title: Geographic accessibility and utilization of orthodontic services among Medicaid children and adolescents.
abstract: OBJECTIVE
  To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care.
  
  
  METHODS
  We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization.
  
  
  RESULTS
  The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas.
  
  
  CONCLUSIONS
  Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees.
authors.affiliation: Department of Preventive and Community Dentistry, College of Dentistry, Public Policy Center, University of Iowa, Iowa City, IA 52242, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: McKernan
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Kuthy
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Momany
authors.forename: Michelle R
authors.initials: MR
authors.lastname: McQuistan
authors.forename: Paul F
authors.initials: PF
authors.lastname: Hanley
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
authors.forename: Peter C
authors.initials: PC
authors.lastname: Damiano
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003729:Dental Care / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007484:Iowa; D008297:Male; D008484:Medicaid / Q000191:economics; D009971:Orthodontics, Corrective / Q000191:economics / Q000706:statistics & numerical data*; D011156:Population Density; D011203:Poverty / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011365:Professional Practice Location / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data