Predicting dentists decisions: a choice-based conjoint analysis of Medicaid participation
Date
2015-11-17
Authors
Kateeb, Elham T.
McKernan, Susan C.
Gaeth, Gary J.
Kuthy, Raymond A.
Adrianse, Nancy B.
Damiano, Peter C.
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley Online Library
Abstract
Objectives: Private practice dentists are the major source of care for the dental
safety net; however, the proportion of dentists who participate in state Medicaid
programs is low, often due to poor perceptions of the program’s administration
and patient population. Using a discrete choice experiment and a series of
hypothetical scenarios, this study evaluated trade-offs dentists make when deciding
to accept Medicaid patients.
Methods: An online choice-based conjoint survey was sent to 272 general dentists
in Iowa. Hypothetical scenarios presented factors at systematically varied levels.
The primary determination was whether dentists would accept a new Medicaid
patient in each scenario. Using an ecological model of behavior, determining
factors were selected from the categories of policy, administration, community, and
patient population to estimate dentists’ relative preferences.
Results: 62 percent of general dentists responded to the survey. The probability of
accepting a new Medicaid patient was highest (81 percent) when reimbursement
rates were 85 percent of the dentist’s fees, patients never missed appointments,
claims were approved on first submission, and no other practices in the area
accepted Medicaid. Although dentists preferred higher reimbursement rates, 56
percent would still accept a new Medicaid patient when reimbursement decreased
to 55 percent if they were told that the patient would never miss appointments and
claims would be approved on initial submission.
Conclusions: This study revealed trade-offs that dentists make when deciding to
participate in Medicaid. Findings indicate that states can potentially improve
Medicaid participation without changing reimbursement rates by making
improvements in claims processing and care coordination to reduce missed
appointments.
Description
Keywords
dental care , access to care , conjoint analysis , discrete choice experiment , Medicaid