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Sealant use in public and private insurance programs
1Division of Community Health, Columbia University School of Dental and Oral Surgery, USA.
The New York State Dental Journal
|April 24, 1999
Summary
Dental sealants effectively prevent tooth decay but remain underutilized. Low insurance coverage and inconsistent reimbursement policies hinder widespread adoption among children, despite proven benefits.
Area of Science:
- Dentistry
- Public Health
- Health Policy
Background:
- Dental sealants are a proven, safe, and effective method for preventing dental caries in tooth pits and fissures.
- Recent surveys indicate an increase in sealant use, yet coverage remains low, with less than 20% of children aged 5-17 benefiting.
Purpose of the Study:
- To examine the current status of dental sealant utilization and identify barriers to their widespread adoption.
- To analyze the impact of insurance coverage and reimbursement policies on the use of dental sealants.
Main Methods:
- Analysis of data from the National Health and Nutrition Examination Survey (NHANES III) to assess sealant prevalence.
- Review of public and private insurance policies, including Medicaid and managed care programs, regarding dental sealant coverage and reimbursement.
Main Results:
- Despite professional acceptance, dental sealant use is limited, with significant disparities in coverage.
- Reimbursement and coverage by insurance programs, including Medicaid and commercial plans, are inconsistent and often inadequate.
- Managed care programs may include sealants but often lack financial incentives to promote their application.
Conclusions:
- The widespread benefits of dental sealants for caries prevention are not fully realized due to systemic issues with insurance coverage and reimbursement.
- Policy changes and financial incentives are needed to improve access to and utilization of dental sealants, particularly for children.
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