Effects of the State Children's Health Insurance Program (SCHIP) on Access to Dental Care and Use of Dental Services
- Presenter:
Chair: Ciaran Phibbs; Discussant: Gabriel Picone Wed June 7, 2006 9:45-11:15 Room 213
Rationale: Lack of dental insurance is one of the main barriers to access to dental care for many low-income children in the U.S. The State Children’s Health Insurance Program (SCHIP), created by Congress in 1997, expands eligibility for public dental insurance to uninsured low-income children in almost all states. SCHIP may have extensive influence because it is also designed to facilitate Medicaid enrollment and it gives states flexibility in experimenting with new models that may overcome historical obstacles to access to dental care in public programs. Yet the extent to which SCHIP has improved children’s access to and use of dental services is largely unknown, especially at the national level.
Objective: To provide national estimates of the total implementation effects of SCHIP on dental care access and use for low-income children.
Methodology: Two separate analyses are conducted to estimate (1) the effect of program availability on dental care access and use for low-income children (regardless of eligibility or enrollment); and (2) more specifically, changes in dental care access and use for children who gained public insurance as a result of SCHIP implementation. In the first analysis, we consider SCHIP implementation a natural experiment, which has considerable variation in the timing of program implementation across states. We use the variation to identify the effect of SCHIP availability on dental care access (unmet need for dental care due to cost in the past year) and dental services use (time since last dental visit) for any low-income (<300% Federal Poverty Level) child in county and time fixed effects models. In the second analysis, we employ the instrumental variables method to “identify” children who had public insurance due to SCHIP implementation in addition to deal with endogeneity of insurance. State-level SCHIP program features are selected as instruments for public coverage, including program availability, eligibility thresholds, and waiting periods. By focusing on SCHIP’s overall effects, both analyses avoid the difficulty of imputing program eligibility or misreporting of SCHIP enrollment in the data. Both analyses estimate linear probability models adjusted for survey designs. The data source is the National Health Interview Survey 1997-2002 (N = 40,000+).
Results: SCHIP availability for more than one year reduced the likelihood of experiencing unmet dental care need for any low-income child by 2.8 percentage point; increased the probability of having a dental visit within 6 months or in the past 6-12 months by 2.2 and 0.9 percentage point, respectively. Compared with their uninsured counterparts, those who obtained public coverage from SCHIP implementation were less likely to report unmet need for dental care by 11.6 percentage point, and more likely to have visited a dentist within 6 months or in the past 6-12 months by 31 and 35.7 percentage point, respectively. School-aged children (6-17 years) fared better than younger children. Type of SCHIP program had no differential effects.
Conclusions: Consistent results from two analytical approaches provide solid evidence that SCHIP implementation has significantly reduced financial barriers to dental care and increased use of dental services for low-income children in the U.S.
