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Variation in prices for an evidence-based pediatric preventive service
Ashley M Kranz1, Grace Gahlon1, Andrew W Dick2
1Health Care, RAND Corporation, Arlington, Virginia, USA.
Insights
Prices for fluoride varnish applications varied significantly among private insurers, potentially limiting access to this vital preventive oral health service for children. Ensuring adequate reimbursement rates is crucial for increasing its uptake in medical settings.
Area of Science:
- Health Services Research
- Pediatric Dentistry
- Health Economics
Background:
- Fluoride varnish is a recommended preventive service for children's oral health.
- Its application in medical settings is a newly reimbursed service with low utilization.
- Understanding reimbursement variations is key to improving access.
Purpose of the Study:
- To analyze price variations for fluoride varnish applications paid by private medical insurers.
- To compare private insurer prices with Medicaid reimbursement rates.
- To explore the impact of price variation on service utilization.
Main Methods:
- Analysis of private insurance medical claims from four Northeastern states (2016-2018).
- Examination of prices paid for fluoride varnish during medical visits for children aged 1-5 years.
- Comparison with state Medicaid rates obtained from the American Academy of Pediatrics.
Main Results:
- Private insurer prices for fluoride varnish ranged widely ($5-$50) within and across states.
- Median private insurer prices generally aligned with Medicaid rates in most states.
- In states with bundled preventive services, Medicaid rates were nearly double private insurer median prices.
Conclusions:
- Significant price variation exists for fluoride varnish reimbursement by private insurers.
- This price variability may be a barrier to the low uptake of this preventive service.
- Optimizing reimbursement rates from both Medicaid and private insurers could enhance fluoride varnish application in medical settings, improving pediatric oral health.
Objective:
To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive.
Data Sources:
Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018).
Study Design:
We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid.
Data Collection/Extraction Methods:
Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics.
Principal Findings:
Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers.
Conclusions:
Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.
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