Health Reform and Oral Health Disparities: a Mixed Methods Evaluation

项目总结/摘要 尽管为增加弱势群体获得牙科保健的机会作出了许多努力，但在口腔健康和 医疗保健仍然存在。医疗补助现在是全国最大的健康保险覆盖面来源， 它主要为低收入和残疾人提供保险，医疗补助是解决这一问题的关键政策杠杆。 医疗保健方面的社会经济差异。《平价医疗法案》（ACA）将医疗补助扩大到数百万人， 以前不符合资格的成年人，但只有31个州和华盛顿特区，选择参加迄今为止。目标 该提案的目的是利用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变化，以评估这些变化的影响。 到目前为止，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计划进行重大改革， 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 提出一项混合方法研究，使用准实验研究设计结合定量成分 和国家公共数据集，以及使用原始数据收集的定性要素， ACA医疗补助扩大口腔健康。该项目包括四项研究;在K99阶段，我们建议 解决以下目标：1）估计ACA下医疗补助扩展对获得和 口腔健康服务的利用率; 2）衡量医疗补助扩张对个人口腔健康的影响- 相关的行为和种族/民族和社会经济不平等的未经治疗的牙科疾病。然后我们将 通过以下目标解决R 00阶段：3）为了更好地了解牙科服务提供者的看法， 对医疗补助扩张的态度和经验，并探讨ACA实施的挑战; 4)在医疗补助计划中，确定ACA扩展后获得口腔保健的障碍和促进因素 受益人。通过对医疗补助提供者和受益者的意见进行三角分析，我们认为我们的方法 将提供一个更全面的理解的障碍和促进ACA的实施。结果 从这项研究将提高我们对获得口腔保健的障碍的理解， 政策和干预措施。此外，它还将有助于评估国家在减少 社会经济和种族/民族的差距，获得口腔保健服务，并探讨机制， 卫生政策可能会影响口腔健康的差异。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。我会继续接受训练 在卫生政策，计量经济学和混合方法的研究，通过教学课程和正式咨询，从 我的导师们，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.这个奖项的设置在哈佛牙科医学院和哈佛公共卫生学院。 这种丰富的研究环境将支持我作为一个独立的研究人员的发展。

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.