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Association Between Insurance Type and Fluoride Varnish Application During Well-Child Visits in Massachusetts
Annie Yu-An Chen1, Kimberley H Geissler2, Andrew W Dick1
1RAND Corporation (A.áYu-An.áChen and.áAW.áDick), Boston, Mass.
Insights
Fluoride varnish applications during well-child visits were low for children with Medicaid and private insurance in Massachusetts. Rates increased from 2016 to 2018, but remained lower for privately insured children.
Area of Science:
- Public Health
- Pediatric Dentistry
- Health Services Research
Background:
- Dental caries is a significant public health issue affecting children.
- Preventive dental services like fluoride varnish (FV) are crucial for early childhood oral health.
- Disparities in access to dental care exist based on insurance type and socioeconomic factors.
Purpose of the Study:
- To compare the rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid versus private medical insurance in Massachusetts.
- To analyze trends in FV application rates over time and by age group.
- To identify potential disparities in preventive dental care delivery based on insurance status.
Main Methods:
- Cross-sectional study analyzing well-child visits for children aged 1-5 years in Massachusetts from 2016-2018.
- Data included visits paid by Medicaid and private insurance.
- Multivariate regression models were used to calculate odds ratios and adjusted predicted probabilities of FV application, with covariates interacting with insurance type.
Main Results:
- A total of 957,551 well-child visits were analyzed; 40.0% were covered by private insurance.
- Unadjusted FV application rates were 14.2% for Medicaid and 6.6% for private insurance.
- Adjusted rates of FV application increased significantly from 2016 to 2018 for both insurance types, but remained higher for Medicaid-covered children. The difference by insurance type declined over time.
Conclusions:
- Fluoride varnish application rates during well-child visits remain low for both Medicaid and privately insured children in Massachusetts, despite observed growth.
- These low rates are concerning given FV's role in preventing early childhood caries and addressing oral health disparities.
- Targeted interventions may be needed to improve FV utilization, particularly for privately insured children, to ensure equitable access to preventive dental care.
Objective:
To compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts.
Methods:
This cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016.Çô18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during well-child visits by calendar year and age.
Results:
Across 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval.á=.á.êÆ8.7 to .êÆ7.3, 2018: 5.3% points, 95% confidence interval.á=.á.êÆ6.6 to .êÆ3.9).
Conclusions:
Rates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes.
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