摘要：Objectives. We compared levels of untreated dental caries in children enrolled in public insurance programs with those in nonenrolled children to determine the impact of public dental insurance and the type of plan (Medicaid vs State Children’s Health Insurance Program [SCHIP]) on untreated dental caries in children. Methods. Dental health outcomes were obtained through a calibrated oral screening of kindergarten children (enrolled in the 2000–2001 school year). We obtained eligibility and claims data for children enrolled in Medicaid and SCHIP who were eligible for dental services during 1999 to 2000. We developed logistic regression models to compare children’s likelihood and extent of untreated dental caries according to enrollment. Results. Children enrolled in Medicaid or SCHIP were 1.7 times (95% confidence interval [CI] = 1.65, 1.77) more likely to have untreated dental caries than were nonenrolled children. SCHIP-enrolled children were significantly less likely to have untreated dental caries than were Medicaid-enrolled children (odds ratio [OR]=0.74; 95% CI=0.67, 0.82). According to a 2-part regression model, children enrolled in Medicaid or SCHIP have 17% more untreated dental caries than do nonenrolled children, whereas those in SCHIP had 16% fewer untreated dental caries than did those in Medicaid. Conclusions. Untreated tooth decay continues to be a significant problem for children with public insurance coverage. Children who participated in a separate SCHIP program had fewer untreated dental caries than did children enrolled in Medicaid. The State Children’s Health Insurance Program (SCHIP), created by Congress in 1997, expanded eligibility for public dental insurance to children of the working poor and has grown to include more than 5 million children. SCHIP has provided states with the flexibility to experiment with new health care delivery models that may overcome long-standing obstacles to low-income populations obtaining dental care. 1 Currently, 18 states operate separate SCHIP programs, 12 offer Medicaid expansions, and 20 have combination programs. 2 Furthermore, the implementation of SCHIP had a spillover effect on Medicaid in some states that led to simplification of their enrollment processes and thus increased enrollment in Medicaid. 3 Information about the effects of SCHIP on children’s access to dental services is just beginning to emerge. 4 , 5 There have been only 3 studies, all using data from the National Health Interview Survey (NHIS), that have considered the impact of SCHIP at the national level. Wang et al. found that for children with low incomes, those with either Medicaid or SCHIP were less likely to have unmet needs for dental care by 8% and more likely to have had a dental visit within the last 12 months by 23% than were those who were uninsured. 6 Davidoff et al. found that SCHIP expansions increased the probability of a dental visit among children with chronic conditions by 4.5% and decreased unmet treatment needs by 7.4%. 7 The third study, by Duderstadt et al., found that children whose family incomes were consistent with SCHIP eligibility and who were insured for a full year visited the dentist about as often as did children with private insurance. 8 State-specific studies of SCHIP’s effects have found favorable results for a number of self-reported indicators, including usual source of dental care, any number of dentist visits, timeliness in obtaining care, and unmet treatment needs. 4 , 7 , 9 In North Carolina, SCHIP is a separate program administered by Blue Cross and Blue Shield of North Carolina (BCBSNC). At the time of this study, SCHIP in North Carolina reimbursed dental providers at rates comparable to those of private insurance, whereas Medicaid reimbursed at rates of 44% to 62% of usual fees. Providers submitted Medicaid claims and negotiated settlements through the Department of Medical Assistance, a governmental agency, whereas, for their patients with SCHIP (with the nonprofit company BCBSNC), providers submitted and negotiated claims just as they did for their privately insured patients. Medicaid and SCHIP provided a similar set of dental benefits, including preventive, diagnostic, and restorative services. The implementation of SCHIP in North Carolina appears to have improved access to dental care for children with low incomes. On the basis of caregivers’ reports, the number of school-aged children who received dental services increased from 47% in the year before enrollment to 64% in the year after enrollment, and perceived unmet dental needs decreased from 43% to 18%, respectively. 10 In an analysis of reimbursement claims, Brickhouse et al. documented a 20% greater use of dental services among pre-school-aged children enrolled in SCHIP than among those enrolled in Medicaid. 11 With this investigation, we extend our ongoing evaluation of the effects of enrollment in public insurance on North Carolina children and are the first, to our knowledge, to directly examine the impact of SCHIP on clinically determined tooth decay and compare it to that of Medicaid. Health status is an important indicator of the effectiveness of policies to improve access to care. 12 We sought to answer 2 questions. First, is the number of untreated dental caries different among children enrolled in public insurance plans from those not enrolled? Second, what is the impact of the type of public insurance plan (Medicaid vs SCHIP) on the number of untreated dental caries?
