通过医疗补助管理护理的牙科覆盖 vs 服务费用
Hawazin W Elani1,2, Ningsheng Zhao1, Jacob Wallace3
1Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts.
JAMA health forum
|February 27, 2026
概括
医疗补助管理护理组织 (MCOs) 扩大了成人牙科福利,但保险的慷慨和交付模式仍然与服务费 (FFS) 计划不一致. 了解这些趋势对于公平的牙科服务至关重要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 牙科福利管理局 牙科福利管理局
背景情况:
- 在医疗补助计划中,成人牙科覆盖率在州一级有很大的差异.
- 大多数成年医疗补助受益人现在都参加了托管护理计划,但这些组织内的福利结构的细节有限.
研究的目的:
- 分析医疗补助管理护理组织 (MCO) 提供的成人牙科福利的范围,交付和入学模式的趋势.
- 评估MCO和医疗补助服务费 (FFS) 计划之间牙科福利慷慨的对齐.
主要方法:
- 在所有50个州和华盛顿特区的MCO或FFS覆盖范围的成年医疗补助受益者 (19岁以上) 的横截面分析.
- 利用来自医疗保险和医疗补助服务中心 (2016-2022) 行政来源的链接国家数据集.
主要成果:
- 通过MCO提供全面成人牙科福利的州从2016年的64.7%增加到2022年的70.6%.
- 在MCO和FFS计划之间,不匹配的福利水平从2016年的51.0%下降到2022年的35.3%.
- 在MCO受益人中,全面牙科覆盖的入学人数从2016年的1420万 (58.7%) 增加到2022年的2530万 (59.8%).
结论:
- 虽然MCO成人牙科福利已经增长,但它们与FFS计划的结合仍然不一致.
- 医疗补助牙科福利的不断变化的格局需要仔细考虑未来的政策决策,以确保公平的获取.
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