Both emergency department and inpatient visits for non-traumatic dental care more than doubled from 14,105 total visits in 2013 to 26,981 visits in 2015 for any insurance type (see Table 1). This is a direct result of Medicaid expansion enrollment, as similar patterns were observed in only Medicaid-enrolled patients with 9,798 total visits in 2013 and 21,758 visits in 2015. Inpatient and emergency department utilization peaked in 2014, both for those with all insurances and Medicaid-only; this finding is consistent with the literature demonstrating similar increases in 2014 with Medicaid expansion, and resulting declines in ED utilization beginning in 2015 (23).
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ED visits for dental-related conditions were evening distributed across the state (Figure 1). Rates of ED visits among Medicaid enrollees are significantly higher in rural counties than non-rural counties (t=2.18, p<0.05). Baker, Crook, Douglas, Jefferson, Sherman, Union, and Wasco counties are all classified as rural and have the seven highest rates of ED visits for dental-related conditions in the state.
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Females access dental care through emergency and inpatient settings more frequently than males across all years (Figure 2). Individuals 20 to 34 represented the highest rate of visits to an emergency department for a dental-related condition for all years. Inpatient admissions remained steady in all age groups, except for those adults over 75, when inpatient admissions for dental-related conditions increased sharply. Patients identifying as black had the highest rate of ED utilization, followed by those identifying as either American Indian or Alaskan Native (Figure 3).
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Medicaid is more likely to pay for an ED or inpatient visit for a dental-related condition than ED or inpatient visits for other reasons. In 2015, 79% of ED visits for any reason (Figure 4). Similarly, 39% of inpatient admissions for dental conditions are paid for by Medicaid, compared to 33% of ED visits for any reason (Figure 5).
The percentage of dental-related ED visits paid by Medicaid increased 12 percent from 67% in 2013 to 79% in 2015; a similar increase was seen for all-reason ED visits from 46% in 2014 to 56% in 2015. At the same time, the share of costs paid by employer-provided commercial plans decreased both for all conditions, and for dental-related visits. Similar patterns were observed for dental-related inpatient admissions. Twenty-three percent of the inpatient admissions were paid for by Medicaid in 2013; this increased to 39% in 2015. This reduction is likely due to increased Medicaid expansion enrollments. Costs for all-reason inpatient admissions remained relatively steady across all insurance types, except for those with Medicare, and dual-eligibles.
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Seventy-six percent of patients made only one visit to an emergency department (Figure 6). The charge for these visits was $13,888,516. Thirteen percent made two or more visits to an ED for a dental-related condition within 365 days for a total charge of $1,367.909. Among the 143% with more than one visit, the majority revisited an ED between 1 and 15 days of the initial, dental-related visit.
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