All ETDs from UAB

Advisory Committee Chair

David J Becker

Advisory Committee Members

Justin Blackburn

Allen Conan Davis

Julie Lynn Locher

Bisakha Sen

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

This dissertation examines the impact of Medicaid dental coverage on dental care utilization and oral health outcome of low-income elderly and non-elderly adults, using a fixed-effects model with longitudinal data of all states and multiple years from the Behavioral Risk Factors Surveillance System (BRFSS). By exploiting within-state variation over time in adult Medicaid dental coverage, the study estimates the effects of Medicaid dental coverage on dental care utilization (i.e., dental visits and dental cleanings) and oral health outcome (i.e., tooth loss). The study evaluates the effects of Medicaid dental benefits with preventive dental services on each of the three dental outcomes as well. This study finds that Medicaid dental coverage has an effect on increase in dental visits for both low-income elderly and non-elderly adults. Among non-elderly adults, Medicaid dental coverage increases the likelihood of dental cleanings while it decreases the likelihood of tooth loss. Meanwhile, the study finds no significant evidence to support the effects of Medicaid dental coverage on dental cleanings and tooth loss of elderly adults. The estimated effects of Medicaid dental benefits with preventive dental services are analogous to the estimated effects of Medicaid dental coverage on the three dental outcomes. Even though the results show that Medicaid dental coverage is positively associated with dental care utilization among low-income adults, the magnitude of the estimated effects is modest. This implies that public dental insurance expansion alone is not enough to succeed in promoting access to dental care of low-income adults. Increasing effect of Medicaid dental coverage on preventive dental care is only seen in non-elderly adults. This suggests further efforts to find out other significant factors affecting access to preventive dental care among the elderly population, who is rapidly growing and expected to make up a substantial part of the total U.S. population in the near future.

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