Evaluation of enrollee satisfaction with Iowa's Dental Wellness Plan for the Medicaid expansion population

Exploring the Challenges in Covering Dental Services through Complementary Insurance in Iran: A Qualitative Study

Background

Financial protection is crucial for attaining universal health coverage. The inclusion of costly dental services in insurance plans poses a significant challenge for all parties involved in the insurance sector. This study aimed to investigate the challenges of covering dental services by complementary insurance in Iran during 2020-2021.

Materials and Methods

This qualitative research was conducted in Iran during 2020-2021. A triangulation of methods and data sources were employed to achieve a comprehensive perspective. In-depth semistructured interviews were conducted on an individual basis, and all national documents, rules, regulations, and instructions pertaining to complementary dental insurance were thoroughly reviewed. Purposeful sampling was used to select participants from all stakeholder groups engaged in dental insurance coverage, including (1) health system policymakers, (2) insurers, (3) policyholders, (4) care providers (dentists), and (5) insured people. Six open-ended questions were formulated to explore various facets of dental insurance, including (1) development, (2) management, (3) population coverage, (4) premium calculation, (5) services coverage, and (6) payment and reimbursement mechanisms. With the consent of the participants, all interviews were recorded and transcribed verbatim. The gathered data were evaluated using a framework analysis approach in the MAXQDA20 software. Finally, the primary themes, each encompassing multiple subthemes, were identified and presented.

Results

A total of 26 interviews were conducted with five groups of interviewees, and nine national documents were evaluated. Six themes were extracted, which included 18 codes from the interviews and seven codes from the documents. The extracted themes were as follows: (1) Insurance commitments and service coverage, (2) reimbursement system, (3) information system, (4) economic issues, (5) population coverage, and (6) regulation and supervision. The high cost of dental services was the most frequent challenge, followed by the insurance commitments and service coverage.

Conclusions

The delivery of dental services through complementary insurance in Iran primarily faces economic and service coverage challenges. The resolution hinges on the collaboration between basic and complementary insurance sectors, the development of a unified information system for insured individuals, and the implementation of a risk-adjusted premium plan.

Perceived social status, socioeconomic status, and preventive dental utilization among a low-income Medicaid adult population

OBJECTIVES

Perceived Social Status (PSS) is a measure of cumulative socioeconomic circumstances that takes perceived self-control into account. It is hypothesized to better capture social class compared to socioeconomic status (SES) measures (i.e., education, occupation, and income). This study examined the association between PSS and dental utilization, comparing the strength of associations between dental utilization and PSS and SES measures among a low-income adult Medicaid population.

METHODS

A cross-sectional survey was administered to a random sample of low-income adults in Iowa, United States with Medicaid dental insurance (N = 18,000) in the spring of 2018. Respondents were asked about PSS, dental utilization, and demographics. A set of multivariable logistic regression models examined the relative effects of PSS and SES measures on dental utilization, controlling for age, sex, health literacy, whether the respondent was aware they had dental insurance, transportation, and perceived need of dental care.

RESULTS

The adjusted response rate was 25%, with a final sample size of 2252. Mean PSS (range 1-10) was 5.3 (SD 1.9). PSS was significantly associated with dental utilization (OR = 1.11; CI = 1.05, 1.18) when adjusting for control variables, whereas other SES measures-education, employment, and income-were not.

CONCLUSIONS

PSS demonstrated a small positive association with dental utilization. Results support the relative importance of PSS, in addition to SES measures, as PSS may capture aspects of social class that SES measures do not. Results suggest the need for future research to consider the effects of PSS on oral health outcomes and behaviors.

Synthesizing 30-years of adult medicaid dental policy research: A scoping review to identify gaps and opportunities

Objective

Despite the importance of Medicaid for the oral health of low-income adults, the extent to which Medicaid dental policy variation influences outcomes is unknown. This study aims to review the evidence evaluating adult Medicaid dental policies to synthesize conclusions and motivate future research.

Data sources

A comprehensive search of academic literature published in English between 1991 and 2020 was conducted to identify studies which evaluated an adult Medicaid dental policy for its effect on outcomes. Studies strictly involving children, policies not related to adult Medicaid dental coverage, and non-evaluation studies were excluded. The data analysis identified the policies, outcomes, methods, populations, and conclusions of the included studies.

Results

Among the 2731 unique articles extracted, 53 met the inclusion criteria. 36 studies evaluated the effect of expanding Medicaid dental coverage, which was found to consistently increase dental service visits (21 studies) and reduce unmet dental needs (4 studies). Provider density, reimbursement rates, and level of benefits appear to influence the effect of expanding Medicaid dental coverage. The evidence for changing Medicaid benefits and reimbursement rates were mixed for its impact on provider participation and emergency dental services. Few studies examined how adult Medicaid dental policies impact health outcomes.

Conclusions

Most of the recent research has focused on evaluating the effect of expanding or reducing Medicaid dental coverage on dental service utilization. Future research investigating the impact of adult Medicaid dental policies on clinical, health, and wellness outcomes remains warranted.

Clinical significance

Low-income adults are responsive to Medicaid dental policy changes and utilize more care with more generous coverage. Less is known about how these policies influence health.

Characteristics of Individuals in Japan Who Regularly Manage Their Oral Health by Having a Family Dentist: A Nationwide Cross-Sectional Web-Based Survey

Dental healthcare systems may differ between countries; however, having a family dentist is generally important for proper oral health management. This study aims to analyze the proportion of people in Japan who have a family dentist, and their characteristics. A nationwide web-based survey with 3556 participants (1708 men and 1848 women) showed that 45.6% of men and 54.1% of women had a family dentist (FD group). A multiple logistic regression analysis revealed that men in the FD group mostly belonged to older age groups (≥70 s, OR: 2.41), received higher household incomes (≥8000 K JPY, OR: 1.47), brushed their teeth three or more times daily (OR: 1.60), practiced habitual interdental cleaning (OR: 3.66), and fewer lived in rural areas (towns and villages, OR: 0.52). Regarding the women, the majority belonged to older age groups (60 s, OR: 1.52; ≥70 s, OR: 1.73), practiced habitual interdental cleaning (OR: 3.68), and fewer received lower household incomes (<2000 K JPY, OR: 0.61). These results suggest that despite Japan being a country with a public insurance coverage system for both men and women, having a family dentist is associated with disparities in individual socioeconomic factors, particularly age and household income.

Member and dentist narratives about a dental programme for the Medicaid expansion population: A content analysis

OBJECTIVES

In the United States, the 2010 Affordable Care Act's Medicaid expansion improved financial access to dental care for new Medicaid enrollees in states with Medicaid dental benefits for adults. Using an existing theoretical framework, we explored dentist and Medicaid member narratives concerning a state's redesigned dental programme for the Medicaid expansion population.

METHODS

Data sources include two surveys conducted in 2016-one to a random sample of Medicaid members and one to private practice dentists in Iowa. A qualitative content analysis approach was used to quantify and describe themes present in open-ended comment data.

RESULTS

The most common themes among Medicaid member narratives were related to oral health needs and status, availability of dentists who accept Medicaid, and Medicaid coverage for dental care. Among dentists, the programme's administrative burden was the most common theme, with coverage and reimbursement commonly cited as well. An emergent theme among both member and dentist comments was patient confusion or lack of knowledge about programme enrolment and coverage.

CONCLUSIONS

Member awareness about enrolment and coverage in public dental benefit plans should be further explored to determine the impact on access to care. Effectively communicating the intent, programme design and expectations of a Medicaid programme to both providers and Medicaid members is important to the success of the programme.