Field Experiment to Assess the Impact of Medicaid on Disparities in Dental Care Utilization

评估医疗补助对牙科护理利用差异影响的现场实验

• 批准号: 10526783
• 负责人: Hawazin W Elani
• 金额: $ 46.1万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10526783
• 关键词: Adult; Affordable Care Act; American; Appointment; Characteristics; Child; Clinic; Data Collection; Dental; Dental Care; Dental Clinics; Dental Insurance; Dentists; Disadvantaged; Emergency department visit; Enabling Factors; Face; Goals; Health; Health Insurance; Health Policy; Health Status; Healthcare; Insurance; Insurance Coverage; Low income; Measures; Medicaid; Minority; National Institute on Minority Health and Health Disparities; Neighborhoods; Oral; Oral health; Patients; Policies; Population; Predisposing Factor; Provider; Research; Schedule; Services; Structural Racism; Testing; Time; Travel; Variant; Vulnerable Populations; Wait Time; Work; beneficiary; design; disparity reduction; ethnic minority; experience; experimental study; geographic barrier; health care model; health care service; health care service utilization; health disparity; health literacy; improved; programs; racial minority; segregation; socioeconomic disadvantage; uptake

PROJECT SUMMARY/ABSTRACT An estimated 9.8 million adults have gained oral health insurance since the implementation of the Affordable Care Act (ACA). However, utilization of dental services among disadvantaged groups remains low, resulting in the stubborn persistence of oral health disparities. These findings suggest that there are persistent barriers to oral health care beyond just coverage alone. According to the Andersen model of healthcare utilization, oral healthcare utilization is driven by enabling factors (such as insurance access) as well as predisposing factors (such as oral health literacy). Hence, it is critical to identify the bottlenecks in boosting the uptake of oral healthcare services, thereby improving the oral health status of minority and low-income Americans. Our overall objective is to assess whether the availability of dental providers poses a barrier to accessing dental care among low-income and minority adults. We propose to conduct a field experiment to simulate the experiences of patients with Medicaid coverage in obtaining dental appointments. Our design takes into account state variations in Medicaid policies and neighborhood characteristics, thus enabling us to examine the extent to which underlying structural factors contribute to disparities in access to dental care. Our specific aims are: 1) To examine the geospatial distribution of dental providers according to neighborhood characteristics; 2) To identify the association between Medicaid insurance status and availability of dental appointments; and 3) To assess the cross-level interaction between structural barriers (state Medicaid dental policy and neighborhood characteristics) and availability of dental appointments among Medicaid beneficiaries. Findings from this study, using a robust experimental approach and primary data collection, will provide direct and objective measures of access to dental care to guide states in implementing effective policies to reduce disparities in oral health.

项目总结/摘要 自实施负担得起的医疗保险计划以来，估计有980万成年人获得了口腔健康保险。 护理法（ACA）。然而，弱势群体对牙科服务的利用率仍然很低， 口腔健康差异的顽固存在。这些发现表明，存在持续的障碍， 口腔保健不仅仅是覆盖范围。根据Andersen的医疗保健利用模型， 医疗保健利用率受促成因素（如保险获取）和诱发因素的驱动 (such口腔卫生知识）。因此，关键是要找出促进口服避孕药吸收的瓶颈。 医疗保健服务，从而改善少数民族和低收入美国人的口腔健康状况。我们的整体 目的是评估牙科服务提供者的可用性是否构成获得牙科保健的障碍， 低收入和少数成年人。我们建议进行一项实地实验，以模拟病人的经验， 获得牙科预约的医疗补助。我们的设计考虑了状态变化， 医疗补助政策和邻里特征，从而使我们能够检查在多大程度上， 结构性因素造成了获得牙科保健方面的差距。我们的具体目标是：1）检查 根据社区特征的牙科提供者的地理空间分布; 2）识别 医疗补助保险状态和牙科预约的可用性之间的关联;以及3）评估 结构性障碍（州医疗补助牙科政策和社区）之间的跨层次互动 特征）和医疗补助受益人之间的牙科预约的可用性。这项研究的结果， 使用强大的实验方法和原始数据收集，将提供直接和客观的措施， 提供牙科保健，以指导各国执行有效政策，减少口腔健康方面的差距。