Putting Your Insurance Where Your Mouth Is: The Effect of Health Insurance Type on Oral Health Outcomes and Unmet Need

Tuesday, June 14, 2016
Lobby (Annenberg Center)

Author(s): Brett O'Hara; Joelle Abramowitz; Michelle Kisiel-Cohen

Discussant: Ausmita Ghosh

Objectives.  To measure under-utilization of oral health care by insurance type (Medicaid in states where Medicaid offers comprehensive coverage of dental services versus employment-based health insurance; ESI). 

Data.  We use information from the Survey of Income and Program Participation (SIPP) in 2010.  The survey has questions about dentist visits as well as teeth missing (all, some, or none).  We only consider working-age adults (aged 26-64).  For the main part of the analysis, we only include states that have comprehensive dental coverage as part of the Medicaid program.

Methods.  Multivariable logistic regression analyses were used to examine whether Medicaid or ESI is associated with better oral health outcomes.  Because the Medicaid population is different from the ESI population, we use propensity scoring to construct a comparison group from our ESI sample.

Results.  We first compare across Medicaid states with comprehensive dental coverage and without comprehensive coverage through tabular analysis.  We found dental visits much lower and edentulism (i.e., missing teeth) higher in states with non-comprehensive dental coverage compared to states with comprehensive dental coverage.  We then focus on adult Medicaid recipients living in states that offer full and comprehensive dental services to the comparison sample.  Adults on Medicaid within these states are less likely to visit a dentist (11 percentage points) and are more likely to be missing teeth (5 percentage points) than adults with employment-based insurance.  In both cases, we find that the Medicaid population was not statistically significantly different vis a vis unmet needs from the comparison sample after accounting for other factors (age, health, metro status, and income). 

Policy Implications.  This research has many implications for states that expanded Medicaid and do not provide comprehensive coverage of dental services. For example, our results support policies to expand Federally Qualified Health Centers.