Association of payment method on orthodontic treatment completion and duration
Creators: name: Wood, Clara
Publisher: name: University of Iowa
Year: 2024

description: Background: There is a large disparity between adolescent orthodontic treatment need and orthodontic utilization in Iowa for patients with state-insurance. This is due, in-part, to low participation in public insurance amongst orthodontists. Reasons cited for why orthodontists choose not to participate in public insurance include low reimbursement rates, administrative burden of enrolling in the program, and poor compliance of public insurance patients. This cross-sectional study aimed to compare orthodontic treatment completion and treatment duration rates of adolescent patients with Medicaid to those with private insurance and self-payment. Materials and Methods: The data sourced was electronic health records collected via a chart audit of AXIUM dental records. The study sample included patients ages 8 -18 years who began comprehensive orthodontic treatment at the University of Iowa Orthodontic Residency Clinic between July 2009 and June 2019. The main independent variable was payment type (private insurance, self-pay, and public insurance). The dependent variables were comprehensive orthodontic treatment completion (Y/N) as well as duration of orthodontic treatment in months. Covariates included patient compliance, initial malocclusion severity, final malocclusion severity, distance travelled to the University dental clinic, and urbanicity. Bivariate and multivariable analyses were performed, and subgroup analyses were conducted for patients with each of the three payer types.
description: Results: 80% of patients included in this study completed orthodontic treatment, and the average treatment length was 23.4 months. In the final models, patients who failed three or more appointments were 50% less likely to complete treatment than those who did not fail any appointments. Patients who late-cancelled three or more appointments were 75% less likely to complete treatment than those who did not late-cancel any appointments. Patients with good oral hygiene were 8.6 times more likely to complete treatment than those with poor hygiene. Patients with a class I malocclusion were the most likely to complete treatment and have the shortest duration of treatment. Patients with more failed appointments, late-cancelled appointments, and a higher initial malocclusion had longer treatment duration. Payment method was not significantly related to either treatment completion or treatment duration. Patients with public insurance did fail more appointments and have worse oral hygiene than their privately insured and self-pay counterparts. Patients with public insurance had the most severe initial malocclusions of the payment groups as well as less acceptable treatment outcomes . However, all payment groups saw significant reduction in severity of malocclusion after completion of orthodontic treatment.
description: Conclusions: In this study, patient compliance, i.e. keeping appointments and oral hygiene, was associated with rate of completion of comprehensive orthodontic treatment but not length of treatment. Initial malocclusion severity was not associated with treatment completion rates but was associated with length of treatment. Distance travelled and urbanicity were not associated with treatment completion rates, but urbanicity was associated with length of treatment.