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Wolf E, Ziesemer K, Van der Hijden E. Policy interventions to improve the accessibility and affordability of Dutch dental care. A scoping review of effective interventions. Heliyon 2024; 10:e28886. [PMID: 38707350 PMCID: PMC11066141 DOI: 10.1016/j.heliyon.2024.e28886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Caries and periodontitis remain prevalent in the Netherlands. Given the assumption that increasing the accessibility and affordability of dental care can improve oral health outcomes, policy interventions aimed at improving these aspects may contribute to better oral health. To identify possible solutions, this scoping review firstly identifies policy interventions from around the world that have effectively improved the accessibility or affordability of dental care. Secondly, this review discusses the potential of the policy interventions identified that are applicable to the Dutch healthcare sector specifically. A literature search was performed in four databases. Two reviewers independently screened all potentially relevant titles and abstracts before doing the same for the full texts. Only studies that had quantitatively evaluated the effectiveness of policy interventions aimed at improving the accessibility or affordability of dental care were included. 61 of the 1288 retrieved studies were included. Interventions were grouped into four categories. Capacity interventions (n = 5) mainly focused on task delegation. Coverage interventions (n = 25) involved the expansion of covered dental treatments or the group eligible for coverage. Managed care interventions (n = 20) were frequently implemented in school or community settings. Payment model interventions (n = 11) focused on dental reimbursement rates or capitation. 199 indicators were identified throughout the 61 included studies. Indicators were grouped into three categories: accessibility (n = 137), affordability (n = 21), and oral health status (n = 41). Based on the included studies, increasing managed care interventions for children and adding dental coverage to the basic health insurance plan for adults could improve access to dental care in the Netherlands. Due to possible spillover effects, it is advisable to investigate a combination of these policy interventions. Further research will be necessary for the development of effective policy interventions in practice.
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Affiliation(s)
- E.H. Wolf
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - K.A. Ziesemer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - E.J.E. Van der Hijden
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
- Zilveren Kruis Health Insurance, Handelsweg 2, 3707 NH Zeist, Utrecht, the Netherlands
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Kopycka-Kedzierawski DT, Feng C, Billings RJ, Watson GE, Ragusa PG, Flint K, Wong CL, Gill SR, Manning S, O'Connor TG. Psychosocial Risk Exposure Limits Routine Pediatric Oral Health Care. AJPM FOCUS 2024; 3:100191. [PMID: 38357551 PMCID: PMC10864889 DOI: 10.1016/j.focus.2024.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Introduction This study aimed to identify social, psychological, and contextual factors that influenced attendance at routine oral health visits in a cohort of 189 preschool children who were followed over a 2-year period. Methods Generalized estimating equation was used to examine the association between clinic attendance and the predictors. ORs and 95% CIs were reported in the multiple logistic regression models. The study was conducted in Rochester, New York, between February 2016 and February 2021. Results Prior to the COVID-19 pandemic declaration, the rate of canceled and no-show appointments was greater for routine clinic visits (20% and 24%, respectively) than for research visits (14% and 9%, respectively) for the same participants; these rates increased during the pandemic. After adjusting for sociodemographic factors, the likelihood of a canceled or no-show appointment was associated with parental depression (OR=1.06, CI=1.03, 1.09), regardless of the type or occurrence of the visit. Conclusions Findings from this study demonstrate that attendance to oral health care in young children is reliably reduced with parental depression and that this may provide one mechanism for early emerging health inequalities of oral health.
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Affiliation(s)
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Ronald J. Billings
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Gene E. Watson
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Pharmacology & Physiology, University of Rochester, Rochester, New York
- Department of Environmental Medicine, University of Rochester, Rochester, New York
| | - Patricia G. Ragusa
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Kimberly Flint
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Cynthia L. Wong
- Department of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Pediatrics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Steven R. Gill
- Department of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Pediatrics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York
| | - Samantha Manning
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Thomas G. O'Connor
- Department of Psychiatry, University of Rochester, Rochester, New York
- Department of Psychology, University of Rochester, Rochester, New York
- Department of Neuroscience, University of Rochester, Rochester, New York
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
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McKernan SM, Ratcliffe C, Braga B. The Effect of the US Safety Net on Material Hardship over Two Decades. JOURNAL OF PUBLIC ECONOMICS 2021; 197:104403. [PMID: 34054155 PMCID: PMC8153365 DOI: 10.1016/j.jpubeco.2021.104403] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We address a question at the center of many policy debates: how effective is the US safety net? Many existing studies evaluate the effect of one program on economic hardship in isolation, though families typically participate in multiple programs. Using 1992-2011 data from the Survey of Income and Program Participation, our analyses examine the simultaneous effect of participation in three programs, TANF, SNAP, or Medicaid/SCHIP, on a set of outcomes of intrinsic importance-measures of material hardship. We find that a 10 percentage point increase in participation in any of these three safety net programs by low-to-moderate income families with children reduces their average number of hardships by 0.11 (-0.41 elasticity), and the incidence of food insufficiency by 1.7 percentage points (-1.27 elasticity). This analysis suggests that hardship would be even more prevalent in the United States without the existence of the current safety net programs.
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Affiliation(s)
- Signe-Mary McKernan
- Urban Institute, 500 L’Enfant Plaza SW, Washington, DC 20024, United States of America
| | - Caroline Ratcliffe
- Consumer Financial Protection Bureau, 1700 G Street NW, Washington, DC 20552, United States of America
| | - Breno Braga
- Urban Institute, 500 L’Enfant Plaza SW, Washington, DC 20024, United States of America
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Lewis CW, Johnston BD, Lee HH, McKinney CM, Reusch C. Income-Based Disparities in a Yearly Dental Visit in United States Adults and Children: Trend Analysis 1997 to 2016. Acad Pediatr 2020; 20:942-949. [PMID: 32544458 DOI: 10.1016/j.acap.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine how income-based disparities in a yearly dental visit (the Healthy People 2020 Leading Health Indicator for Oral Health) changed since legislation to expand dental coverage and to compare disparity trends in children and adults. METHODS We analyzed Medical Expenditure Panel Survey 1997 to 2016 to determine yearly dental visit rates for US children and adults by family income. We determined measures of income disparity, including the Slope Index of Inequality and the Relative Index of Inequality and examined trends in yearly dental visit, Slope Index of Inequality, and Relative Index of Inequality using joinpoint regression. RESULTS Income-based disparities, absolute and relative, narrowed over time for children. Steady upward trends in yearly dental visit rates were observed for poor and low-income/poor children and no joinpoint was identified that corresponded to legislation expanding dental care coverage for lower income children. Relative income-based disparities in yearly dental visit rates widened for adults over 20 years. After declining for 14 years, yearly dental visit rate increased for poor adults from 2013 to 2016 suggesting a possible positive effect in adult dental care use trends following enactment of the Affordable Care Act. CONCLUSIONS In 1997, US children and adults had similar levels of income-based disparity in yearly dental visits, but by 2016, they differed markedly. Trends in income-based disparities in yearly dental visit rate narrowed for children but widened for adults. There are lessons from the expansion of dental care coverage for children that could be applied to improve access to dental care for adults.
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Affiliation(s)
- Charlotte W Lewis
- Department of Pediatrics, University of Washington School of Medicine (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Seattle Children's (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash.
| | - Brian D Johnston
- Department of Pediatrics, University of Washington School of Medicine (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Seattle Children's (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Harborview Medical Center (BD Johnston), Seattle, Wash
| | - Helen H Lee
- Department of Anesthesiology, University of Illinois at Chicago College of Medicine (HH Lee), Chicago, Ill
| | - Christy M McKinney
- Department of Pediatrics, University of Washington School of Medicine (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash; Seattle Children's (CW Lewis, BD Johnston, and CM McKinney), Seattle, Wash
| | - Colin Reusch
- Children's Dental Health Project (C Reusch), Washington, DC
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Grytten J, Skau I. Educational inequalities in access to fixed prosthodontic treatment in Norway. Causal effects using the introduction of a school reform as an instrumental variable. Soc Sci Med 2020; 260:113105. [PMID: 32653812 DOI: 10.1016/j.socscimed.2020.113105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Equality in access to dental services, independent of level of education, is an important aim of Scandinavian welfare policy. In Norway, this policy is the main justification for a dental public subsidy scheme for adults. An important part of the subsidy scheme is to cover the cost of fixed prosthodontic treatment, including implant-based crowns and bridges for premolars, canines and incisors. A stated policy goal is to secure equal access to everybody in need of these services, independent of their level of education. The aim of this study was to estimate the causal effect of education on the probability of receiving fixed prosthodontic treatment in the adult Norwegian population. METHODS During the period 1960-1972, all municipalities in Norway were required to increase the number of compulsory years of education from seven to nine years. We used this education reform as the instrumental variable to create exogenous variation in the individual's number of years of education. The education data were combined with data from the Norwegian Health Economics Administration, which contained our outcome variable. Our sample included individuals with 9 years education or less. Altogether 113 237 individuals were included in the study. RESULTS For men, the first stage regression coefficient was 0.87 (confidence interval: 0.82-0.92). This means that the reform resulted in 0.87 additional years of education. For men, the probability of receiving fixed prosthodontic treatment increased by 0.67 percentage points per additional year of schooling. For women, the first stage regression coefficient was 0.84 (confidence interval: 0.79-0.88). The second stage regression coefficient was small (= 0.0022) and not statistically significant at a conventional level. CONCLUSION From a welfare policy point of view, for men, the subsidy scheme has not succeeded to redistribute resources so that dental services are accessible independent of their social status.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, Dental Faculty, University of Oslo, Norway; Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway.
| | - Irene Skau
- Department of Community Dentistry, Dental Faculty, University of Oslo, Norway
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Dehmoobadsharifabadi A, Singhal S, Quiñonez CR. Impact of public dental care spending and insurance coverage on utilization disparities among Canadian jurisdictions. J Public Health Dent 2018; 78:346-351. [DOI: 10.1111/jphd.12283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/01/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry; University of Toronto; Toronto ON Canada
- Public Health Ontario; Toronto ON Canada
| | - Carlos R. Quiñonez
- Dental Public Health, Faculty of Dentistry; University of Toronto; Toronto ON Canada
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Statewide Policy Change in Pediatric Dental Care, and the Impact on Pediatric Dental and Physician Visits. Matern Child Health J 2017; 21:1939-1948. [PMID: 28741086 DOI: 10.1007/s10995-017-2310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction In 2007, the California signed legislation mandating a dental visit for all children entering kindergarten or first grade; no such mandate was made for physician visits. This study examines the impact of this policy change on the risk factors associated with obtaining pediatric dental and physician health care visits. Methods Every 2 years, California Health Interview Survey conducts a statewide survey on a representative community sample. This cross-sectional study took advantage of these data to conduct a "natural experiment" assessing the impact of this policy change on both pediatric physician and dental care visits in the past year. Samples included surveys of adults and children (ages 5-11) on years 2005 (n = 5096), 2007 (n = 4324) and 2009 (n = 4100). Results Although few changes in risk factors were noted in pediatric physician visits, a gradual decrease in risk factors was found in pediatric dental visits from 2005 to 2009. Report of no dental visit was less likely for: younger children (OR -0.81, CI 0.75-0.88), insured children (OR 0.34, CI 0.22-0.53), and children who had a physician's visit last year (OR 0.37, CI 0.25-0.53) in 2005. By 2007, absence of insurance was the only risk factor related to having no dental visit (OR 0.34, CI 0.19-0.61). By 2009, no a priori measured risk factors were associated with not having a dental visit for children aged 5-11 years. Conclusions A statewide policy mandating pediatric dental visits appears to have reduced disparities. A policy for medical care may contribute to similar benefits.
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Waddington H, Aloe AM, Becker BJ, Djimeu EW, Hombrados JG, Tugwell P, Wells G, Reeves B. Quasi-experimental study designs series-paper 6: risk of bias assessment. J Clin Epidemiol 2017; 89:43-52. [PMID: 28351693 DOI: 10.1016/j.jclinepi.2017.02.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/03/2016] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Rigorous and transparent bias assessment is a core component of high-quality systematic reviews. We assess modifications to existing risk of bias approaches to incorporate rigorous quasi-experimental approaches with selection on unobservables. These are nonrandomized studies using design-based approaches to control for unobservable sources of confounding such as difference studies, instrumental variables, interrupted time series, natural experiments, and regression-discontinuity designs. STUDY DESIGN AND SETTING We review existing risk of bias tools. Drawing on these tools, we present domains of bias and suggest directions for evaluation questions. RESULTS The review suggests that existing risk of bias tools provide, to different degrees, incomplete transparent criteria to assess the validity of these designs. The paper then presents an approach to evaluating the internal validity of quasi-experiments with selection on unobservables. CONCLUSION We conclude that tools for nonrandomized studies of interventions need to be further developed to incorporate evaluation questions for quasi-experiments with selection on unobservables.
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Affiliation(s)
- Hugh Waddington
- International Initiative for Impact Evaluation, New Delhi, India.
| | | | | | - Eric W Djimeu
- International Initiative for Impact Evaluation, New Delhi, India
| | | | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - George Wells
- Department of Medicine, University of Ottawa, Ottawa, Canada
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Park HJ, Lee JH, Park S, Kim TI. Changes in dental care access upon health care benefit expansion to include scaling. J Periodontal Implant Sci 2016; 46:405-414. [PMID: 28050318 PMCID: PMC5200866 DOI: 10.5051/jpis.2016.46.6.405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/22/2016] [Indexed: 11/08/2022] Open
Abstract
Purpose This study aimed to evaluate the effects of a policy change to expand Korean National Health Insurance (KNHI) benefit coverage to include scaling on access to dental care at the national level. Methods A nationally representative sample of 12,794 adults aged 20 to 64 years from Korea National Health and Nutritional Examination Survey (2010–2014) was analyzed. To examine the effect of the policy on the outcomes of interest (unmet dental care needs and preventive dental care utilization in the past year), an estimates-based probit model was used, incorporating marginal effects with a complex sampling structure. The effect of the policy on individuals depending on their income and education level was also assessed. Results Adjusting for potential covariates, the probability of having unmet needs for dental care decreased by 6.1% and preventative dental care utilization increased by 14% in the post-policy period compared to those in the pre-policy period (2010, 2012). High income and higher education levels were associated with fewer unmet dental care needs and more preventive dental visits. Conclusions The expansion of coverage to include scaling demonstrated to have a significant association with decreasing unmet dental care needs and increasing preventive dental care utilization. However, the policy disproportionately benefited certain groups, in contrast with the objective of the policy to benefit all participants in the KNHI system.
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Affiliation(s)
- Hee-Jung Park
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea
| | - Jun Hyup Lee
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea.; BK21 PLUS Program in Embodiment: Health-Society Interaction, Department of Public Health Sciences, Korea University Graduate School, Seoul, Korea
| | - Sujin Park
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea
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Abstract
OBJECTIVE The authors conducted a study to measure the gap in dental care utilization between poor and nonpoor adults at the state level and to show how the gap has changed over time. METHODS The authors collected data from the 2002, 2004, 2006, 2008 and 2010 Behavioral Risk Factor Surveillance System prevalence and trends database maintained by the Centers for Disease Control and Prevention to measure differences in dental care utilization between poor and nonpoor adults. Poor adults are defined as those at or below the federal poverty threshold. The authors estimated a series of linear probability models to measure the dental care utilization gap between poor and nonpoor adults, while controlling for potentially confounding covariates. RESULTS In 12 states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Nebraska, Ohio, Oklahoma, South Carolina, Texas and Washington), the gap in dental care utilization between poor and nonpoor adults grew from 2002 through 2010. The remaining states had a stable utilization gap from 2002 through 2010. The study results show that four states (Alaska, Massachusetts, Minnesota, New York) and the District of Columbia had a smaller gap in dental care utilization in 2010 than that in other states. CONCLUSIONS At the state level, poor adults face greater access barriers to dental care than do nonpoor adults. As states limit dental coverage through Medicaid, poor adults are at greater risk of experiencing poor oral health outcomes. Practical Implications In states that are experiencing increasing inequality in dental care utilization between poor and nonpoor adults, policymakers may wish to explore alternative approaches that could address this situation.
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Capurro DA, Iafolla T, Kingman A, Chattopadhyay A, Garcia I. Trends in income-related inequality in untreated caries among children in the United States: findings from NHANES I, NHANES III, and NHANES 1999-2004. Community Dent Oral Epidemiol 2015; 43:500-10. [PMID: 26037290 DOI: 10.1111/cdoe.12174] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this analysis was to describe income-related inequality in untreated caries among children in the United States over time. METHODS The analysis focuses on children ages 2-12 years in three nationally representative U.S. surveys: the National Health and Nutrition Examination Survey (NHANES) 1971-1974, NHANES 1988-1994, and NHANES 1999-2004. The outcome of interest is untreated dental caries. Various methods are employed to measure absolute and relative inequality within each survey such as pair-wise comparisons, measures of association (odds ratios), and three summary measures of overall inequality: the slope index of inequality, the relative index of inequality, and the concentration index. Inequality trends are then assessed by comparing these estimates across the three surveys. RESULTS Inequality was present in each of the three surveys analyzed. Whether measured on an absolute or relative scale, untreated caries disproportionately affected those with lower income. Trend analysis shows that, despite population-wide reductions in untreated caries between NHANES I and NHANES III, overall absolute inequality slightly increased, while overall relative inequality significantly increased. Between NHANES III and NHANES 1999-2004, both absolute and relative inequality tended to decrease; however, these changes were not statistically significant. CONCLUSIONS Socioeconomic inequality in oral health is an important measure of progress in overall population health and a key input to inform health policies. This analysis shows the presence of socioeconomic inequality in oral health in the American child population, as well as changes in its magnitude over time. Further research is needed to determine the factors related to these changes and their relative contribution to inequality trends.
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Affiliation(s)
| | - Timothy Iafolla
- National Institute of Dental and Craniofacial Research, National Institutes of Health (NIDCR/NIH), Bethesda, MD, USA
| | - Albert Kingman
- National Institute of Dental and Craniofacial Research, National Institutes of Health (NIDCR/NIH), Bethesda, MD, USA
| | - Amit Chattopadhyay
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Isabel Garcia
- College of Dentistry, University of Florida, Gainesville, FL, USA
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Abstract
BACKGROUND The Affordable Care Act included a dependent coverage policy that extends parents' or guardians' health insurance to adults aged 19-25. This policy does not apply directly to private dental benefits. However, for various reasons it could still have an indirect "spillover" effect if employers voluntarily expand dental coverage in conjunction with medical coverage. OBJECTIVE To assess the effect of the Affordable Care Act's dependent coverage policy on private dental benefits coverage, utilization, and financial barriers to dental care. RESEARCH DESIGN Difference-in-differences models were used to measure the association between the dependent coverage policy and private dental benefits coverage, utilization, and financial barriers to dental care. We analyze 2008-2012 National Health Interview Survey data, comparing results in 2011 and 2012 with results from 2008 to 2010 (prereform period). SUBJECTS Adults aged 19-25 were compared with adults aged 26-34. MEASURES Private dental benefits coverage, dental care utilization, and financial barriers to obtaining needed dental care. RESULTS Relative to the prereform period, private dental benefits coverage among adults aged 19-25 increased by 5.6 percentage points in 2011 (P<0.001) and 6.9 percentage points in 2012 (P<0.001) compared with adults aged 26-34. Dental care utilization among adults aged 19-25 increased by 2.8 percentage points in 2011 (P=0.062) and 3.3 percentage points in 2012 (P=0.038) compared with adults aged 26-34. Adults aged 19-25 experienced a 2.1 percentage point decrease in 2011 (P=0.068) and a 2.0 percentage point decrease in 2012 (P=0.087) in financial barriers to dental care compared with adults aged 26-34. CONCLUSIONS The dependent coverage policy was associated with an increase in private dental benefits coverage and dental care utilization, and a decrease in financial barriers to dental care among young adults aged 19-25.
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Nasseh K, Vujicic M. Health reform in Massachusetts increased adult dental care use, particularly among the poor. Health Aff (Millwood) 2014; 32:1639-45. [PMID: 24019370 DOI: 10.1377/hlthaff.2012.1332] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
States frequently expand or limit dental benefits for adults covered by Medicaid. As part of statewide health reform in 2006, Massachusetts expanded dental benefits to all adults ages 19-64 whose annual income was at or below 100 percent of the federal poverty level. We examined the impact of this reform and found that it led to an increase in dental care use among the Massachusetts adult population, driven by gains among poor adults. Compared to the prereform period, dental care use increased by 2.9 percentage points among all nonelderly adults in Massachusetts, relative to all nonelderly adults in eight control states. For poor Massachusetts adults, the effect was larger-an eleven-percentage-point increase in dental care use above the increase among the state's nonpoor residents. The Massachusetts experience provides evidence that providing dental benefits to poor adults through Medicaid can improve dental care access and use. Our results imply that the lack of expanded dental coverage for low-income adults under the Affordable Care Act is a missed opportunity to improve access to oral care.
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Vujicic M, Nasseh K. A decade in dental care utilization among adults and children (2001-2010). Health Serv Res 2014; 49:460-80. [PMID: 24299620 PMCID: PMC3976182 DOI: 10.1111/1475-6773.12130] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To decompose the change in pediatric and adult dental care utilization over the last decade. DATA 2001 through 2010 Medical Expenditure Panel Survey. STUDY DESIGN The Blinder-Oaxaca decomposition was used to explain the change in dental care utilization among adults and children. Changes in dental care utilization were attributed to changes in explained covariates and changes due to movements in estimated coefficients. Controlling for demographics, overall health status, and dental benefits variables, we estimated year-specific logistic regression models. Outputs from these models were used to compute the Blinder-Oaxaca decomposition. PRINCIPAL FINDINGS Dental care utilization decreased from 40.5 percent in 2001 to 37.0 percent in 2010 for adults and increased from 43.2 percent in 2001 to 46.3 percent in 2010 for children (p<.05). Among adults, changes in insurance status, race, and income contributed to a decline in adult dental care utilization (-0.018, p<.01). Among children, changes in controlled factors did not substantially change dental care utilization, which instead may be explained by changes in policy, oral health status, or preferences. CONCLUSIONS Dental care utilization for adults has declined, especially among the poor and uninsured. Without further policy intervention, disadvantaged adults face increasing barriers to dental care.
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Affiliation(s)
- Marko Vujicic
- Health Policy Resources Center, American Dental Association211 East Chicago Avenue, Chicago, IL 60611-2637
- Health Policy Resources Center, American Dental AssociationChicago, IL
| | - Kamyar Nasseh
- Address correspondence to Kamyar Nasseh, Ph.D., Health Economist, Health Policy Resources Center, American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611-2637; e-mail:
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Meyerhoefer CD, Zuvekas SH, Manski R. The demand for preventive and restorative dental services. HEALTH ECONOMICS 2014; 23:14-32. [PMID: 23349123 DOI: 10.1002/hec.2899] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 11/02/2012] [Accepted: 12/03/2012] [Indexed: 06/01/2023]
Abstract
Chronic tooth decay is the most common chronic condition in the United States among children ages 5-17 and also affects a large percentage of adults. Oral health conditions are preventable, but less than half of the US population uses dental services annually. We seek to examine the extent to which limited dental coverage and high out-of-pocket costs reduce dental service use by the nonelderly privately insured and uninsured. Using data from the 2001-2006 Medical Expenditure Panel Survey and an American Dental Association survey of dental procedure prices, we jointly estimate the probability of using preventive and both basic and major restorative services through a correlated random effects specification that controls for endogeneity. We found that dental coverage increased the probability of preventive care use by 19% and the use of restorative services 11% to 16%. Both conditional and unconditional on dental coverage, the use of dental services was not sensitive to out-of-pocket costs. We conclude that dental coverage is an important determinant of preventive dental service use, but other nonprice factors related to consumer preferences, especially education, are equal if not stronger determinants.
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Affiliation(s)
- Chad D Meyerhoefer
- Department of Economics, Lehigh University, Bethlehem, USA; National Bureau of Economic Research, Cambridge, USA
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Matsuyama Y, Aida J, Takeuchi K, Tsakos G, Watt RG, Kondo K, Osaka K. Inequalities of dental prosthesis use under universal healthcare insurance. Community Dent Oral Epidemiol 2013; 42:122-8. [DOI: 10.1111/cdoe.12074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Yusuke Matsuyama
- Department of International and Community Oral Health; Tohoku University Graduate School of Dentistry; Sendai Japan
| | - Jun Aida
- Department of International and Community Oral Health; Tohoku University Graduate School of Dentistry; Sendai Japan
| | - Kenji Takeuchi
- Department of International and Community Oral Health; Tohoku University Graduate School of Dentistry; Sendai Japan
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; University College London; London UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health; University College London; London UK
| | - Katsunori Kondo
- Center for Well-being and Society; Nihon Fukushi University; Nagoya Japan
| | - Ken Osaka
- Department of International and Community Oral Health; Tohoku University Graduate School of Dentistry; Sendai Japan
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17
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Higbea RJ, Palumbo CH, Pearl SA, Byrne MJ, Wise J. Dentists’ Partnership Of Michigan’s Calhoun County: A Care Model For Uninsured Populations. Health Aff (Millwood) 2013; 32:1646-51. [DOI: 10.1377/hlthaff.2013.0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Raymond J. Higbea
- Raymond J. Higbea is an assistant professor of public affairs and administration at Western Michigan University, in Kalamazoo
| | - Charles H. Palumbo
- Charles H. Palumbo is the dental director at Community HealthCare Connections, in Battle Creek, Michigan
| | - Samantha A. Pearl
- Samantha A. Pearl ( ) is the executive director of Community HealthCare Connections
| | - Mary Jo Byrne
- Mary Jo Byrne is the executive director of Fountain Clinic, in Marshall, Michigan
| | - Jill Wise
- Jill Wise is the director of community projects at Family Health Center of Battle Creek, in Michigan
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18
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He F, White C. The effect of the children's health insurance program on pediatricians' work hours. MEDICARE & MEDICAID RESEARCH REVIEW 2013; 3:mmrr2013_003_01_a01. [PMID: 24753962 DOI: 10.5600/mmrr.003.01.a01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Our study examines changes in physicians' work hours in response to a coverage expansion. METHODS We use as a natural experiment the Children's Health Insurance Program (CHIP), which was established in 1997 and significantly expanded children's eligibility for public health insurance coverage. The magnitude of the CHIP expansion varied across states and over time, allowing its effects to be identified using a state-year fixed effects model. We focus on pediatricians, and we measure their self-reported work hours using multiple waves (pre- and post-CHIP) of the physician survey component of the Community Tracking Study. To address endogeneity concerns, we instrument for CHIP enrollment using key program features (income eligibility cutoffs and waiting times). RESULTS We find a large negative relationship between the magnitude of a state's CHIP expansion and trends in pediatricians' work hours. This relationship could be due to key supply-side features of CHIP, including relatively low provider reimbursements and heavy use of managed care tools.
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Affiliation(s)
- Fang He
- U.S. Government Accountability Office
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19
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Health insurance, socio-economic position and racial disparities in preventive dental visits in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:178-91. [PMID: 23282482 PMCID: PMC3564136 DOI: 10.3390/ijerph10010178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/25/2012] [Accepted: 12/25/2012] [Indexed: 11/17/2022]
Abstract
This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs.
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21
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Lai B, Milano M, Roberts MW, Hooper SR. Unmet dental needs and barriers to dental care among children with autism spectrum disorders. J Autism Dev Disord 2012; 42:1294-303. [PMID: 21909827 DOI: 10.1007/s10803-011-1362-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mail-in pilot-tested questionnaires were sent to a stratified random sample of 1,500 families from the North Carolina Autism Registry. Multivariate logistic regression analysis was used to determine the significance of unmet dental needs and other predictors. Of 568 surveys returned (Response Rate = 38%), 555 were complete and usable. Sixty-five (12%) children had unmet dental needs. Of 516 children (93%) who had been to a dentist, 11% still reported unmet needs. The main barriers were child's behavior, cost, and lack of insurance. The significant predictor variables of unmet needs were child's behavior (p = 0.01), child's dental health (p < 0.001), and caregiver's last dental visit greater than 6 months (p = 0.002). Type of ASD did not have an effect on having unmet dental needs.
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Affiliation(s)
- Bien Lai
- School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
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22
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Isong IA, Soobader MJ, Fisher-Owens SA, Weintraub JA, Gansky SA, Platt LJ, Newacheck PW. Racial disparity trends in children's dental visits: US National Health Interview Survey, 1964-2010. Pediatrics 2012; 130:306-14. [PMID: 22753556 PMCID: PMC3408679 DOI: 10.1542/peds.2011-0838] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Research that has repeatedly documented marked racial/ethnic disparities in US children's receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children's receipt of dental care from 1964 to 2010. METHODS We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: child's receipt of a dental visit in the previous 12 months and child's history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ(2) tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census. RESULTS The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in children's dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010. CONCLUSIONS We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of children's receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in children's oral health status are eliminated.
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Affiliation(s)
- Inyang A. Isong
- MassGeneral Hospital Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jane A. Weintraub
- The University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina; and
| | - Stuart A. Gansky
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, California
| | - Larry J. Platt
- Philip R. Lee Institute for Health Policy, School of Medicine, University of California, San Francisco, California
| | - Paul W. Newacheck
- Department of Pediatrics and,Philip R. Lee Institute for Health Policy, School of Medicine, University of California, San Francisco, California
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23
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Pourat N, Finocchio L. Racial And Ethnic Disparities In Dental Care For Publicly Insured Children. Health Aff (Millwood) 2010; 29:1356-63. [PMID: 20606188 DOI: 10.1377/hlthaff.2009.0089] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nadereh Pourat
- Nadereh Pourat ( ) is an associate professor in the Department of Health Services, School of Public Health, at the University of California, Los Angeles
| | - Len Finocchio
- Len Finocchio is a senior program officer at the California HealthCare Foundation, in Oakland
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Assessing patterns of restorative and preventive care among children enrolled in Medicaid, by type of dental care provider. J Am Dent Assoc 2009; 140:886-94. [PMID: 19571052 DOI: 10.14219/jada.archive.2009.0282] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children. METHODS The authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally. RESULTS Among the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers. CONCLUSIONS The study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care-only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.
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25
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Liao CC, Ganz ML, Jiang H, Chelmow T. The impact of the public insurance expansions on children's use of preventive dental care. Matern Child Health J 2008; 14:58-66. [PMID: 19067137 DOI: 10.1007/s10995-008-0432-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 11/12/2008] [Indexed: 11/26/2022]
Abstract
To determine if children eligible for coverage by the State Children's Health Insurance Program (SCHIP) and Medicaid Programs were more likely to receive preventive dental visits after implementation of the SCHIP policy, retrospective cross-sectional analysis was done from the 1996-2000 Medical Expenditure Panel Surveys (MEPS) data. We linked the individual level data from the MEPS to state-level information on program eligibility. Using logistic regression models that adjust for the complex survey design, the association between SCHIP implementation and receipt of preventive dental care was examined for children aged 3-18 with family incomes < or =200% of the Federal Poverty Line (FPL). Children who were eligible for SCHIP/Medicaid coverage in their respective states were more likely to have received preventive care three years after SCHIP implementation than children with similar eligibility profiles prior to SCHIP implementation. SCHIP has successfully increased the proportion of eligible children receiving preventive dental care among children in families with incomes less than or equal to 200% FPL. Our findings indicate, however, that SCHIP needed time to mature before detecting significant effects on national level.
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Affiliation(s)
- Chi-Chi Liao
- Executive Office of Health and Human Services, The Commonwealth of Massachusetts,OAAC, Boston, MA 02110, USA.
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26
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Fernald LCH, Gertler PJ, Hou X. Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults. J Nutr 2008; 138:2250-7. [PMID: 18936227 PMCID: PMC3151439 DOI: 10.3945/jn.108.090506] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 05/12/2008] [Accepted: 08/25/2008] [Indexed: 11/14/2022] Open
Abstract
The cash component of Oportunidades, a large conditional cash transfer (CCT) program in Mexico, has previously been shown to be associated with better outcomes for child growth and development. The objective of this analysis was to determine whether the cash transfers were also associated with positive outcomes for adult health. Oportunidades was originally randomized across 506 rural (<2500 inhabitants) communities assigned to immediate incorporation into the program in 1997 or incorporation 18 mo later. Adults (n = 1649 early, n = 2039 late intervention) aged 18-65 y were then assessed in 2003. All of the households included in the analysis reported here complied with Oportunidades's requirements for the entire period, but some received higher cumulative cash transfers because they were living in communities randomized to begin receiving transfers earlier and/or they accumulated cash at a faster rate because they had more school-aged children at baseline. Our primary findings were that a doubling of cumulative cash transfers to the household was associated with higher BMI (beta = +0.83, 95% CI 0.46, 1.20; P < 0.0001), higher diastolic blood pressure (beta = +1.19, 95% CI 0.09, 2.29; P = 0.03), and higher prevalence of overweight [odds ratio (OR) = 1.41, 95% CI 1.18, 1.67; P < 0.0001), grade I obesity (OR = 1.41, 95% CI 1.14, 1.75; P = 0.002), and grade II obesity (OR = 1.57, 95% CI 1.05, 2.36; P = 0.03), while controlling for a wide range of covariates, including household composition at baseline. Oportunidades has been portrayed as a model for CCT programs worldwide, but the results reported here support the notion that the cash component of Oportunidades may be negatively associated with some adult health outcomes.
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Affiliation(s)
- Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
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27
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Brickhouse TH, Rozier RG, Slade GD. Effects of enrollment in medicaid versus the state children's health insurance program on kindergarten children's untreated dental caries. Am J Public Health 2008; 98:876-81. [PMID: 18382008 DOI: 10.2105/ajph.2007.111468] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared levels of untreated dental caries in children enrolled in public insurance programs with those in nonenrolled children to determine the impact of public dental insurance and the type of plan (Medicaid vs State Children's Health Insurance Program [SCHIP]) on untreated dental caries in children. METHODS Dental health outcomes were obtained through a calibrated oral screening of kindergarten children (enrolled in the 2000-2001 school year). We obtained eligibility and claims data for children enrolled in Medicaid and SCHIP who were eligible for dental services during 1999 to 2000. We developed logistic regression models to compare children's likelihood and extent of untreated dental caries according to enrollment. RESULTS Children enrolled in Medicaid or SCHIP were 1.7 times (95% confidence interval [CI] = 1.65, 1.77) more likely to have untreated dental caries than were nonenrolled children. SCHIP-enrolled children were significantly less likely to have untreated dental caries than were Medicaid-enrolled children (odds ratio [OR]=0.74; 95% CI=0.67, 0.82). According to a 2-part regression model, children enrolled in Medicaid or SCHIP have 17% more untreated dental caries than do nonenrolled children, whereas those in SCHIP had 16% fewer untreated dental caries than did those in Medicaid. CONCLUSIONS Untreated tooth decay continues to be a significant problem for children with public insurance coverage. Children who participated in a separate SCHIP program had fewer untreated dental caries than did children enrolled in Medicaid.
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Affiliation(s)
- Tegwyn H Brickhouse
- School of Public Health, University of North Carolina, Chapel Hill, NC, USA.
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Hoffman C, Paradise J. Health insurance and access to health care in the United States. Ann N Y Acad Sci 2007; 1136:149-60. [PMID: 17954671 DOI: 10.1196/annals.1425.007] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Health insurance, poverty, and health are all interconnected in the United States. This article synthesizes a large and compelling body of health services research, finding a strong association between health insurance coverage and access to primary and preventive care, the treatment of acute and traumatic conditions, and the medical management of chronic illness. Moreover, by improving access to care, health insurance coverage is also fundamentally important to better health care and health outcomes. Research connects being uninsured with adverse health outcomes, including declines in health and function, preventable health problems, severe disease at the time of diagnosis, and premature mortality.
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Affiliation(s)
- Catherine Hoffman
- Kaiser Commission on Medicaid and the Uninsured, Menlo Park, California 94025, USA.
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29
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Glied S. Lessons from SCHIP. Health Serv Res 2007. [DOI: 10.1111/j.1475-6773.2007.00757.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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