A comparison of dental services received by Medicaid and privately insured adult populations

Background. Few studies have compared differences in dental care utilization rates between a publicly and a privately insured adult population in the same geographic area. The authors conducted this study to compare the demographic characteristics and use of dental services for enrollees in the Iowa Medicaid program and in the Delta Dental Plan of Iowa. The focus was on the overall use of dental services, with an emphasis on the use of tertiary care services such as endodontic therapy and tooth extraction services. Methods. The authors used insurance claims data for adults aged 21 to 64 years who were enrolled in Delta Dental of Iowa and the Iowa Medicaid program for fiscal year 1998. They calculated utilization of dental services rates by type of dental procedure. Results. In fiscal year 1998, 69.3 percent of Delta Dental enrollees and 27.2 percent of Medicaid enrollees had a dental visit. More than 90 percent of those in both populations with a dental visit had used preventive dental services during the year. Medicaid users were nearly twice as likely as Delta Dental enrollees to receive endodontic therapy (9.9 percent versus 5.0 percent, respectively) and nearly four times as likely to have had a tooth extracted (27.4 percent versus 7.1 percent, respectively). Conclusions. Privately insured enrollees were more likely to use dental services that were Medicaid enrollees. The greater use of tertiary care services by the Medicaid population than by the privately insured population is indicative of a lower oral health status for this group at the time they sought care, even though it was a much younger group of adults. Practice implications. The oral health status of low-income adults enrolled in Medicaid could benefit greatly from higher use of routine preventive dental services and earlier treatment of oral diseases to prevent the substantial need for preventable tertiary care services.