Provision of fluoride varnish treatment by medical and dental care providers: variation by race/ethnicity and levels of urban influence. 2010

Christopher Okunseri, and Aniko Szabo, and Raul I Garcia, and Scott Jackson, and Nicholas M Pajewski
Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI 53201-1881, USA. christopher.okunseri@marquette.edu

OBJECTIVE In 2004, Wisconsin Medicaid policy changed to allow medical care providers to be reimbursed for fluoride varnish treatment (FVT) to children's teeth to improve access and utilization. To date, no study has been published on whether geographic and racial/ethnic variation in the provision of FVT in response to this policy change exists. This study's objective is to examine the association of rates of FVT for children enrolled in Wisconsin Medicaid with race/ethnicity, urban influence codes (UIC), and dental health professional shortage area (DHPSA) designation based on county of residence. METHODS A retrospective, pre-post design was used based on FVT claims for children in the Wisconsin Medicaid program from 2002 to 2006. Poisson regression models were used to evaluate the association of rates of FVT claims with race/ ethnicity, UIC, and DHPSA designation. RESULTS The rate of FVT claims varied by resident county-type according to UIC and DHPSA designation, age, and race/ethnicity. Post-policy, the largest increases were observed for Native Americans residing in non-DHPSA counties, enrollees living in rural counties, and for Hispanics living in partial and entire DHPSA counties. African-Americans residing in partial DHPSA and metropolitan counties displayed the lowest rates of FVT claims. CONCLUSIONS Overall access and utilization of FVT increased, but substantial racial/ ethnic and geographic variation in the provision of FVT for children enrolled in Wisconsin Medicaid was observed. Future policies should incorporate measures that will specifically address the racial and geographic variations identified in this study.

UI MeSH Term Description Entries
D007198 Indians, North American Members of indigenous North American populations with pre-colonial contact origins. Amerinds, North American,Indigenous North Americans,American Indian, North,American, Indigenous North,Amerind, North American,Indian, North American,Indigenous North American,North American Amerind,North American Amerinds,North American Indian,North American Indians,North American, Indigenous
D007223 Infant A child between 1 and 23 months of age. Infants
D008329 Managed Care Programs Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS. Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D008484 Medicaid Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons. Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D008507 Medically Underserved Area A geographic location which has insufficient health resources (manpower and/or facilities) to meet the medical needs of the resident population. National Health Service Corps,Physician Shortage Area,Area, Medically Underserved,Health Service Corps, National,Medically Underserved Population,Area, Physician Shortage,Areas, Medically Underserved,Areas, Physician Shortage,Medically Underserved Areas,Medically Underserved Populations,Physician Shortage Areas,Population, Medically Underserved,Populations, Medically Underserved,Shortage Area, Physician,Shortage Areas, Physician,Underserved Area, Medically,Underserved Areas, Medically,Underserved Population, Medically,Underserved Populations, Medically
D012111 Residence Characteristics Elements of residence that characterize a population. They are applicable in determining need for and utilization of health services. Community,Domicile,Living Arrangements,Neighborhood,Place of Birth,Residential Selection,Arrangement, Living,Birth Place,Communities,Domiciles,Living Arrangement,Neighborhoods,Residence Characteristic
D001741 Black or African American A person having origins in any of the black racial groups of Africa (https://www.federalregister.gov/documents/1997/10/30/97-28653/revisions-to-the-standards-for-the classification-of-federal-data-on-race-and-ethnicity). In the United States it is used for classification of federal government data on race and ethnicity. Race and ethnicity terms are self-identified social construct and may include terms outdated and offensive in MeSH to assist users who are interested in retrieving comprehensive search results for studies such as in longitudinal studies. African American,African Americans,African-American,Afro-American,Afro-Americans,Black Americans,Blacks,Negroes,African-Americans,Negro,Afro American,Afro Americans,American, African,American, Black,Black American
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003815 Dentists Individuals licensed to practice DENTISTRY. Dentists, Pediatric,Dentists, Prosthetic,Dentists, Restorative,Periodontists,Prosthodontists,Dentist,Dentist, Pediatric,Dentist, Prosthetic,Dentist, Restorative,Pediatric Dentist,Pediatric Dentists,Periodontist,Prosthetic Dentist,Prosthetic Dentists,Prosthodontist,Restorative Dentist,Restorative Dentists

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