Variation in prices for an evidence-based pediatric preventive service

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.