摘要：Objectives. This study evaluated how the elimination of Medicaid reimbursement to dentists for the treatment of adult dental problems affected patients’ visits to physicians. Methods. Data tapes describing physicians’ claims for adult Medicaid patients were obtained from the Maryland Medicaid Management Information System. The database contains information on all claims made to Maryland Medicaid, including date, provider, International Classification of Diseases, Ninth Revision, Clinical Modification Manual code, and payments. Results. A total of 5334 individuals made physician’s office claims related to dental problems sometime during the 4-year study period. The rate of dental-related claims by physicians decreased by 8% after the policy change. Conclusions. Visits to physicians’ offices decreased even though an increase might have been expected because of the elimination of access to dentists in private practice. Patients might have assumed that if visits to dentists would no longer be paid for, neither would visits to physicians’ offices. During any 6-month period in the United States, more than 20 million adults experience pain from toothache. 1 Although physicians may provide care for dental pain, dentists are the usual source of care for definitive treatment. 2, 3 Unfortunately, lowincome and minority patients who exhibit the greatest dental need 1, 4– 7 also have the poorest access to private oral health care services. 5, 8– 10 Individuals who lack a usual source for dental care may visit hospital emergency departments (EDs) or physicians’ offices to seek relief for dental pain and related conditions. In the United States during the period 1992–1999, general visits to EDs increased by approximately 14%. 11 Studies have documented the use of EDs for the treatment of dental disease in children. 12– 15 The use of EDs for the treatment of adult dental problems has also received attention. 3, 16– 23 Although several authors have discussed the role of medical practitioners in addressing oral health problems, 24– 29 few studies have gathered data on visits to physicians for the treatment and prevention of dental problems. The role of physicians in the early detection of oral cancer has been examined. 30 Several studies have explored patients’ use of visits to physicians’ offices to obtain treatment for dental problems 31, 32 and preventive oral health services for children. 33 Few studies examining adults’ visits to physicians for the treatment of dental emergencies exist. A few studies outside the United States have documented use of medical practitioners for treatment of dental problems. 34, 35 Approximately 0.3% of patients’ visits to 30 medical practices in Wales during a 1-year period were for oral problems. 34 Another limited study conducted at a hospital ED reported that 41% of patients who had received emergency services for dental problems before visiting the hospital ED had first sought treatment from medical practitioners. 35 To gain a better understanding of the role of physicians in the treatment of dental problems, our study examined adult Medicaid patients’ visits to Maryland physicians for the treatment of dental problems. In addition to examining visits to physicians in general, we also conducted an analysis of use of physicians before and after a change in the coverage status of Medicaid-eligible adults. Attempting to reduce its dental-related costs, in February 1993 Maryland Medicaid eliminated reimbursement to dentists for adult emergency dental services (routine adult dental services were eliminated in 1976). Reimbursement for visits to physicians and EDs for dental-related problems was not eliminated. To examine the impact of this policy change, physician claims data were analyzed to test the hypothesis that elimination of Medicaid reimbursement to dentists in private practice for the treatment of adult dental problems would result in increased use of physicians for the treatment of dental problems. A previous report described the impact of the policy change on ED claims. 22
