Kamyar Nasseh

A decade in dental care utilization among adults and children (2001-2010).

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.

The Effect of Chairside Chronic Disease Screenings by Oral Health Professionals on Health Care Costs

OBJECTIVES We estimated short-term health care cost savings that would result from oral health professionals performing chronic disease screenings. METHODS We used population data, estimates of chronic disease prevalence, and rates of medication adherence from the literature to estimate cost savings that would result from screening individuals aged 40 years and older who have seen a dentist but not a physician in the last 12 months. We estimated 1-year savings if patients identified during screening in a dental setting were referred to a physician, completed their referral, and started pharmacological treatment. RESULTS We estimated that medical screenings for diabetes, hypertension, and hypercholesterolemia in dental offices could save the health care system from

Health Reform In Massachusetts Increased Adult Dental Care Use, Particularly Among The Poor

42.4 million (

The Impact of Medicaid Reform on Children’s Dental Care Utilization in Connecticut, Maryland, and Texas

13.51 per person screened) to

The effect of the Affordable Care Act's expanded coverage policy on access to dental care.

102.6 million (

The Relationship between Periodontal Interventions and Healthcare Costs and Utilization. Evidence from an Integrated Dental, Medical, and Pharmacy Commercial Claims Database

32.72 per person screened) over 1 year, dependent on the rate of referral completion from the dental clinic to the physicians office. CONCLUSIONS Oral health professionals can potentially play a bigger role in detecting chronic disease in the US population. Additional prevention and monitoring activities over the long term could achieve even greater savings and health benefits.

The effect of growing income disparities on U.S. adults' dental care utilization

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 states 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.

Early Impact of the Affordable Care Act's Medicaid Expansion on Dental Care Use

Objective To measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children. Data 2007 and 2011–2012 National Survey of Children’s Health. Study Design Difference-in-differences and triple differences models were used to measure the impact of reforms. Principal Findings Relative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas. Conclusions Increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Earnings of Employed and Self-employed US Health Care Professionals, 2001 to 2015

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.

The impact of the affordable care act's Medicaid expansion on dental care use through 2016

Abstract Periodontal disease has been linked to poor glycemic control among individuals with type 2 diabetes. Using integrated dental, medical, and pharmacy commercial claims from Truven MarketScan® Research Databases, we implement inverse probability weighting and doubly robust methods to estimate a relationship between a periodontal intervention and healthcare costs and utilization. Among individuals newly diagnosed with type 2 diabetes, we find that a periodontal intervention is associated with lower total healthcare costs (−