Temporal association of implementation of the Arizona Health Care Cost Containment System (AHCCCS) with changes in dental-related emergency department visits in Maricopa County from 2006 to 2012.

Abstract

To evaluate changes in emergency department (ED) dental-related visits in Maricopa County before and after the elimination of dental benefits for adult Medicaid-insured patients as of October 2010. Hospital visits extracted from a hospital discharge dataset were used to calculate a yearly rate ratio of dental-related versus non-dental-related ED visits (as a comparison group) for adults, children, and payer types. Changes in ED visits over time were evaluated from 2006 to 2012. Overall, 1.3 percent of all ED visits (8,030,767) were for dental-related purposes. Medicaid-insured patients accounted for 41.9 percent and 44.3 percent of all dental-related ED visits in 2006 and 2012, respectively. The rate ratio for the percentage of dental-related versus non-dental-related ED visits in each age category and payer type showed little fluctuation over time indicating no evidence of change in the dental-related ED visits as a proportion of the overall number of visits due to the cuts in the dental benefits for adult Medicaid-insured patients. We found no evidence that cuts in dental benefits for adult Medicaid-insured patients resulted in increased dental-related ED visits in Maricopa County during the study period. Rather, we found evidence of a shift in payer type after the 2010 policy change where dental-related ED visits by self-paid patients increased as dental-related ED visits by Medicaid-insured patients decreased. Such payer shifts will result in high uncompensated care burdens for providers and, ultimately, governmental payers.