Department of Economics, Lehigh University, National Bureau of Economic Research, Cambridge, Massachusetts.
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland.
Health Econ. 2019 Sep;28(9):1151-1158. doi: 10.1002/hec.3921. Epub 2019 Jul 2.
Many older Americans have poor access to dental care, resulting in a high prevalence of oral health problems. Because traditional Medicare does not include dental care benefits, only older Americans who are employed, have post-retirement dental benefits or spousal coverage, or enroll in certain Medicare Advantage plans are able to obtain dental care coverage. We seek to determine the extent to which poor access to dental insurance and high out-of-pocket costs affect dental service use by the elderly. Using the 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices, we estimate a demand system for preventive dental services and basic and major restorative services. Selection into dental and medical insurance is addressed using a correlated random effects panel data specification. Consistent with prior studies of the nonelderly population, dental service use was not sensitive to out-of-pocket prices. However, private dental insurance increased preventive service use by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%, respectively. The use of services was more responsive to dental insurance for women than men. These estimates suggest that a Medicare dental benefit could significantly increase dental service use by older Americans.
许多美国老年人难以获得牙科护理,导致口腔健康问题高发。由于传统的医疗保险不包括牙科保健福利,只有在职的、有退休后牙科福利或配偶保险的、或参加某些医疗保险优势计划的老年人才能获得牙科保健覆盖。我们旨在确定获得牙科保险的机会不足和自付费用高对老年人牙科服务使用的影响程度。我们使用 2007-2015 年的医疗支出面板调查和牙科保健价格的补充数据,估计了预防牙科服务和基本及主要修复服务的需求系统。使用相关随机效应面板数据规范来解决牙科和医疗保险的选择问题。与对非老年人人口的先前研究一致,牙科服务的使用对自付价格不敏感。然而,私人牙科保险使预防性服务的使用增加了 25%,而通过医疗补助获得的牙科保险分别使基本和主要服务的使用增加了 23%和 36%。女性对牙科保险的反应比对男性更敏感。这些估计表明,医疗保险中的牙科福利可以显著增加美国老年人的牙科服务使用。