Department of Health Management and Policy.
Department of Economics.
Med Care. 2020 Aug;58(8):749-755. doi: 10.1097/MLR.0000000000001344.
Low-income adults in the United States have historically had poor access to dental services largely due to limited dental coverage.
We examined the effects of recent Medicaid income-eligibility expansions under the Affordable Care Act on dental visits separately for preventive care and treatments.
We used restricted data from the 2011 to 2016 Medical Expenditure Panel Survey with state geocodes. The main analytical sample included nearly 21,000 individuals who were newly eligible for Medicaid. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions effective in 2014 on dental services use by the level of state Medicaid dental benefit for the newly eligible.
Expanding Medicaid in 2014 with extensive or limited dental coverage increased preventive dental visits and use of major dental treatments by over 5 percentage-points in 2014 and 2015. The increase in preventive visits continued in 2016 in expanding states with extensive coverage, while increase in major dental treatments continued in 2016 in expanding states with limited coverage. There is some but less consistent evidence of an increase in dental treatment with emergency-only coverage.
Medicaid expansions with dental coverage beyond emergency-only services have increased access of the newly eligible low-income adults to dental treatments and preventive services, with extensive coverage showing continuing increase in preventive services use 3 years after the expansion. With limited coverage, there is some evidence of individuals needing to stretch treatments over a longer period. Providing comprehensive dental coverage can address unmet dental needs and improve oral health among low-income adults.
由于牙科保险覆盖范围有限，美国的低收入成年人在历史上一直难以获得牙科服务。
我们研究了《平价医疗法案》下最近的医疗补助收入资格扩大对牙科预防保健和治疗服务的影响。
我们使用了 2011 年至 2016 年医疗支出面板调查的受限数据，并带有州地理编码。主要分析样本包括近 21000 名新符合医疗补助条件的人。我们采用准实验差分法来确定 2014 年生效的州医疗补助扩张对新符合条件者的州医疗补助牙科福利水平对牙科服务使用的影响。
2014 年扩大医疗补助，无论是广泛的还是有限的牙科保险覆盖范围，都使预防牙科就诊和主要牙科治疗的次数在 2014 年和 2015 年增加了 5 个百分点以上。在有广泛覆盖的扩张州，预防就诊的增加在 2016 年仍在继续，而在有有限覆盖的扩张州，主要牙科治疗的增加仍在 2016 年继续。有一些但不太一致的证据表明，有紧急保险覆盖的牙科治疗有所增加。
除了紧急保险服务之外，扩大医疗补助的牙科保险覆盖范围增加了新符合条件的低收入成年人获得牙科治疗和预防服务的机会，在扩大范围后的 3 年内，广泛覆盖范围显示出预防服务使用的持续增加。在有限覆盖的情况下，有证据表明，一些人需要将治疗延长更长的时间。提供全面的牙科保险可以满足低收入成年人未满足的牙科需求，改善他们的口腔健康。
