Children in Foster Care in the State of Washington: Dental Service Utilization and Expenditures

Abstract

Objectives: This study describes dental utilization, expenditures and use of dental services among children in Washington State foster care. Methods: Washington State enrollment and claims data were used to identify children ages 0 months through 17 years who were enrolled in the foster care program for 11 months or more during 2008 (N=10,589). The overall dental utilization rate and for groups of services (diagnostic, preventive, routine restorative, complex/surgical, orthodontic) were calculated as the proportion of children who had any dental claim or for that service grouping. Individual total expenditures and by service grouping were calculated among children with at least one claim. Using Patrick et al.'s model of oral health disparities as a framework, measures were analyzed under three domains: individual (sex, race/ethnicity, age group, disability status, child history of substance abuse, child history of behavior problems); interpersonal (placement type); and community (placement urbanicity). Bivariate analysis was used to assess differences in utilization or expenditures across each measure. Results: Among the study population, 44% of children had at least one dental claim. By service grouping, the proportion of children with at least one claim was: diagnostic 41%; preventive 41%; routine restorative 12%; complex/surgical 14%; and orthodontic <1%. Utilization differed significantly by all measures except sex and a child's history of substance abuse. The mean individual dental expenditure was $287 (2008 dollars) and differed significantly by age group, race/ethnicity and behavior problems. Conclusions: The majority of children in this study did not receive an EPSDT dental service, to which they were entitled. Children in this study were more likely to receive a complex or surgical than a routine restorative service, and less than 1% of children had an orthodontic claim suggesting restorative and orthodontic services are underutilized, and delivery of care may be episodic. Children's individual measures were directly associated with their receipt of care, and several suggest a child's connectedness to the health system influences their access to dental services. Overall, these findings strongly suggest that unmet dental need exists among children in foster care, and that disparities in receipt of dental services exist among subpopulations of children in foster care.