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National Expansion of Dental Insurance Among Young Adults: A Natural Experiment

在全国范围内扩大年轻人牙科保险：一项自然实验

基本信息

批准号：
9342794
负责人：
Dan Shane
金额：
$ 7.63万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2019-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9342794
关键词：
Academic achievement Accident and Emergency department Address Adolescent Adult Affect Affordable Care Act Age Attention Child Chronic Control Groups Data Data Set Dental Dental Care Dental Insurance Dental caries Dentists Diabetes Mellitus Emergency Care Ethnic Origin Expenditure Future Goals Health Health Care Reform Health Insurance Health Services Accessibility Healthcare Systems Heart Diseases Heterogeneity Income Individual Insurance Carriers Insurance Coverage Intervention Investigation Knowledge Life Link Medical National Health Interview Survey Natural experiment Oral health Parents Periodontal Diseases Persons Policies Population Preventive Privatization Public Policy Race Recording of previous events Research Risk Rural Services Surveys Time Tooth Diseases Tooth Loss Tooth structure United States National Institutes of Health Visit aged design improved innovation interest permanent tooth prevent psychosocial public health relevance service utilization socioeconomics trait urban setting young adult

项目摘要

DESCRIPTION (provided by applicant): National health reforms relating to the Affordable Care Act have devoted little attention to oral health despite the importance of oral health to overall health, particularly for children and younger adults. A key factor in improving oral health is expanding access to preventive and curative dental care. Expanding access to care often occurs through increased access to dental insurance coverage. Despite limited attention, one of the early policy changes due to the Affordable Care Act has had a spillover effect on dental insurance coverage. The dependent coverage mandate requiring private health insurance plans to allow dependents up to the age of 26 to remain on parental health insurance plans has resulted in young adults gaining access to private dental coverage as well. Coverage rates have increased by as much as 6-7 percentage points, providing dental coverage to nearly 2 million young adults nationwide. This national expansion of private dental insurance provides a unique and unprecedented opportunity of a natural experiment to study the effects of a policy-driven expansion in dental insurance on preventive and curative dental services utilization and dental spending. Previous studies that have contributed to the topic of dental insurance and dental services use have typically focused on public coverage or have suffered from confounding that detracts from the ability to understand the casual effects of dental insurance rather than differences in socioeconomic or demographic traits. In contrast, the private expansion of dental insurance resulting from the dependent coverage mandate was specific to a select group of young adults and took effect in late 2010. In combination, these factors allow for an analysis of dental coverage that can uncover the causal effects of coverage on dental services utilization and overall spending. The proposed study will identify the impacts of the ACA-driven expansion in private dental coverage on utilization of preventive and curative dental services as well as dental spending among young adults. This study is highly innovative as it takes advantage of nationwide expansion of private dental coverage, a natural experiment that can contribute important knowledge about potential future policies directed at increasing dental insurance coverage and the implications for access to dental care. We plan to evaluate preventive, curative, and emergency room dental visits to provide a comprehensive assessment of the effects of the ACA policy and the resulting private dental coverage expansion on dental services utilization and evaluate potential heterogeneity by race/ethnicity, income levels, and rural/urban status. We will use a nationally representative dataset to accomplish the proposed Specific Aims.

描述（由申请人提供）：尽管口腔健康对整体健康，特别是对儿童和年轻人的重要性，但与《平价医疗法案》有关的国家卫生改革对口腔健康的关注很少。改善口腔健康的关键因素正在扩大获得预防性和治疗性牙科保健的机会。扩大获得保健的机会往往是通过增加获得牙科保险的机会来实现的。尽管关注有限，但由于《平价医疗法案》的早期政策变化之一对牙科保险范围产生了溢出效应。受抚养人保险的规定要求私人健康保险计划允许26岁以下的受抚养人继续参加父母健康保险计划，这使得年轻人也可以获得私人牙科保险。覆盖率增加了6-7个百分点，为全国近200万年轻人提供了牙科保险。私人牙科保险在全国范围内的扩大提供了一个独特的和前所未有的自然实验机会，以研究政策驱动的牙科保险扩大对预防和治疗牙科服务利用率和牙科支出的影响。以前的研究，有助于牙科保险和牙科服务使用的主题通常集中在公共保险或遭受混淆，削弱了理解牙科保险的偶然影响的能力，而不是社会经济或人口特征的差异。相比之下，受抚养人保险授权导致的私人牙科保险的扩大是针对特定的年轻成年人群体的，并于2010年底生效。结合起来，这些因素允许对牙科覆盖范围进行分析，可以揭示覆盖范围对牙科服务利用率和整体支出的因果影响。这项拟议的研究将确定由ACA推动的私人牙科覆盖范围的扩大对年轻人使用预防和治疗牙科服务以及牙科支出的影响。这项研究是高度创新的，因为它利用了全国范围内扩大私人牙科保险，一个自然的实验，可以贡献有关潜在的未来政策的重要知识，旨在增加牙科保险覆盖面和获得牙科保健的影响。我们计划评估预防，治疗和急诊室牙科就诊，以全面评估ACA政策的影响以及由此产生的私人牙科覆盖范围扩大对牙科服务利用的影响，并评估种族/民族，收入水平和农村/城市地位的潜在异质性。我们将使用具有全国代表性的数据集来实现拟议的具体目标。