Longitudinal Examination of Changes in Medicaid Adult Dental Coverage and Spillover Effects on Children

医疗补助成人牙科覆盖范围的变化和对儿童的溢出效应的纵向研究

• 批准号: 10592152
• 负责人: Julie Reynolds
• 金额: $ 15.44万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592152
• 关键词: Accident and Emergency department; Adult; Age; Awareness; Behavior; Caring; Child; Data; Dental; Dental Care; Dental Care for Children; Dental Health Services; Dental Offices; Development; Disparity; Emergency Situation; Emergency department visit; Enrollment; Future; Goals; Health; Health Services Accessibility; Health Services Research; Improve Access; Insurance; Interruption; Intervention; Knowledge; Low income; Measures; Medicaid; National Institute of Dental and Craniofacial Research; Natural experiment; Oral health; Outcome; Parents; Policies; Preventive; Preventive care; Privatization; Quasi-experiment; Research; Research Design; Resources; Series; Testing; Time; Tooth Diseases; United States; Work; care seeking; care systems; health disparity; improved; lower income families; secondary analysis; sound; trend

Project Summary Despite significant overall progress in improving access to dental care among children in the United States in recent decades, substantial disparities in oral health have persisted among publicly insured children. Although Medicaid provides comprehensive dental coverage for all enrolled children, dental benefits for adults are optional and vary across states and over time. There is evidence that reducing Medicaid adult dental benefits (MADB) lowers access to dental care for low-income adults. However, the impact of changes in MADB on access to dental care for Medicaid-enrolled children is not yet understood. Our long-term goal is to improve access to dental care and oral health outcomes among children in low-income families. To achieve this goal, we will leverage natural experiments in states that changed MADB generosity to examine the spillover effect on dental utilization by Medicaid-enrolled children. We hypothesize that expanding MADB generosity results in increases in both preventive and overall dental utilization and a decline in emergency department visits for dental problems by Medicaid-enrolled children. Using a causal inference approach, we will estimate the longitudinal impact of changes in MADB on children’s dental care utilization through these research aims: Aim 1: Determine the impact of changes in MADB generosity on overall dental utilization by children enrolled in Medicaid using administrative data with a quasi-experimental design. Aim 2: Determine the impact of changes in MADB generosity on preventive dental utilization by children enrolled in Medicaid using administrative data with a quasi-experimental design. Aim 3: Determine the impact of changes in MADB generosity on emergency department (ED) dental utilization by children enrolled in Medicaid using administrative data with a quasi-experimental design. Using administrative data, we will generate monthly estimates of these three measures of utilization and use a causal inference framework to assess the changes in child dental utilization trends before and after the MADB policy changes. We will use interrupted time series approach to account for any secular trends and make robust within state comparisons, and supplement it with a differences in difference approach to provide comparison with control states that did not experience a policy change. Our findings will provide evidence on the spillover effect of MADB generosity on children’s access to dental care. This study will be the first to use administrative data to examine the spillover effect of changing MADB generosity on children’s dental care use. The study aligns with the strategic priorities of NIDCR to understand and work to reduce child oral health disparities.

项目摘要 尽管在改善美国儿童的牙科护理方面的总体进展取得了重大进展 最近几十年，公开保险的儿童中持续存在大量口腔健康分布。虽然 医疗补助为所有注册儿童提供全面的牙科覆盖范围，成人的牙科福利是 可选的，随着时间的流逝而变化。有证据表明医疗补助成人牙科福利 （MADB）降低了低收入成年人的牙科护理。但是，MADB变化对 尚未了解获得医疗补助注册儿童的牙科护理。 我们的长期目标是提高低收入儿童的牙科护理和口腔健康状况 家庭。为了实现这一目标，我们将利用改变MADB慷慨的州的自然实验 检查医疗补助注册儿童对牙齿利用的Spilover效果。我们假设扩大 MADB的慷慨导致预防和整体牙齿利用率增加，并且下降 急诊室访问医疗补助注册儿童的牙齿问题。使用因果推断 方法，我们将估计MADB变化对儿童牙科护理利用的纵向影响 通过这些研究目的： 目标1：确定MADB慷慨的变化对儿童整体牙齿利用的影响 使用具有准实验设计的管理数据参加了医疗补助。 目标2：确定MADB慷慨的变化对儿童预防牙齿利用的影响 使用具有准实验设计的管理数据参加了医疗补助。 AIM 3：确定MADB慷慨对急诊科（ED）牙科的变化的影响 儿童使用使用准实验设计的行政数据招募了医疗补助。 使用管理数据，我们将对这三种利用率的每月估算，并使用 因果推理框架，以评估MADB之前和之后儿童牙科利用率的变化 政策变化。我们将使用中断的时间序列方法来解释任何世俗的趋势并使强大 在州比较中，并以差异方法的差异来补充比较 与没有发生政策变化的控制状态。 我们的发现将提供有关MADB慷慨对儿童进入牙齿的敏感效果的证据 关心。这项研究将是第一个使用行政数据来检查更改MADB的Spilover效果的研究 儿童护理的慷慨使用。该研究与NIDCR的战略优先事项一致 并努力减少儿童口腔健康差异。