Department of Health Policy and Management Works

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Browsing Department of Health Policy and Management Works by Subject "Access to Health Care"

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    Pediatric dental care utilization and parent/caregiver-rated oral health among Medicaid enrollees in Alabama
    (American Dental Association, 2020-06) Blackburn, Justin; Bennett, Aleena; Fifolt, Matt; Rucks, Andrew; Taylor, Heather; Wolff, Paul; Sen, Bisakha
    Background: Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children's dental care use, including the association with children's oral health. Methods: A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means. Results: The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33). Conclusions: It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship. Practical implications: Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health.
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    Prevalence of and factors associated with unmet dental need among the U.S. adult population in 2016
    (2021-08) Taylor, Heather; Holmes, Ann M.; Blackburn, Justin
    Objectives: Understanding and addressing contributing factors to unmet dental need is an important public health challenge. This study investigated the prevalence of, and factors associated with, self-reported unmet dental need using a nationally representative sample of US adults. Methods: This was a cross-sectional study using the Medical Expenditures Panel Survey (MEPS) from 2016. The weighted prevalence of unmet dental need was estimated among individuals aged 18 years or older. Chi-squared and multivariate logit regression with marginal effects (ie absolute risk differences) were used to measure the association of unmet dental need with respondent characteristics. Results: The prevalence of adults reporting unmet dental need was 6% (95% CI: 5.5 to 6.5). Adults with dental insurance were 1.7 percentage points (95% CI: -2.8 to -0.6) less likely to report unmet dental needs than adults without dental insurance. Those with middle income were 2.3 percentage points (95% CI: 1.2 to 3.4), those with low income were 3.3 percentage points (95% CI: 1.7 to 5.0), and those with poor/negative/near-poor income were 4.2 percentage points (95% CI: 2.7 to 5.7) more likely to report an unmet dental need than adults with high income. Both Hispanics (-1.7 percentage points [95% CI: -2.8 to -0.6]) and non-Hispanic Blacks (-1.1 percentage points [95% CI: -2.1 to -0.1]) were less likely to report an unmet dental need than whites. Smoking, education, general health status, chronic disease and marital status were also significantly associated with reporting an unmet dental need. Conclusions: Future policies should continue to address cost and coverage barriers to adult dental care, as these remain significant barriers to access, particularly for low-income adults. Future research should evaluate the reasons adults report unmet dental need and explore how adults' judgment of dental need compares to providers' clinical judgment. Additionally, research that explores how race and ethnicity affect perceptions of unmet dental need is warranted.
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    The impact of narrow and tiered networks on costs, access, quality, and patient steering: A systematic review
    (Sage, 2022-10) Mazurenko, Olena; Taylor, Heather L.; Menachemi, Nir
    Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.