The effect of North Carolina hospital payor mix on dental-related pediatric emergency room utilization

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We examined the effect of hospital payor mix on the proportion of pediatric emergency department (ED) visits that were dental related.


We used the North Carolina (NC) Emergency Room Discharge Database from 2007 to 2009 to estimate the relationship between the percent of pediatric ED patients that were covered by Medicaid and the percent of pediatric ED visits that were dental related. Hospital-level fixed effects controlled for unobserved hospital-level characteristics. Discharge claims from 110 ED facilities in NC were analyzed over the 3-year study period. Claims were limited to individuals under 18 years old with dental disease-related International Classification of Diseases, Ninth Edition, Clinical Modification diagnostic codes, 520.00-530.00.


Using 327 hospital-years of data, 62 percent of ED visits for pediatric dental reasons were covered by Medicaid, a proportion over two times greater than for pediatric reasons overall, 26 percent. Hospitals with a greater proportion of Medicaid payors had a greater proportion of pediatric dental ED visits (P < 0.01).


Hospitals serving a large population of children on Medicaid should be prepared to provide emergency dental services. Public health administrators should prioritize oral health resources at hospital communities with a high proportion of Medicaid payors.

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