Nasseh K.
        • Vujicic M.
        Most important barriers to dental care are financial, not supply related.
        Health Policy Institute Research Brief. American Dental Association, 2014 (Available at:)