Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid.
BACKGROUND
Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective.


METHODS
The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition.


RESULTS
Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies.


CONCLUSIONS
Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness.


CONCLUSIONS
Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.
Bresnahan
Brian W
BW
Health Services Research Section, Department of Radiology, School of Medicine, University of Washington, Seattle, and Harborview Medical Center, 325 Ninth Ave., Box 359736, Seattle, Wash. 98104-2499, USA. bres@u.washington.edu
Kiyak
H Asuman
HA
Masters
Samuel H
SH
McGorray
Susan P
SP
Lincoln
Adam
A
King
Gregory
G
D003190:Comprehensive Dental Care / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006801:Humans; D008310:Malocclusion / Q000191:economics* / Q000523:psychology; D008484:Medicaid / Q000191:economics; D009971:Orthodontics, Corrective / Q000191:economics; D009972:Orthodontics, Interceptive / Q000191:economics; D009973:Orthodontics, Preventive / Q000191:economics; D011788:Quality of Life; D014481:United States