Spillover Effects of Medicaid Dental Coverage Expansions on Health Status

项目概要/摘要 美国低收入成年人的牙齿健康状况历来较差， 健康状况比收入高的人差，获得牙科和医疗服务的机会少。 口腔健康是整体健康和福祉的关键组成部分。然而，关系 口腔健康和整体健康之间的关系是双向的，并受到几个混杂因素的影响。 鉴于这些复杂的关系，需要有证据来检验因果影响 获得牙科服务的变化对整体健康状况的影响。我们将作出重大贡献 通过利用牙科覆盖率的最新外源性变化来填补这一知识空白， 由于平价医疗法案（ACA）医疗补助扩张，牙科服务的使用是自然的， 研究牙科服务使用对整体健康状况的影响的实验。截至2019年，33个国家 将医疗补助资格扩大到所有低于联邦贫困线138%的非老年人。 然而，医疗补助牙科覆盖成年人是可选的国家，因此，有 各州和不同时间的牙科覆盖率存在显著差异。这种变化提供了一种 独特的机会，了解牙科覆盖面和服务使用的溢出效应， 整体健康状况。ACA医疗补助与牙科福利的扩张增加了牙科 访问和使用预防和治疗牙科服务，但效果不同的慷慨， 牙科福利。这一证据表明，医疗补助的扩张与他们的变化， 牙科福利提供了一个独特的机会，以了解访问之间的联系， 牙科服务和整体健康状况。利用自然实验和现有的 从两个全国代表性的调查数据，我们将提供第一个证据的影响， 最近医疗补助计划的扩大，为低收入成年人提供牙科福利， 从第一次扩张开始的7年内。我们将按国家研究影响的异质性 牙科覆盖率，牙医供应和与l相关的人口统计变量的慷慨度 健康状况、口腔健康和牙科服务使用情况。这项研究的证据高度 与准确评估口腔健康项目的有效性和成本效益相关 和政策，通过考虑对整体健康的溢出效益。证据也将是 对国家和州的医疗补助政策都很有用。调查结果还将为讨论提供信息 在政策制定者和利益相关者中， 成年人和雇主赞助或独立购买的计划。该研究还将 鼓励使用其他数据源（如索赔数据）进行更大规模的研究，以评估变化 在牙科和医疗保健使用在个人层面上使用准实验设计。

PROJECT SUMMARY/ABSTRACT Low-income adults in the United States have historically had worse dental health and overall health status than higher income individuals and less access to dental and medical services. Oral health is a key component of overall health and wellbeing. However, the relationships between oral health and overall health are bi-directional and subject to several confounders. Given these complex relationships, there is a need for evidence examining the causal impacts of changes in access to dental services on overall health status. We will contribute substantially to filling this knowledge gap by leveraging recent exogenous changes in dental coverage and dental services use due to the Affordable Care Act (ACA) Medicaid expansions as a natural experiment to study effects of dental services use on overall health status. As of 2019, 33 states expanded Medicaid eligibility to all non-elderly adults below 138% of the federal poverty level. However, Medicaid dental coverage for adults is optional for states, and as a result, there is significant variation in dental coverage across states and over time. This variation provides a unique opportunity to understand the spillover effects of dental coverage and services use on overall health status. The ACA Medicaid expansions with dental benefits have increased dental visits and use of preventive and treatment dental services but effects differed by generosity of dental benefits. That evidence demonstrates that the Medicaid expansions with their variation in dental benefits provide a unique opportunity to understand connections between access to dental services and overall health status. Taking advantage of a natural experiment and existing data from two nationally representative surveys, we will provide the first evidence on effects of the recent Medicaid expansions with dental benefits for low-income adults on their overall health status over 7 years from the first expansions. We will examine heterogeneity in effects by state generosity of dental coverage, dentist supply, and demographic variables associated with l health status, oral health and dental services use. The evidence from the study is highly relevant for accurate evaluations of the effectiveness and cost-benefit of oral health programs and policies by accounting for spillover benefits to overall health. The evidence will also be useful for Medicaid policies both nationally and for states. Findings will also inform discussions among policymakers and stakeholders about offering dental coverage in Medicare for older adults and in employer-sponsored or independently purchased plans. The study will also motivate larger scale studies using other data sources such as claims data to assess changes in dental and medical care use at the individual-level using quasi-experimental designs.