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

 说明(申请人提供)：与《平价医疗法案》相关的国家卫生改革很少关注口腔健康，尽管口腔健康对整体健康很重要，特别是对儿童和年轻人来说。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护理的机会。扩大获得护理的机会往往通过增加获得牙科保险的机会来实现。尽管关注有限，但《平价医疗法案》带来的早期政策变化之一已经对牙科保险覆盖范围产生了溢出效应。受抚养人保险授权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，这导致年轻人也获得了私人牙科保险。覆盖率提高了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展提供了一个独特的、史无前例的自然实验机会，以研究政策驱动的牙科保险扩展对预防和治疗牙科服务利用和牙科支出的影响。以前对牙科保险和牙科服务使用做出贡献的研究通常侧重于公共覆盖范围，或者受到混淆的影响，这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，受抚养人承保任务导致的牙科保险私人扩大是专门针对选定的一批年轻人的，并于2010年底生效。这些因素结合在一起，可以分析牙科覆盖范围，揭示覆盖范围对牙科服务利用和总支出的因果影响。拟议的研究将确定ACA推动的私人牙科覆盖范围的扩大对预防和治疗牙科服务的利用以及年轻人牙科支出的影响。这项研究具有很高的创新性，因为它利用了私人牙科覆盖范围在全国范围内扩大的优势，这是一项自然的实验，可以为未来旨在扩大牙科保险覆盖范围的潜在政策及其对获得牙科护理的影响提供重要的知识。我们计划评估预防、治疗和急诊室牙科就诊，以全面评估ACA政策和由此导致的私人牙科覆盖范围扩大对牙科服务利用的影响，并按种族/民族、收入水平和城乡地位评估潜在的异质性。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。

 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.