Health Reform and Oral Health Disparities: a Mixed Methods Evaluation

项目摘要/摘要 尽管作出了许多努力以增加弱势群体获得牙科保健的机会，但口腔健康和 医疗保健仍然存在。医疗补助现在是美国最大的医疗保险覆盖来源，自 它主要为低收入和残疾人提供保险，医疗补助是解决以下问题的关键政策杠杆 医疗保健方面的社会经济差距。《平价医疗法案》(ACA)将医疗补助扩大到数百万人 以前没有资格的成年人，但到目前为止只有31个州和华盛顿特区选择参加。目标是 这一建议的目的是利用ACA实施所创建的自然实验，并利用 医疗补助覆盖的牙科护理范围的州一级差异，以评估这些影响 迄今为止关于口腔健康不平等的政策。随着国会继续考虑对医疗补助和医疗补助进行重大改革 ACA，我们的分析结果可以为口腔健康不平等的未来提供重要的见解。我们 提出一种混合方法研究，采用准实验研究设计，结合定量成分 和国家公共数据集，以及利用初级数据收集来评估气候变化影响的定性要素 ACA口腔健康医疗补助计划的扩展。该项目包括四项研究；在K99阶段，我们建议 解决以下目标：1)评估在ACA下扩大医疗补助对获得和 口腔健康服务的利用；以及2)衡量医疗补助扩大对个人口腔健康的影响- 未经治疗的牙病的相关行为和种族/民族和社会经济不平等。到时候我们会的 通过以下目标解决R00阶段：3)更好地了解牙科提供商对 对扩大医疗补助的态度和经验，以及探索ACA实施挑战；以及 4)在医疗补助计划中扩大ACA后，确定获得口腔保健的障碍和促进者 受益人。通过综合医疗补助提供者和受益人的意见，我们相信我们的方法 将更全面地了解ACA实施的障碍和促进者。发现 这项研究将加强我们对获得口腔保健的障碍的理解，这可能会为未来 政策和干预。此外，它将有助于评估国家在减少排放方面的进展。 在获得口腔保健服务方面的社会经济和种族/族裔差距，并探讨 卫生政策可能会影响口腔健康方面的差异。这个职业发展奖将为我提供保护 研究时间，从而有机会扩大我的研究技能和知识。我会继续深造 在卫生政策、计量经济学和混合方法研究中，通过授课课程和来自 我的导师，他们是公共卫生、卫生政策、卫生经济学、健康差距和质量方面的专家 方法：研究方法。这个奖项的背景是哈佛大学牙医学院和哈佛大学公共卫生学院。 这种丰富的研究环境将支持我作为一名独立研究员的发展。

Project Summary/Abstract Despite numerous efforts to increase access to dental care for vulnerable groups, disparities in oral health and healthcare continue to exist. Medicaid is now the nation's largest source of health insurance coverage, and since it primarily offers insurance to low-income and disabled individuals, Medicaid is a key policy lever for addressing socioeconomic disparities in health care. The Affordable Care Act (ACA) expanded Medicaid to millions of previously ineligible adults, but only 31 states and Washington DC, have chosen to participate thus far. The goal of this proposal is to leverage the natural experiment created by ACA implementation and take advantage of state-level variation in the extent of dental care covered by Medicaid in order to assess the impact of these policies to date on oral health inequalities. As Congress continues to consider major changes to Medicaid and the ACA, the results of our analysis can offer important insights for the future of oral health inequalities. We propose a mixed-methods study, combining a quantitative component using a quasi-experimental study design and national public datasets, and a qualitative element using primary data collection to assess the impact of the ACA Medicaid expansion on oral health. This project includes four studies; during the K99 phase we propose to address the following aims: 1) To estimate the effect of Medicaid expansion under the ACA on access to and utilization of oral health services; and 2) To measure the impact of Medicaid expansion on individuals' oral health- related behaviors and race/ethnic and socioeconomic inequalities in untreated dental disease. We will then address the R00 phase through the following aims: 3) To better understand dental providers' perceptions of, attitudes toward, and experiences with Medicaid expansion and to explore ACA implementation challenges; and 4) To identify barriers to and facilitators of accessing oral health care after ACA expansion among Medicaid beneficiaries. By triangulating the views from both Medicaid providers and beneficiaries, we believe our approach will provide a more comprehensive understanding of the barriers and facilitators to ACA implementation. Findings from this study will enhance our understanding of barriers to access to oral health care that could inform future policies and interventions. Furthermore, it will aid in assessing national progress towards reducing socioeconomic and racial/ethnic disparities in access to oral health services and explore mechanisms by which health policy could impact disparities in oral health. This career development award will provide me with protected research time and thus the opportunity to expand my research skills and knowledge. I will pursue further training in health policy, econometrics and mixed-methods research through didactic courses and formal advising from my mentors, who are experts in public health, health policy, health economics, health disparities, and qualitative methods. The setting of this award is at Harvard School of Dental Medicine and Harvard School of Public Health. This rich research environment will support my development as an independent researcher.