A comparison of Medicaid reimbursement for non-definitive pediatric dental treatment in the emergency room versus periodic preventive care.
OBJECTIVE
This study compared the expenditure by the state Medicaid program for episodic, nondefinitive care provided through the emergency room (ER) of a children's hospital with the cost to Medicaid of covering that same child with the recommended preventive service calculated on the fee schedule of the state dental Medicaid program.


METHODS
Records of patients discharged from the ER during 1996-1998 who had a payor source of Medicaid were reviewed and the reimbursement amount determined. This was compared to an estimate of preventive services which would have been reimbursed by Medicaid for each child.


RESULTS
During 1996-1998, 97 patients made 102 visits to the ER. Of these, 9 were admitted to the hospital for treatment. The reimbursement amounts for patients admitted to the hospital were ten times greater than the anticipated amount for preventive care. The reimbursement amounts for preventive services was approximately three times more costly than outpatient treatment in the ER for symptoms related to dental caries.


CONCLUSIONS
Greater expenditures by the state Medicaid program for treatment in the ER as compared to the cost to Medicaid for providing routine, preventive care depended on whether the child was treated as an inpatient or outpatient.
Pettinato
E S
ES
Dental Services, Children's Medical Center of Dallas, USA. miwebb@childmed.dallas.tx.us
Webb
M D
MD
Seale
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NS
D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics; D002648:Child; D002675:Child, Preschool; D019140:Dental Care for Children / Q000191:economics*; D003731:Dental Caries / Q000191:economics / Q000628:therapy; D004636:Emergency Service, Hospital / Q000191:economics*; D017050:Episode of Care; D005250:Fees, Dental; D005102:Health Expenditures; D017722:Hospital Charges; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D008484:Medicaid / Q000191:economics*; D010351:Patient Discharge; D011313:Preventive Dentistry / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics; D012189:Retrospective Studies; D013781:Texas; D014481:United States