IADR Abstract Archives
Comparing Costs for Pediatric Dental Surgeries Across Settings of Care
Objectives: The expansion of ambulatory surgical centers (ASCs) offers opportunities for reducing costs and expanding access to pediatric dental surgeries. We compared total costs, patient payments, and insurer payments for pediatric dental surgeries occurring in ASCs and hospital outpatient departments (HOPDs).
Methods: This study used a 2018-2019 national sample of commercial claims for pediatric surgeries having a primary diagnosis of dental caries and occurring in either an ASC or HOPD. To address concerns that results may be driven by the fact that ASCs typically treat healthier patients, we exploited a source of exogeneous variation influencing the supply of ASCs. Specifically, we used an instrumental variables (IV) estimation approach using state-level certificate of need (CON) laws regulating ASCs. In states with these laws, new ASCs cannot enter the market and existing ASCs cannot increase capacity without demonstrating that a market’s existing availability of facilities is insufficient. We estimated the IV model using a control function-based two-stage residual inclusion (2SRI) because the dependent variable in the first-stage model was a dichotomous indicator of the surgery occurring in an ASC (vs. HOPD). We implemented a logit-regression at the first stage and a generalized linear model (GLM) at the second stage with log-form link function.
Results: We examined 6,003 surgeries occurring in 50 states, of which 18% occurred in ASCs. Receiving care in an ASC rather than an HOPD reduced total costs by $4,852 (P<0.001). Both patients and insurance firms spent significantly less on care delivered in ASCs. Compared with those who went to HOPDs, patients who went to ASCs paid $467 less out of pocket (P<0.001). Insurers paid $3,857 less for surgeries performed at ASCs than at HOPDs (P<0.001).
Conclusions: Using ASCs for pediatric dental surgeries could significantly reduce costs for both patients and insurers. Additional research should examine impacts on quality and among non-commercially insured populations.
Methods: This study used a 2018-2019 national sample of commercial claims for pediatric surgeries having a primary diagnosis of dental caries and occurring in either an ASC or HOPD. To address concerns that results may be driven by the fact that ASCs typically treat healthier patients, we exploited a source of exogeneous variation influencing the supply of ASCs. Specifically, we used an instrumental variables (IV) estimation approach using state-level certificate of need (CON) laws regulating ASCs. In states with these laws, new ASCs cannot enter the market and existing ASCs cannot increase capacity without demonstrating that a market’s existing availability of facilities is insufficient. We estimated the IV model using a control function-based two-stage residual inclusion (2SRI) because the dependent variable in the first-stage model was a dichotomous indicator of the surgery occurring in an ASC (vs. HOPD). We implemented a logit-regression at the first stage and a generalized linear model (GLM) at the second stage with log-form link function.
Results: We examined 6,003 surgeries occurring in 50 states, of which 18% occurred in ASCs. Receiving care in an ASC rather than an HOPD reduced total costs by $4,852 (P<0.001). Both patients and insurance firms spent significantly less on care delivered in ASCs. Compared with those who went to HOPDs, patients who went to ASCs paid $467 less out of pocket (P<0.001). Insurers paid $3,857 less for surgeries performed at ASCs than at HOPDs (P<0.001).
Conclusions: Using ASCs for pediatric dental surgeries could significantly reduce costs for both patients and insurers. Additional research should examine impacts on quality and among non-commercially insured populations.