Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Health Serv Res. 2020 Oct;55(5):642-650. doi: 10.1111/1475-6773.13324. Epub 2020 Jul 22.
To examine whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid.
Medical Expenditure Panel Survey (2011-2016), Area Health Resources File, and Medicaid adult dental coverage policies.
We conducted a quasi-experimental analysis using linked parent-child dyads in low-income families (≤125 percent of the Federal Poverty Level). We assessed whether expansions of Medicaid to low-income adults under the Affordable Care Act were associated with increases in the use of preventive dental services among low-income children when state Medicaid programs did vs did not cover these services for adults.
Over the study period, 37.8 percent of low-income children received at least one annual preventive dental visit. We found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered (1.26 percentage points; 95% CI: -3.74 to 6.27) vs did not cover preventive dental services for adults (3.03 percentage points; 95% CI: -2.76 to 8.81). (differential change: -1.76 percentage points; 95% CI: -8.09, 4.56). However, our estimates are imprecise, with wide confidential intervals that are unable to rule out sizable effects in either direction.
We did not find an association between Medicaid expansions with concurrent coverage of preventive dental services for adults and children's use of these services. Factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.
考察低收入儿童是否使用预防性牙科服务与影响父母在医疗补助计划中获得牙科护理的州医疗补助政策变化有关。
医疗支出面板调查（2011-2016 年）、区域卫生资源文件和医疗补助成人牙科保险政策。
我们使用低收入家庭（≤联邦贫困水平的 125%）中父母-子女对进行了准实验分析。我们评估了平价医疗法案下对低收入成年人扩大医疗补助是否与州医疗补助计划覆盖（1.26 个百分点；95%置信区间：-3.74 至 6.27）与不覆盖成年人预防性牙科服务（3.03 个百分点；95%置信区间：-2.76 至 8.81）的情况下，低收入儿童接受预防性牙科服务的增加有关。
在研究期间，37.8%的低收入儿童接受了至少一次年度预防性牙科就诊。我们没有发现与覆盖（-1.76 个百分点；95%置信区间：-8.09，4.56）或不覆盖（3.03 个百分点；95%置信区间：-2.76，8.81）成人预防性牙科服务的州扩大医疗补助与儿童接受预防性牙科护理之间的变化相关。（差异变化：-1.76 个百分点；95%置信区间：-8.09，4.56）。然而，我们的估计结果不够精确，置信区间较宽，无法排除任何方向上的显著影响。
我们没有发现与扩大医疗补助计划同时覆盖成人和儿童预防性牙科服务与儿童使用这些服务之间的关联。除了通过医疗补助获得牙科福利外，其他因素可能是低收入儿童预防性牙科护理使用的更重要决定因素。
