Role of State Medicaid Policies in Improving Access to Dental Care among Low-Income Adults

国家医疗补助政策在改善低收入成年人获得牙科保健机会方面的作用

基本信息

批准号：
10851307
负责人：
Astha Singhal
金额：
$ 6.05万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10851307
关键词：
Role State Medicaid Policies Improving

项目摘要

PROJECT SUMMARY The purpose of this study is to examine how access to dental care among low-income adults is impacted by state Medicaid policies regarding eligibility, dental coverage, cost-sharing and dentist reimbursement. Oral health is integral to overall health, economic productivity and well-being. Yet access to dental care continues to be a major public health problem for low-income adults, leading to untreated disease, pain, poor systemic health and substantial economic burden. In recent years, several policy changes under the Affordable Care Act (ACA) such as Medicaid expansion and dependent care coverage could significantly impact access to dental care among the poor non-elderly adults. In addition, there is extensive cross-state variation in terms of dental benefits covered for Medicaid adults. These variations provide natural experiments to examine the effect of Medicaid policies on access to dental care. Moreover, under the current health reform discussions, state Medicaid programs are anticipated to gain autonomy in resource allocation, yet may receive significantly less federal funding, making the need for robust evidence on relative effectiveness of Medicaid policy alternatives available to the states paramount. The overarching goal of this application is to advance the research career of the candidate (Dr. Singhal) by protecting her time for training and research on these critical issues in oral health policy. This goal will be accomplished through additional training in complementary disciplines of econometrics and machine learning, and their application to estimate the impacts of Medicaid coverage and payment generosities on access to dental care. The project brings together complementary secondary data from multiple sources including: large national survey data (National Health Interview Survey), administrative enrollment and claims data (Medicaid Analytic eXtract) and linked survey and claims data. Leveraging these data and training resources, this project will: 1) develop synthetic indices of Medicaid dental coverage and payment generosities; 2) estimate the effect of each policy alternative and combined generosity indices on various measures of access to dental care; and 3) predict the relative effectiveness of policy alternatives and their combinations on access to dental care. We will use econometric methods including instrumental variables, difference-in-difference and regression discontinuity models to develop the generosity indices and to estimate the impact of Medicaid generosity. To develop and validate the predictive model, we will use supervised machine learning approaches (e.g. decision tree learning) using linked survey and claims data. The results will provide evidence needed to inform future strategies to ensure efficient use of health care resources to reduce oral health disparities. The completion of this project will also enable Dr. Singhal to establish a research program as an independent research investigator with support from her multi-disciplinary mentoring and advising teams and the vibrant research community at The University of Florida.

项目摘要这项研究的目的是研究低收入成年人的牙科护理如何受到有关资格，牙科覆盖，成本分担和牙医报销的国家医疗补助政策。口服健康是整体健康，经济生产力和福祉不可或缺的一部分。然而，继续使用牙科护理成为低收入成年人的主要公共卫生问题，导致未经治疗的疾病，疼痛，全身性差健康和实质性的经济负担。近年来，《平价医疗法案》中的几项政策变更（ACA）例如医疗补助扩张和依赖护理覆盖范围可能会极大地影响对牙齿的使用在贫穷的非老年人中照顾。另外，牙齿有很大的跨州差异医疗补助成年人涵盖的好处。这些变化提供了自然实验，以检查有关获得牙科护理的医疗补助政策。此外，根据当前的卫生改革讨论，国家预计医疗补助计划将获得资源分配的自主权，但可能会少得多联邦资金，需要关于医疗补助政策替代方案相对有效性的有力证据可用于状态最重要的。该应用程序的总体目标是推进研究职业候选人（Singhal博士）通过保护她在口头上进行这些关键问题的培训和研究的时间。卫生政策。这个目标将通过在补充学科的额外培训中实现计量经济学和机器学习及其用于估计医疗补助覆盖范围的影响的应用获得牙科护理的付款代属性。该项目汇集了互补的辅助数据来自多个来源，包括：大型国家调查数据（国家健康访谈调查），行政注册和索赔数据（医疗补助分析提取物）以及链接的调查和索赔数据。利用这些数据和培训资源，该项目将：1）开发医疗补助牙科覆盖范围的合成指标付款代理； 2）估算每个政策替代方案的影响和慷慨指数对各种获得牙科护理的措施； 3）预测政策替代方案的相对有效性和他们结合使用牙科护理。我们将使用计量经济学方法在内变量，差异差异和回归不连续性模型，以开发慷慨指数和到估计医疗补助慷慨的影响。为了开发和验证预测模型，我们将使用使用链接的调查和索赔数据，监督机器学习方法（例如决策树学习）。这结果将提供所需的证据，以告知未来的策略，以确保有效利用医疗保健资源减少口腔健康差异。该项目的完成还将使Singhal博士建立一个在她的多学科指导的支持下，作为独立研究研究者的研究计划并为佛罗里达大学的团队和充满活力的研究社区提供建议。