title: Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits?
abstract: OBJECTIVE
  On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital.
  
  
  METHODS
  A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts.
  
  
  RESULTS
  Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million.
  
  
  CONCLUSIONS
  After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL.
authors.forename: David
authors.initials: D
authors.lastname: Salomon
authors.affiliation: Assistant Professor of Biostatistics, Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, TN.
authors.forename: R Eric
authors.initials: RE
authors.lastname: Heidel
authors.affiliation: Department Chair, Department of Oral and Maxillofacial Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Antonia
authors.initials: A
authors.lastname: Kolokythas
authors.affiliation: Department Head and Professor, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Miloro
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX. Electronic address: tschlieve@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlieve
mesh_terms: D000328:Adult; D003796:Dental Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005491:Focal Infection, Dental / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007347:Insurance, Dental / Q000331:legislation & jurisprudence*; D008297:Male; D011634:Public Health; D012189:Retrospective Studies; D012720:Severity of Illness Index