Field Experiment to Assess the Impact of Medicaid on Disparities in Dental Care Utilization

评估医疗补助对牙科护理利用差异影响的现场实验

• 批准号: 10526783
• 负责人: Hawazin W Elani
• 金额: $ 46.1万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10526783
• 关键词: Adult; Affordable Care Act; American; Appointment; Characteristics; Child; Clinic; Data Collection; Dental; Dental Care; Dental Clinics; Dental Insurance; Dentists; Disadvantaged; Emergency department visit; Enabling Factors; Face; Goals; Health; Health Insurance; Health Policy; Health Status; Healthcare; Insurance; Insurance Coverage; Low income; Measures; Medicaid; Minority; National Institute on Minority Health and Health Disparities; Neighborhoods; Oral; Oral health; Patients; Policies; Population; Predisposing Factor; Provider; Research; Schedule; Services; Structural Racism; Testing; Time; Travel; Variant; Vulnerable Populations; Wait Time; Work; beneficiary; design; disparity reduction; ethnic minority; experience; experimental study; geographic barrier; health care model; health care service; health care service utilization; health disparity; health literacy; improved; programs; racial minority; segregation; socioeconomic disadvantage; uptake

PROJECT SUMMARY/ABSTRACT An estimated 9.8 million adults have gained oral health insurance since the implementation of the Affordable Care Act (ACA). However, utilization of dental services among disadvantaged groups remains low, resulting in the stubborn persistence of oral health disparities. These findings suggest that there are persistent barriers to oral health care beyond just coverage alone. According to the Andersen model of healthcare utilization, oral healthcare utilization is driven by enabling factors (such as insurance access) as well as predisposing factors (such as oral health literacy). Hence, it is critical to identify the bottlenecks in boosting the uptake of oral healthcare services, thereby improving the oral health status of minority and low-income Americans. Our overall objective is to assess whether the availability of dental providers poses a barrier to accessing dental care among low-income and minority adults. We propose to conduct a field experiment to simulate the experiences of patients with Medicaid coverage in obtaining dental appointments. Our design takes into account state variations in Medicaid policies and neighborhood characteristics, thus enabling us to examine the extent to which underlying structural factors contribute to disparities in access to dental care. Our specific aims are: 1) To examine the geospatial distribution of dental providers according to neighborhood characteristics; 2) To identify the association between Medicaid insurance status and availability of dental appointments; and 3) To assess the cross-level interaction between structural barriers (state Medicaid dental policy and neighborhood characteristics) and availability of dental appointments among Medicaid beneficiaries. Findings from this study, using a robust experimental approach and primary data collection, will provide direct and objective measures of access to dental care to guide states in implementing effective policies to reduce disparities in oral health.

项目摘要/摘要 自实施负担得起以来，估计有980万成年人获得了口腔健康保险 护理法（ACA）。但是，处境不利的群体之间牙科服务的利用仍然很低，导致 口腔健康差异的顽固持久性。这些发现表明，存在持续的障碍 口腔卫生保健仅仅是仅仅覆盖。根据Andersen医疗保健利用模型，口服 医疗保健利用是由有利因素（例如保险获得）以及诱发因素驱动的 （例如口腔健康素养）。因此，至关重要的是识别提高口服吸收的瓶颈 医疗保健服务，从而改善了少数民族和低收入美国人的口腔健康状况。我们的整体 目的是评估牙科提供者的可用性是否在获得牙科护理的障碍 低收入和少数民族成年人。我们建议进行现场实验以模拟患者的经历 在获得牙科约会的情况下，医疗补助覆盖范围。我们的设计考虑了状态变化 医疗补助政策和邻里特征，从而使我们能够检查潜在的程度 结构性因素导致获得牙科护理的差异。我们的具体目的是：1）检查 根据邻里特征的牙科提供者的地理空间分布； 2）确定 医疗补助保险状况与牙科预约可用性之间的关联； 3）评估 结构性障碍（州医疗补助牙科政策与邻里）之间的跨层次相互作用 特征）和医疗补助受益人之间牙科任命的可用性。这项研究的结果， 使用强大的实验方法和主要数据收集，将提供直接和客观的度量 获得牙科护理，指导各州实施有效政策以减少口腔健康的差异。