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

项目摘要/摘要 自平价医疗计划实施以来，估计有980万成年人获得了口腔健康保险 《关怀法案》(ACA)。然而，弱势群体的牙科服务利用率仍然很低，导致 口腔健康差距的顽固存在。这些发现表明，存在着持久的障碍 口腔健康保健不只是覆盖范围。根据安徒生的医疗保健利用模式，口腔 医疗保健利用率是由促成因素(如获得保险)和易感因素推动的 (如口腔健康素养)。因此，找出提高口语吸收的瓶颈是至关重要的 医疗保健服务，从而改善少数族裔和低收入美国人的口腔健康状况。我们的整体 目的是评估牙科提供者的可获得性是否构成获得牙科保健的障碍 低收入和少数族裔成年人。我们建议进行一项现场实验来模拟患者的经历 获得牙科预约的医疗补助覆盖范围。我们的设计考虑到了 医疗补助政策和社区特征，从而使我们能够检查潜在的 结构性因素导致在获得牙科保健方面存在差异。我们的具体目标是：1)审查 根据社区特征确定牙科服务提供者的地理空间分布；2)识别 医疗补助保险状况与牙科预约的可获得性之间的关联；以及3)评估 结构性障碍之间的跨层互动(州医疗补助牙科政策和社区 特征)和医疗补助受益人的牙科预约情况。这项研究的发现， 使用强有力的实验方法和原始数据收集，将提供直接和客观的措施 获得牙科保健，以指导各州实施有效的政策，减少口腔健康方面的差距。

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.