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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要自 Affordable 计划实施以来，估计有 980 万成年人获得了口腔健康保险护理法（ACA）。然而，弱势群体对牙科服务的利用率仍然很低，导致口腔健康差异顽固地持续存在。这些发现表明，存在持续的障碍口腔保健不仅仅是承保范围。根据安徒生医疗保健利用模型，口服医疗保健的利用是由有利因素（例如保险获取）和诱发因素驱动的（例如口腔健康素养）。因此，找出促进口服药物吸收的瓶颈至关重要。医疗保健服务，从而改善少数族裔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服务提供者的可用性是否对人们获得牙科护理构成障碍低收入和少数民族成年人。我们建议进行现场实验来模拟患者的经历获得医疗补助以获取牙科预约。我们的设计考虑了状态变化医疗补助政策和社区特征，从而使我们能够检查潜在的程度结构性因素造成了获得牙科护理机会的差异。我们的具体目标是： 1) 检验根据社区特征的牙科服务提供者的地理空间分布； 2) 识别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和邻里关系）之间的跨级互动特征）以及医疗补助受益人牙科预约的可用性。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测量获得牙科护理的机会，指导各国实施有效的政策，减少口腔健康方面的差异。