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《平价医疗法案》受抚养人保险强制规定对牙科治疗和预防服务使用情况的影响

The Impact of the Affordable Care Act's Dependent Coverage Mandate on Use of Dental Treatments and Preventive Services.

作者信息

Shane Dan M, Wehby George L

机构信息

Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA.

出版信息

Med Care. 2017 Sep;55(9):841-847. doi: 10.1097/MLR.0000000000000775.

Abstract

BACKGROUND

Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate.

OBJECTIVES

To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults.

DATA

2006-2013 Medical Expenditure Panel Surveys.

STUDY DESIGN

We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women.

CONCLUSIONS

Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.

摘要

背景

口腔健康问题是儿童和年轻人中最主要的慢性病。缺乏牙科保险被认为是获得治疗的一个重要障碍,但关于私人牙科保险对牙科服务使用的因果效应的实证证据很少。我们通过分析一项因《平价医疗法案》(ACA)相关保险授权导致私人牙科保险增加的自然实验,来探讨牙科保险与牙科服务利用之间的关系。

目的

评估因ACA相关保险授权的溢出效应导致的私人牙科保险增加是否影响了一组受影响的年轻成年人的牙科服务利用情况。

数据

2006 - 2013年医疗支出面板调查。

研究设计

我们采用了双重差分回归方法,将受该政策影响的25岁人群与未受影响的27岁人群的牙科护理利用变化进行比较。我们评估对牙科治疗和预防服务的影响。

结果

与27岁人群相比,在授权后的3年里,25岁人群拥有私人牙科保险的可能性高出8个百分点。我们没有找到令人信服的证据表明年轻人因获得保险而增加了预防性牙科服务的使用。我们确实发现,在授权后,25岁人群接受牙科治疗的可能性增加了近5个百分点,这种影响似乎集中在女性中。

结论

因ACA相关保险授权导致的私人牙科保险增加似乎并没有推动总体预防性牙科服务利用的显著变化,但有证据表明修复性护理有所增加。

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本文引用的文献

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Continued Gains in Health Insurance but Few Signs of Increased Utilization: An Update on the ACA's Dependent Coverage Mandate.
Med Care Res Rev. 2016 Aug;73(4):478-92. doi: 10.1177/1077558715617066. Epub 2015 Nov 27.
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Spillover Effects of the Affordable Care Act? Exploring the Impact on Young Adult Dental Insurance Coverage.
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