Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA.
J Dent Res. 2021 Jan;100(1):50-57. doi: 10.1177/0022034520954126. Epub 2020 Aug 28.
Unemployment rates in the United States are rapidly increasing as a result of the COVID-19 pandemic and attendant economic disruption. As employees lose their jobs, many will lose their employer-sponsored dental insurance (ESDI). Changes in insurance coverage are directly related to the oral health of the population, with many at risk of losing access to dental care. We assessed the impact of recent unemployment rates on insurance coverage and dental utilization. We estimated changes in dental insurance coverage at the state level, using previously applied econometric estimates. Expected changes in types of dental procedures performed at dental practices nationwide were assessed using a microsimulation model, using national practice survey data. Changes in emergency department (ED) visits for dental problems were estimated by fitting trendlines to ED visit patterns by payer type. Sensitivity analyses were conducted to assess how variations in unemployment rates and rates of ESDI in response to unemployment could alter the results. Since March 2020, the national unemployment rate has increased by 8.40 percentage points, an increase expected to result in more than 16 million individuals losing ESDI in the United States. Of these individuals, 45.0% are likely to enroll in their state's Medicaid and Children's Health Insurance Program, and 47.0% are expected to become uninsured. With these expected changes in dental insurance coverage, the average dental practice would experience decreases in routine checkup visits but increases in tooth extraction, a procedure that is highly used by publicly insured or uninsured patients. In addition, dental-related ED visits would be expected to grow by 4.0%. Losses of employment caused by the COVID-19 in the United States can have countervailing effects on people's health by impeding access to dental care. Lack of dental insurance is expected to be more pronounced in states that have not expanded Medicaid or do not provide Medicaid dental benefits for adults.
由于 COVID-19 大流行及其带来的经济混乱，美国的失业率正在迅速上升。随着员工失业，许多人将失去雇主赞助的牙科保险（ESDI）。保险覆盖范围的变化与人口的口腔健康直接相关，许多人面临失去获得牙科护理的机会。我们评估了最近失业率对保险覆盖范围和牙科利用率的影响。我们使用先前应用的计量经济学估计值，在州一级估计牙科保险覆盖范围的变化。使用全国性实践调查数据，使用微模拟模型评估全国牙科实践中进行的牙科治疗类型的预期变化。通过拟合按付款人类型划分的 ED 就诊模式的趋势线来估计因牙科问题前往急诊部（ED）就诊的次数变化。进行敏感性分析以评估失业率和对失业的 ESDI 反应率的变化如何改变结果。自 2020 年 3 月以来，全国失业率上升了 8.40 个百分点，预计这将导致美国超过 1600 万人失去 ESDI。在这些人中，45.0%可能会参加所在州的医疗补助和儿童健康保险计划，47.0%预计将失去医疗保险。随着牙科保险覆盖范围的这些预期变化，普通牙科诊所的常规检查就诊量将减少，但拔牙就诊量将增加，这种治疗方法被公共保险或无保险患者广泛使用。此外，预计与牙科相关的 ED 就诊量将增长 4.0%。美国 COVID-19 造成的失业会阻碍人们获得牙科保健，从而对人们的健康产生相反的影响。预计在没有扩大医疗补助或不为成年人提供医疗补助牙科福利的州，牙科保险的损失会更加明显。
