Dental Coverage Transistions, Utilization and Retirement

描述（由申请人提供）：本项目的目标是提供更好地了解老年人牙科保健覆盖范围和牙科使用之间的关系，并随后提供所需的信息，以帮助政策制定者，因为他们考虑将牙科覆盖范围纳入医疗保险，医疗补助计划和医疗补助计划，或作为私营部门退休后覆盖范围的延伸。该项目是一个多学科研究小组的合作努力，将使用密歇根大学社会研究所（ISR）和兰德公司提供的数据进行。 具体而言，该项目将：1。估计年龄在51岁及以上的人的数量和特征，他们在退休后仍然受到牙科保险的保护，退休后仍然没有保险，退休后失去保险，或退休后获得保险。这一具体目标的工作假设是，人们退休后不太可能有牙科保健保险。 2.估计牙科保健使用作为牙科保健覆盖状况和过渡控制个人和家庭特征和逆向选择的函数。这一具体目标的工作假设是，没有牙科保健保险的人不太可能去看牙医。 3a.估计牙科保健自付支出作为牙科保健覆盖面和退休状况和过渡控制个人和家庭特征和逆向选择的函数。这一具体目标的工作假设是，退休和/或没有牙科保险的人看牙医的自付费用较高。 3b.估计牙科保健自付支出的变化，作为牙科保健覆盖面和退休过渡控制个人和家庭特征和逆向选择的函数。这一具体目标的工作假设是，退休和/或没有牙科保险的人去看牙医的自付费用会更高。 4.估计牙科保健使用，覆盖范围和自付费用与净财富状况和过渡之间的关系，控制个人和家庭特征以及逆向选择。工作假设是，较低的水平，减少，净财富与较少的牙科保健利用率和覆盖率，以及较高的自付费用为那些使用牙科保健。 5.根据口腔健康和牙科护理覆盖状况，估计牙科手术类型的牙科护理使用情况，控制个人和家庭特征以及逆向选择。这一特定目标的工作假设是，牙科保险引起定期预防性牙科护理，改善口腔健康，并减少对昂贵的非预防性程序的需要。 6.估计51岁及以上报告牙科保健覆盖率的人数和特征，牙科使用水平低和/或牙科使用者自付支出水平高。这一特定目标的工作假设是，这些群体更有可能期望牙科保险包括在医疗保险中，因此误报有牙科保险。 该项目的成果将有助于决策者制定政府政策，包括拟议扩大医疗保险以包括牙科保险，将牙科保险纳入Medigap计划，将全部成人牙科护理纳入医疗补助，以及扩大退休后继续保险以包括私营部门的牙科保险。 公共卫生相关性：该项目的目标是更好地了解老年人牙科保健覆盖面和牙科使用之间的关系，并随后提供所需信息，以协助决策者考虑将牙科覆盖面纳入医疗保险、医疗补助和医疗补助计划，或作为私营部门退休后覆盖面的延伸。

DESCRIPTION (provided by applicant): The goal of this project is to provide a better understanding of the relationship between dental care coverage and dental use among the elderly and subsequently provide the information needed to assist policy makers as they consider the inclusion of dental coverage under Medicare, Medigap and Medicaid plans or as an extension of post-retirement coverage within the private sector. This project is a collaborative effort of a multidisciplinary research team and will be conducted using data available from the Institute for Social Research (ISR) at the University of Michigan and The RAND Corporation. Specifically this project will: 1. Estimate the number and characteristics of those persons age 51 years and above who stay covered by dental insurance after retirement, stay uninsured after retirement, lose coverage after retirement, or gain coverage after retirement. The working hypothesis for this specific aim is that persons are less likely to have dental care coverage after retirement. 2. Estimate dental care use as a function of dental care coverage status and transitions controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that persons are less likely to have a dental visit without dental care coverage. 3a. Estimate dental care out-of pocket expenditures as a function of dental care coverage and retirement status and transitions controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that persons with a dental visit who are retired and/or without dental coverage will have higher out-of-pocket expenditures. 3b. Estimate changes in dental care out-of-pocket expenditures as a function of dental care coverage and retirement transitions controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that persons with a dental visit who become retired and/or without dental coverage will have higher out-of-pocket expenditures. 4. Estimate the relationships between dental care use, coverage, and out-of-pocket payments and net wealth status and transitions, controlling for individual and household characteristics and adverse selection. The working hypothesis is that lower levels of, and reductions in, net wealth are associated with less dental care utilization and coverage, and higher out-of-pocket payments for those using dental care. 5. Estimate dental care use by dental procedure type as a function of oral health and dental care coverage status controlling for individual and household characteristics and adverse selection. The working hypothesis for this specific aim is that dental coverage induces regular preventive dental care, improves oral health, and lessens the need for expensive non-preventive procedures. 6. Estimate the number and characteristics of persons age 51 years and above reporting dental care coverage with atypically low levels of dental use and/or atypically high levels of out of pocket expenditures for those with dental use. The working hypothesis for this specific aim is that these groups are more likely to expect that dental coverage is included in Medicare and as a consequence mis-report having dental coverage. Results of this project will assist policy makers in the formulation of governmental policies, including a proposed extension of Medicare to include dental coverage, inclusion of dental coverage under Medigap plans, inclusion of full adult dental care coverage in Medicaid and an extension of post-retirement continuation coverage to include dental coverage within the private sector. PUBLIC HEALTH RELEVANCE: The goal of this project is to provide a better understanding of the relationship between dental care coverage and dental use among the elderly and subsequently provide the information needed to assist policy makers as they consider the inclusion of dental coverage under Medicare, Medigap and Medicaid plans or as an extension of post-retirement coverage within the private sector.