Medicaid Expansion and the Dental Workforce: Policy Issues Affecting Emergency Department Use for Nontraumatic Dental Conditions
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In the United States, emergency department use for non-traumatic dental complaints has been on the rise. This rising trend has been associated with substantial consequences: increased demand on emergency departments, inefficient use of healthcare dollars and resources, non-definitive treatment of patients dental complaints and continual unmet dental care need. As this problematic trend gains the attention of stakeholders and policy makers, there is a need to shed light on the individual, contextual, and policy-related factors that influence visits to the emergency department for non-traumatic dental conditions. This dissertation focuses on three areas: (1) factors that have been associated with emergency department visits for dental conditions in the literature, the settings in which such studies have been conducted, and the potential predictors that have not been investigated, (2) the impact of the 2014 Affordable Care Act Medicaid expansion on emergency department dental visits, with further focus on the differential impact in rural and urban areas, (3) the associations between scope of practice regulations for dental hygienists and emergency department dental visits. Findings from the systematic review of literature indicate that insurance plays a major role in emergency department visits for non-traumatic dental complaints. Specifically, individuals with publicly funded health insurance such as Medicaid and Medicare, as well as those who are uninsured are more likely to use the emergency department for dental visits. Other important factors associated with emergency department dental visits include age, dental provider density, rurality, dental health professional shortage area designation, and expansion or restriction of Medicaid adult dental benefits. The second study found that among expansion states that provided Medicaid adult dental benefits, dental emergency department visits declined relative to non-expansion states, and relative to expansion states that did not provide dental benefits. However, dental emergency department visits among Medicaid enrollees increased significantly. Finally, findings from the third study indicate that less restrictive scope of practice regulations are associated with fewer dental emergency department visits, particularly among those aged 20 to 34.
