Health Reform and Oral Health Disparities: a Mixed Methods Evaluation

医疗改革和口腔健康差异：混合方法评估

• 批准号: 10405417
• 负责人: Hawazin W Elani
• 金额: $ 24.84万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-12 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10405417
• 关键词: Address; Adult; Affordable Care Act; Attitude; Award; Awareness; Behavior; Congresses; Data; Data Collection; Data Set; Dental; Dental Care; Dental Insurance; Dental Schools; Dentists; Development; Disabled Persons; District of Columbia; Elements; Environment; Evaluation; Future; Goals; Health Care Reform; Health Insurance; Health Policy; Health Services; Health behavior; Healthcare; Immigrant; Improve Access; Individual; Inequality; Insurance; Insurance Coverage; Intervention; Interview; Investments; K-Series Research Career Programs; Knowledge; Language; Light; Low income; Maintenance; Measures; Medicaid; Medicine; Mentors; Methods; Minority; National Institute on Minority Health and Health Disparities; Natural experiment; Oral health; Patients; Perception; Phase; Policies; Policy Developments; Population; Provider; Public Health; Public Health Schools; Qualitative Methods; Quasi-experiment; Race; Research; Research Design; Research Methodology; Research Personnel; Single Parent; Source; Structure; Surveys; System; Time; Tooth Diseases; Training; United States; Variant; Visit; Vulnerable Populations; beneficiary; cost; disparity reduction; econometrics; ethnic minority; experience; health disparity; health economics; health inequalities; health service use; implementation barriers; improved; insight; programs; racial and ethnic; racial and ethnic disparities; racial minority; skills; social stigma; socioeconomic disparity; socioeconomics

Project Summary/Abstract Despite numerous efforts to increase access to dental care for vulnerable groups, disparities in oral health and healthcare continue to exist. Medicaid is now the nation's largest source of health insurance coverage, and since it primarily offers insurance to low-income and disabled individuals, Medicaid is a key policy lever for addressing socioeconomic disparities in health care. The Affordable Care Act (ACA) expanded Medicaid to millions of previously ineligible adults, but only 31 states and Washington DC, have chosen to participate thus far. The goal of this proposal is to leverage the natural experiment created by ACA implementation and take advantage of state-level variation in the extent of dental care covered by Medicaid in order to assess the impact of these policies to date on oral health inequalities. As Congress continues to consider major changes to Medicaid and the ACA, the results of our analysis can offer important insights for the future of oral health inequalities. We propose a mixed-methods study, combining a quantitative component using a quasi-experimental study design and national public datasets, and a qualitative element using primary data collection to assess the impact of the ACA Medicaid expansion on oral health. This project includes four studies; during the K99 phase we propose to address the following aims: 1) To estimate the effect of Medicaid expansion under the ACA on access to and utilization of oral health services; and 2) To measure the impact of Medicaid expansion on individuals' oral health- related behaviors and race/ethnic and socioeconomic inequalities in untreated dental disease. We will then address the R00 phase through the following aims: 3) To better understand dental providers' perceptions of, attitudes toward, and experiences with Medicaid expansion and to explore ACA implementation challenges; and 4) To identify barriers to and facilitators of accessing oral health care after ACA expansion among Medicaid beneficiaries. By triangulating the views from both Medicaid providers and beneficiaries, we believe our approach will provide a more comprehensive understanding of the barriers and facilitators to ACA implementation. Findings from this study will enhance our understanding of barriers to access to oral health care that could inform future policies and interventions. Furthermore, it will aid in assessing national progress towards reducing socioeconomic and racial/ethnic disparities in access to oral health services and explore mechanisms by which health policy could impact disparities in oral health. This career development award will provide me with protected research time and thus the opportunity to expand my research skills and knowledge. I will pursue further training in health policy, econometrics and mixed-methods research through didactic courses and formal advising from my mentors, who are experts in public health, health policy, health economics, health disparities, and qualitative methods. The setting of this award is at Harvard School of Dental Medicine and Harvard School of Public Health. This rich research environment will support my development as an independent researcher.

项目摘要/摘要 尽管为增加弱势群体的牙科护理的努力，口腔健康方面的差异以及 医疗保健继续存在。医疗补助现在是美国最大的健康保险范围来源，此后 它主要为低收入和残疾人提供保险，医疗补助是解决问题的关键政策杠杆 医疗保健中的社会经济差异。 《平价医疗法案》（ACA）将医疗补助扩展到数百万 迄今为止，以前不合格的成年人，但只有31个州和华盛顿特区参加了参加。目标 该建议的是利用ACA实施创建的自然实验，并利用 医疗补助涵盖的牙科护理范围的州级差异，以评估这些影响的影响 迄今为止口腔健康不平等的政策。随着国会继续考虑医疗补助和 ACA，我们的分析结果可以为口腔健康不平等的未来提供重要的见解。我们 提出了一项混合方法研究，使用准实验研究设计结合了定量成分 和国家公共数据集，以及使用主要数据收集的定性元素来评估 ACA医疗补助扩展口腔健康。该项目包括四项研究；在K99阶段，我们建议 解决以下目的：1）估计ACA下医疗补助扩展对进入和的影响 利用口腔卫生服务； 2）衡量医疗补助扩张对个人口腔健康的影响 - 未经治疗的牙科疾病中的相关行为以及种族/种族和社会经济不平等。然后我们会 通过以下目的解决R00阶段：3）更好地了解牙科提供者对， 对医疗补助扩张的态度和经验，并探索ACA实施挑战；和 4）确定ACA扩张后医疗补助后获得口腔保健的障碍和促进者 受益人。通过从医疗补助提供者和受益人的三角观点，我们相信我们的方法 将对ACA实施的障碍和促进者提供更全面的了解。发现 从这项研究中将增强我们对获得口腔卫生保健障碍的理解，这可能会为未来提供信息 政策和干预措施。此外，它将有助于评估国家的进步 获得口腔卫生服务的社会经济和种族/种族差异，并探索机制 卫生政策可能会影响口腔健康的差异。这个职业发展奖将为我提供受保护的 研究时间，因此有机会扩大我的研究技能和知识。我将进行进一步的培训 在卫生政策，计量经济学和混合方法研究中，通过教学课程和正式建议 我的导师是公共卫生，健康政策，健康经济学，健康差异和定性的专家 方法。该奖项的设定是在哈佛大学牙科医学学院和哈佛公共卫生学院的。 这个丰富的研究环境将支持我作为独立研究人员的发展。