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The Effect of Medicaid Payment Rates on Access to Dental Care Among Children

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  • Thomas C. Buchmueller
  • Sean Orzol
  • Lara D. Shore-Sheppard

Abstract

Historically, low Medicaid reimbursement rates have limited the willingness of health care providers to accept Medicaid patients, leading to access problems in many communities. This problem has been especially acute in the case of dental care. We combine data from several sources to examine the effect of payment rates on access to dental care among children on Medicaid and on dentists' participation in the program. The main utilization analysis is based on data from the Survey of Income and Program Participation combined with data on Medicaid payment rates and private market dental fees for the years 2001 to 2010. Conditioning on state fixed effects, we find a modest, but statistically significant, positive relationship between Medicaid payment rates and several measures of dental care utilization. We find a comparable effect in aggregate data reported by state Medicaid programs. The most likely explanation for this result is that higher fees increase the number of dentists that accept Medicaid patients. We test this hypothesis directly using data from annual surveys of dentists conducted by the American Dental Association between 1999 and 2009. The results indicate a positive and statistically significant effect of Medicaid payment rates on whether a dentist treats any publicly insured patients and the percent of the practice's patients who have public insurance. Similar to the utilization results, the magnitude of the effect is relatively small. As a result, the estimates imply that increasing Medicaid payments to the level of private market fees would increase access to care, but the incremental cost of the additional visits induced would be very high.

Suggested Citation

  • Thomas C. Buchmueller & Sean Orzol & Lara D. Shore-Sheppard, 2013. "The Effect of Medicaid Payment Rates on Access to Dental Care Among Children," NBER Working Papers 19218, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:19218
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    1. Weintraub, J.A. & Stearns, S.C. & Rozier, R.G. & Huang, C.-C., 2001. "Treatment outcomes and costs of dental sealants among children enrolled in Medicaid," American Journal of Public Health, American Public Health Association, vol. 91(11), pages 1877-1881.
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    3. Jonathan Gruber & Kathleen Adams & Joseph P. Newhouse, 1997. "Physician Fee Policy and Medicaid Program Costs," Journal of Human Resources, University of Wisconsin Press, vol. 32(4), pages 611-634.
    4. Laurence C. Baker & Anne Beeson Royalty, 2000. "Medicaid Policy, Physician Behavior, and Health Care for the Low-Income Population," Journal of Human Resources, University of Wisconsin Press, vol. 35(3), pages 480-502.
    5. Long, Stephen H. & Settle, Russell F. & Stuart, Bruce C., 1986. "Reimbursement and access to physicians' services under Medicaid," Journal of Health Economics, Elsevier, vol. 5(3), pages 235-251, September.
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    7. Rosenbach, M.L., 1989. "The impact of Medicaid on physician use by low-income children," American Journal of Public Health, American Public Health Association, vol. 79(9), pages 1220-1226.
    8. Frank Sloan & Janet Mitchell & Jerry Cromwell, 1978. "Physician Participation in State Medicaid Programs," NBER Chapters, in: The Economics of Physician and Patient Behavior, pages 211-245, National Bureau of Economic Research, Inc.
    9. Sandra Decker, 2007. "Medicaid physician fees and the quality of medical care of Medicaid patients in the USA," Review of Economics of the Household, Springer, vol. 5(1), pages 95-112, March.
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    Cited by:

    1. Marianne P. Bitler & Madeline Zavodny, 2014. "Medicaid: A Review of the Literature," NBER Working Papers 20169, National Bureau of Economic Research, Inc.
    2. Sonchak, Lyudmyla, 2015. "Medicaid reimbursement, prenatal care and infant health," Journal of Health Economics, Elsevier, vol. 44(C), pages 10-24.
    3. Pinka Chatterji & Sandra L. Decker & Jason Huh, 2022. "Medicaid physician fees and access to care among children with special health care needs," Review of Economics of the Household, Springer, vol. 20(3), pages 887-919, September.
    4. Johanna Catherine Maclean & Chandler McClellan & Michael F. Pesko & Daniel Polsky, 2023. "Medicaid reimbursement rates for primary care services and behavioral health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 32(4), pages 873-909, April.
    5. Thomas C. Buchmueller & Sarah Miller & Marko Vujicic, 2014. "How Do Providers Respond to Public Health Insurance Expansions? Evidence from Adult Medicaid Dental Benefits," NBER Working Papers 20053, National Bureau of Economic Research, Inc.
    6. Michael R. Richards & Coady Wing, 2019. "Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1356-1369, November.
    7. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    8. Lipton, Brandy J., 2021. "Adult Medicaid benefit generosity and receipt of recommended health services among low-income children: The spillover effects of Medicaid adult dental coverage expansions," Journal of Health Economics, Elsevier, vol. 75(C).
    9. Kamyar Nasseh & John R. Bowblis, 2022. "The effect on dental care utilization from transitioning pediatric Medicaid beneficiaries to managed care," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1103-1128, June.
    10. Nibene H. Somé & Bernard Fortin & Bruce Shearer, 2024. "Measuring physicians' response to incentives: Labour supply, multitasking and earnings," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 57(2), pages 622-661, May.
    11. Decker, Sandra L. & Lipton, Brandy J., 2015. "Do Medicaid benefit expansions have teeth? The effect of Medicaid adult dental coverage on the use of dental services and oral health," Journal of Health Economics, Elsevier, vol. 44(C), pages 212-225.
    12. Shooshan Danagoulian & Thomas A. Wilk, 2022. "Locking out prevention: Dental care in the midst of a pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1973-1992, September.
    13. Kamyar Nasseh & John R. Bowblis & Coady Wing, 2024. "How do dental practices respond to changes in scope of practice regulations?," Health Economics, John Wiley & Sons, Ltd., vol. 33(11), pages 2508-2524, November.
    14. Thomas Buchmueller & Sarah Miller & Marko Vujicic, 2016. "How Do Providers Respond to Changes in Public Health Insurance Coverage? Evidence from Adult Medicaid Dental Benefits," American Economic Journal: Economic Policy, American Economic Association, vol. 8(4), pages 70-102, November.

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    More about this item

    JEL classification:

    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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