A Comparison of Compliance in Medicaid versus Non-Medicaid Orthodontic Patients

Hypothesis: There is no difference in patient compliance regarding appointment keeping behavior, broken appliances, wearing orthodontic auxiliaries, or oral hygiene maintenance in the Medicaid and non-Medicaid orthodontic populations studied. Objective: To determine if perceived problems with the orthodontic Medicaid population are justified by examining whether patients whose orthodontic treatment is covered by Medicaid have more late and failed appointments, more broken appliances and are less compliant with orthodontic auxiliaries wear and oral hygiene maintenance than patients who are paying for orthodontic services themselves. Methods: A retrospective chart review was conducted at two sites: 1) Wicker Park Orthodontics – a private orthodontic practice in Chicago and 2) the University of Illinois at Chicago Orthodontic Clinic. Charts of 30 Medicaid and 30 non-Medicaid patients were reviewed at each site. From each chart, the following information was recorded: mean percentage of failed and late appointments, number of broken appliances, auxiliary wear, and oral hygiene maintenance. Student t-tests and Chi-square tests were performed to determine if there were any statistically significant differences in the aforementioned categories between the Medicaid and non-Medicaid orthodontic patients. Results: The student t-tests showed no statistically significant differences between the two groups with regards to the mean percentage of late and failed appointments (p = 0.107, p = 0.393). Cross-tabulation and Chi-square results also showed no statically significant differences between the two groups with regards to the number of broken appliances, auxiliary wear, and oral hygiene (p = 0.075-0.600). Conclusions: The results of this study indicate there is a lack of evidence behind orthodontists’ perceptions that Medicaid orthodontic patients are less compliant than non-Medicaid orthodontic patients. While there are still some difficulties in treating Medicaid patients, such as low fee reimbursement and cumbersome paperwork, the current study will hopefully alleviate some of the doubts practitioners may have regarding this population’s compliance making them more open to participating in the Medicaid program to help reduce the access to care issue faced by these patients.