title: Dental visits to hospital emergency departments by adults receiving Medicaid: assessing their use.
abstract: BACKGROUND
  Pain from toothaches represents a significant problem. People lacking access to private dental services may use hospital emergency departments, or EDs. In 1993, Maryland eliminated Medicaid reimbursement to dentists for adult emergency services.
  
  
  METHODS
  The authors used the change in Medicaid policy that eliminated dentist reimbursement to establish two study periods. Data tapes describing patients' use of EDs were obtained from the Maryland Medicaid Management Information System. A total of 3,639 people visited EDs for dental problems sometime during the four-year study period.
  
  
  RESULTS
  After controlling for age, race and sex, the authors found that the rate of ED claims was 12 percent higher in the postchange period than in the prechange period. Comparisons between periods show significant rate increases during the postchange period for men, whites, African-Americans and patients aged 21 through 44 years and 45 through 64 years.
  
  
  CONCLUSIONS
  The change in Medicaid policy that eliminated dentist reimbursement and participation in the program appears to have increased the use of EDs for the treatment of dental problems. Practice Implications. Many EDs lack dental services and are not capable of providing definitive treatment. When definitive treatment is not provided, this pattern of care may be repeated if patients are forced to return for treatment.
authors.affiliation: Department of Oral Health Care Delivery, University of Maryland Dental School, Baltimore 21201, USA. lac001@dental.umaryland.edu
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Cohen
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Manski
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Magder
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Mullins
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D007344:Insurance Claim Reporting; D007347:Insurance, Dental / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008396:Maryland; D008484:Medicaid / Q000191:economics; D008875:Middle Aged; D010510:Periodontal Diseases / Q000145:classification / Q000191:economics; D012044:Regression Analysis; D014076:Tooth Diseases / Q000145:classification / Q000191:economics; D014098:Toothache / Q000191:economics*; D014481:United States