《患者保护与平价医疗法案》对私人医疗保险家属覆盖范围的溢出效应是否广泛共享？：利用医疗支出面板调查数据的分析。
Were Patient Protection and Affordable Care Act spillover gains to private dental coverage for dependents widely shared?: An analysis using Medical Expenditure Panel Survey data.
出版信息
J Am Dent Assoc. 2020 Mar;151(3):182-189. doi: 10.1016/j.adaj.2019.11.014.
BACKGROUND
The dependent coverage mandate policy of the Patient Protection and Affordable Care Act led to spillover increases in private dental coverage among affected young adults. The authors investigate whether such gains were widely shared across racial or ethnic groups and shared across income levels. The authors further explore the relationship between dental coverage and dental services use stratified by race or ethnicity and income using the mandate as a natural experiment.
METHODS
Using nationally representative Medical Expenditure Panel Survey data from 2006 through 2015, the authors used a difference-in-difference regression approach comparing changes in private dental coverage and dental services use for 19- through 25-year-olds affected by the policy with those for unaffected 27- through 30-year-olds. The authors stratified the model by race or ethnicity and income to understand potential differences in the effects of the mandate across these groups.
RESULTS
The authors found significant increases in private dental coverage across all racial or ethnic groups as well as across higher- and lower-income young adults. However, despite notable increases in private dental coverage, the authors found little evidence of any overall effects on dental services use. The authors did find evidence suggesting an increased relative likelihood of dental visits for 19- through 25-year-old non-Hispanic blacks compared with slightly older non-Hispanic blacks.
CONCLUSIONS
The spillover effect of the dependent coverage mandate on private dental coverage was widely shared across racial or ethnic groups and across income levels.
PRACTICAL IMPLICATIONS
Among young adults aged 19 through 25 years, increases in private dental coverage may not be enough on its own to increase the use of preventive dental services and ultimately lead to improved oral health.
背景
《患者保护与平价医疗法案》的从属保险覆盖政策导致受影响的年轻成年人的私人牙科保险覆盖范围溢出增加。作者研究了这些收益是否在不同种族或族裔群体中广泛共享，以及是否在不同收入水平上共享。作者进一步探讨了在考虑到该政策作为自然实验的情况下，按种族或族裔和收入分层的牙科保险覆盖范围和牙科服务使用之间的关系。
方法
利用 2006 年至 2015 年具有全国代表性的医疗支出面板调查数据，作者采用差分法回归方法，比较受政策影响的 19 岁至 25 岁年轻人与不受影响的 27 岁至 30 岁年轻人的私人牙科保险覆盖范围和牙科服务使用变化。作者根据种族或族裔和收入对模型进行分层，以了解该政策对这些群体的影响可能存在的差异。
结果
作者发现，所有种族或族裔群体以及高收入和低收入的年轻成年人的私人牙科保险覆盖范围都有显著增加。然而，尽管私人牙科保险覆盖范围显著增加，但作者几乎没有发现对牙科服务使用有任何总体影响的证据。作者确实发现了一些证据表明，与年龄稍大的非西班牙裔黑人相比，19 岁至 25 岁的非西班牙裔黑人看牙医的相对可能性增加。
结论
从属保险覆盖政策的溢出效应在不同种族或族裔群体以及不同收入水平上广泛共享。
实际意义
在 19 岁至 25 岁的年轻人中，私人牙科保险覆盖范围的增加本身可能不足以增加预防性牙科服务的使用，并最终导致口腔健康状况的改善。
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