Digital Commons Network^™

The Effect Of Dental Insurance Coverage And Economic Fluctuations On Oral Health Outcomes In The United States, Laura Singletary

Senior Theses

Proper oral health is imperative to overall health, but obstacles often persist in

receiving proper oral health care. Lack of dental insurance coverage and economic recessions are two main factors contributing to oral health outcomes. Extended time without cleanings or addressing current oral health concerns exacerbates oral health problems into more costly procedures for the patient that are conveniently not covered by many insurance plans. This thesis investigates the oral health outcomes associated with periods following economic downturns, specifically citing the time of the Great Recession from 2007-2009.

Perceived Barriers To Health Care Access And Delivery Among Arkansas Medicaid Beneficiaries, Kimbra D. Butler

Walden Dissertations and Doctoral Studies

Arkansas has historically been one of the lowest ranking states in the United States in education, economy, opportunity, crime and corrections, and health care. Though more than 3 million Arkansans live in the state, nearly 1 million receive Medicaid-funded health insurance. This phenomenological study employed a constructivist paradigm and focused on the perceptions of underserved Arkansans regarding their health and their access to health care; additionally, within this study, the Health Belief Model shifted the study’s focus to individuals’ perspectives, perceptions, experiences, and opinions through interview responses. The research was intended to identify factors that may relate to the higher …

Medicaid In The Orthodontic Community: Provider Trends And Perceptions, Miranda L. Fabrega

Graduate Theses, Dissertations, and Problem Reports

Background and Objectives: Medicaid is a federal and state insurance program aimed at helping economically disadvantaged individuals and families with gaining access to health care. Lack of provider participation in the Medicaid program leaves many Medicaid-eligible individuals with the inability to obtain certain medical services, such as orthodontic care. The objective of this study was to use an electronic survey to better understand the beliefs and behaviors of orthodontists in regard to participation in the Medicaid program, and to determine if differences exist between Medicaid providers and non-Medicaid providers. Experimental Design and Methods: Survey: Requests to participate in an electronic …

Disparities In Oral Health: Socioeconomic Status And Policies To Increase Access To Primary Dental Care, Mckenzie Nutter

Theses/Capstones/Creative Projects

Primary dental care is a patient-centered service consisting of routine dental checkups. The oral cavity is the first point of entrance to the body for many harmful pathogens. Therefore, primary dental care is essential to not only prevent and treat conditions in the mouth, but to also reduce the number of systemic diseases in the rest of the body. However, people with higher incomes or wealth have increased access to primary dental care. People with low socioeconomic status have decreased access to primary dental care, at least in part due to difficulties in paying for separate dental insurance. Disparities in …

How Did Medicaid Expansion Affect The Provider Labor Market?, Aaron Wu

Honors Theses

One provision of the Affordable Care Act was to expand Medicaid eligibility for a greater number of low-income patients. The resulting increase in demand for care was largely explored, but the effect of the 2014 Medicaid expansion on the physician and advanced practitioner labor market has not been well researched by economists. Using pooled cross-sectional data from the 2010 – 2018 American Community Surveys, this paper examines whether the Medicaid expansion has caused notable changes in physician, physician assistant, and nurse practitioner hours, compensation, and overall employment. The literature shows that practices that employ nurse practitioners are far more likely …

An Evaluation Of The Treatment Of Asthma In The State Of Mississippi Using Hedis Quality Control Measures, Kyle Kantor

Honors Theses

Introduction: Asthma is an inflammatory condition of the lungs that can have significant impacts on a patient’s quality of life. Asthma attacks can be very uncomfortable and even deadly in some cases. The objective of this study is to evaluate the treatment of asthma in the state of Mississippi and to describe the disparities between demographics to help healthcare providers identify patients who might be at risk for poor treatment and help those patients receive quality healthcare. Methods: The data was retrospectively collected from January to December 2014 Mississippi Centers for Medicare and Medicaid Services claims data. This study is …

Health Care Access For Children In Latinx Immigrant Families In The Greater Philadelphia Area, Sophia King

Politics Honors Papers

This work examines the gap that exists in access to health care in the Greater Philadelphia Region for children of Latinx immigrant families in comparison to other children in the nation. It provides a critical analysis of the gap in access to coverage, noting that this exists despite wide support for a human right to health. This study draws on existing scholarly research as well as interviews with staff at two health clinics and one community outreach center that are located in Greater Philadelphia. It demonstrates that Latinx immigrant families are less likely to have health insurance and get primary …

Outcomes Of Primary Endodontic Therapy In Medicaid Enrollees, Timothy Gainey

Master's Theses (2009 -)

The objective of this study was to determine factors affecting survival of teeth after nonsurgical root canal therapy (NSRCT) among enrollees of Wisconsin Medicaid during the years 2001-2009. Only permanent teeth with NSRCTs and that had permanent restorations within 60 days after treatment completion were included in the analysis. Patients with less than 60 days of insurance coverage after treatment completion were excluded. NSRCTs and untoward events (extraction) were identified based on Code on Dental Procedures and Nomenclature (CDT). Kaplan-Meier methods were used to plot the survival distribution for the overall cohort and subgroups by age, gender, race, tooth location, …

Did Medicaid Expansion Under The Affordable Care Act Reduce The Likelihood That People Report Employment Status Changes Due To Health, U.S., 2009-2017, Songyuan Deng

Theses and Dissertations

Medicaid expansion of Affordable Care Act (ACA) extended coverage to low-income working adults. While Medicaid expansion led to increased healthcare use and national healthcare expenditures, current studies do not examine the effects of Medicaid expansion on health status from the perspective of social roles, for example, changes in employment status. This study use data from the Current Population Survey to examine the association between Medicaid expansion and the probability to attribute part-time work or not-in-labor- force to health issues among people with family annual income no more than 138 of Federal Poverty Level, with a difference-in-differences study design. We found …

Healthcare Utilization & Health Behaviors Among Older Adults: The Role Of Insurance, Jennifer Rose Geiger

LSU Doctoral Dissertations

As the population of older adults in the U.S. continues its exponential growth, so too will the need for high-quality health and preventive services. Despite the widely acknowledged need for proactive solutions to the coming public health challenges for this rapidly expanding age cohort, healthcare providers and social work practitioners continue to lack the proper education training to serve the needs of older adults. Furthermore, these allied health professionals also frequently engage in ageist behaviors across care settings that also often employ institutionally ageist policies and procedures. As a result, older adults may be particularly at risk of negative health …

Florida Orthodontist Participation As Medicaid Providers, Lisa Brooks

Student Theses, Dissertations and Capstones

Low-income families are usually unable to afford the cost of orthodontic treatment. The Medicaid program exists to assist these families’ access to medical and dental care, including orthodontics in children and adolescents with severe malocclusions. There exists a contrast between need and care-received, which is a product of several general factors. This study will examine the factors involved with orthodontist participation. Previous studies have indicated that low reimbursement rates and excessive paperwork are among the reasons that providers choose not to participate in Medicaid. New studies have identified factors that were accurately able to predict if a dentist is a …

Consequences Of Community Water Fluoridation Cessation For Medicaid Eligible Children And Adolescents, Jennifer Meyer

Walden Dissertations and Doctoral Studies

Oral health impacts general health and well-being throughout the lifespan. Recent trends in the United States towards cessation of community water fluoridation (CWF) may increase disparities in oral health. The purpose of this quantitative retrospective cohort study was to analyze Medicaid dental claims records for caries related procedures among 0 to18-year-old patients during an optimal CWF year 2003 (n = 854) and compare them to claims records from 2012 (n = 1,053), 5 years after CWF was ceased. The theoretical framework of this study was the diffusion of innovations theory. Statistically significant results included higher mean number of caries related …

Socio-Demographics And Exclusive Breastfeeding In The Medicaid/Women Infant And Children (Wic) Population In Spartanburg County, April D. Miller

Nursing Theses and Capstone Projects

Breast milk is recognized as the optimal source of nutrition for infants because of its unique nutritional and immunological characteristics. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of an infant’s life. "Exclusive breastfeeding (EBF)" is defined as no other food or drink except breast milk for the first six months of life. Despite its countless benefits to children and mothers, the continuation rates of exclusive breastfeeding are low in the United States, especially in the Medicaid/Women Infant and Children population. It is vital to understand how multiple factors affect breastfeeding practices in order to …

The Future Of Healthcare In The United States, Aaron James Deyo

Chancellor’s Honors Program Projects

No abstract provided.

The New York State Nursing Home Transition And Diversion Medicaid Waiver Program : A Descriptive Cost Comparison, Joe Atsushi Katagiri

Legacy Theses & Dissertations (2009 - 2024)

The New York State Nursing Home Transition and Diversion Medicaid waiver program (NHTD) assists individuals with long-term care needs with the goal of living safely in their communities. This program is founded on two assumptions: it is less expensive to provide long-term care services to Medicaid recipients in the community as opposed to a nursing home and those who are willing and capable of living in a community setting should do so. However, the healthcare environment in the United States is facing the rising cost of long-term care. The first assumption, if true, could be used as a means to …

An Evaluation Of Prenatal Care Clinic Selection And The Association With Subsequent Process/Outcome Measures Among Medicaid Beneficiaries, Lynn Vanderwielen

Theses and Dissertations

In 2010 Medicaid financed approximately 48% of all births in the United States and nearly 30% of all births in Virginia. Due to strict state-specific eligibility criteria, many low-income women qualify for Medicaid coverage exclusively as a result of pregnancy status. As the nation moves forward with the Patient Protection and Affordable Care Act (PPACA), state-elected Medicaid expansion has the potential to expand services to women of reproductive age that would precede pregnancy events and offer continuous access to care postpartum. Despite this potential influx of newly insured women, little is known about how this population may make decisions regarding …

Predictors Of Emergency Room And Hospital Utilization Among Adults With Intellectual And Developmental Disabilities (Idd) In New York City, Meghan G. Blaskowitz

Legacy Theses & Dissertations (2009 - 2024)

Background. Avoidable emergency room (ER) visits and hospital admissions among people with intellectual and developmental disabilities (IDD) contribute significantly to rising Medicaid costs. The Affordable Care Act (ACA) and New York State (NYS) Medicaid Redesign Team have identified a critical need to reduce ER and hospital utilization in an effort to contain healthcare costs and improve quality of care. Study Objective. This study identifies independent predictors of medical and behavioral/psychiatric ER and hospital utilization for a cohort of individuals with IDD (n=597) residing in supported living arrangements in New York City, the most Medicaid-dense region of NYS. Methods. A retrospective …

Oral Health Literacy Of Parents And Dental Service Use For Children Enrolled In Medicaid, Angel Smith

Walden Dissertations and Doctoral Studies

Many people in the United States have untreated dental disease due to a lack of dental insurance, a lack of oral health knowledge, and a lack of priority placed on dental health. Despite an increase in dental service use by Medicaid recipients as a result of local programs, children enrolled in Medicaid often have low rates of use of dental services. Using the health literacy framework of the Paasche-Orlow and Wolf (POW) model, the purpose of this study was to explore to the relationship between oral health literacy of parents and dental service use for children enrolled in Medicaid and …

The Impact Of Medicaid Reform On Dental Practice Setting, Barrett W. R. Peters

Theses and Dissertations

Purpose: To assess the impact of dental Medicaid reform in Virginia on dental practice settings (private practice, corporate practice and safety net clinics). Methods: This retrospective cohort study of 16.2 million dental claims is from the Virginia Department of Medical Assistance Services, which included claims for providers participating in Virginia’s Medicaid program during a 10-year period (2002-2012). The dividing date for the reform was July 1, 2005. The outcome measure was mean claims per participating provider. A Poisson regression model was used to predict the mean number of claims per provider with the following predictors: reform period, practice setting, provider …

Retrospective Evaluation Of Oral Health Services For Underserved Children In Clark County, Nevada, Earl Taylor Spader

UNLV Theses, Dissertations, Professional Papers, and Capstones

Disparities in utilization of oral health services have been shown to exist through epidemiological investigations and data analysis. Specifically, disparities exist for utilization of preventative dental care (PDC) and unmet dental need (UDN). The disparities in utilization of PDC and UDN are associated with demographic and insurance variables.

To address the oral health disparities, the University of Nevada, Las Vegas-School of Dental Medicine (UNLV-SDM) was created to improve the health of the citizens of Nevada through innovative programs of oral healthcare services to the community. More recently, UNLV-SDM opened a pediatric dental residency training program to provide care directly to …

Dental Plan Performance With Medicaid Reform In Virginia, James Reed

Theses and Dissertations

Purpose: To assess the effect of dental Medicaid reforms in the state of Virginia on dental plan performance. Methods: This project is a retrospective cohort study of 825,000 dental claims obtained from the Virginia Department of Medical Assistance Services. This cohort includes dental claims for children enrolled in Virginia’s Medicaid program from July 1, 2002 through June 30, 2008. The independent variable was enrollment pre or post policy reform with July 1, 2005 as the period dividing date. The dependent variable was dental benefit utilization measured as the average number of restorative, preventative, and total procedures. Statistical methods include Welch’s …

The Effect Of Medicaid Policy Reform On Dental Utilization Rates For Children, Matthew Winheim

Theses and Dissertations

Background: Regular access to dental services is a well-known factor in the oral health and development of children.1 As such, the United States federal government mandates each state to include dental services for children enrolled in Medicaid through the age of 21. Despite this mandate, the utilization rate of dental services among Medicaid enrolled children has remained remarkably low.2 In July 2005, Virginia implemented a sweeping Medicaid policy reform titled “Smiles for Children,” specifically aiming to increase Medicaid pediatric dental utilization rates. The purpose of this study aims to assess the effect of this 2005 policy reform on the utilization …

Treatment Outcomes And Retention In Medicaid And Non-Medicaid Orthodontic Patients, Ashkan Ghaffari

Theses and Dissertations

Medicaid orthodontic patients have been shown to miss more appointments and break more appliances than self-pay patients, indicating a greater tendency toward non-compliance. Lack of compliance during the post-treatment phase can be detrimental to retention. The purpose of this study was to determine whether there is a difference in PAR score changes between Medicaid and non-Medicaid patients during and after orthodontic treatment. PAR scores were determined using study models of 43 Medicaid and 39 non-Medicaid patients before and at the end of active treatment, and 24 Medicaid and 42 non-Medicaid patients at the end of treatment and at an average …

The Effect Of A Nominal Fee On Treatment Choices For Children Needing Dental Rehabilitation, D'Audra M. Cole

Theses and Dissertations

Objective: The purpose of the study was to determine if a co-payment resulted in a differential preference for general anesthesia (GA) or oral sedation (OS) and, if so, to examine whether age, the number of appointments, perceived risks of treatment, child's awareness during treatment, or insurance type appeared to play a role in this preference.Methods: Using a cross-sectional survey design, questionnaires were distributed to caregivers of patients in the waiting room of the Virginia Commonwealth University Pediatric Dental Clinic. Two different questionnaires were distributed randomly. Both surveys described a scenario with the need for dental treatment under general anesthesia (GA) …

Effect Of Medicaid/Schip And Wic On Oral Health Of Low-Income Children, Dahlia Naqib

Theses and Dissertations

Oral caries is the most prevalent chronic disease among US children, and disproportionately impacts those of low socioeconomic status. Studies have shown that the Special Supplemental Nutrition Program for Women Infants and Children (WIC) improves access to dental care among Medicaid children. This study investigated the impact of WIC, Medicaid, and the State Children's Health Insurance Program (SCHIP) on the prevalence of dental caries among low-income children. The 1999-2000 and 2001-2002 NHANES data were utilized for this analysis. Children 2-4 years old who participated in WIC, Medicaid, or SCHIP, or who were uninsured, and for whom both interview and complete …

Appointment Keeping Behavior Of Medicaid Vs. Non-Medicaid Orthodontic Patients, Bryan P. Horsley

Theses and Dissertations

State Medicaid programs were established to care for the poor by eliminating financial barriers and increasing their ability to be treated within the mainstream of the heath care system. The number of children eligible for Medicaid services is increasing, yet the number of Medicaid providers remains low. Health care providers cite failed appointments as being a major problem with Medicaid patients and one of the largest deterrents to participating. The purpose of this study was to determine whether a difference in appointment keeping behavior exists between Medicaid and non-Medicaid orthodontic patients. During a twelve-month period, a tally of appointments was …

A Rural Vs. Urban Analysis Of Procedures Provided To Medicaid Recipients By Pediatric, General, And Public Health Dentists In The Commonwealth Of Virginia: Fiscal Years 1994-1995, Frank Carmen Pettinato

Theses and Dissertations

Purpose: The purpose of this study was to report the distribution of procedures provided to Virginia Medicaid children by three types of dental providers in rural and urban areas. Methods: Medicaid claims filed for dental patients younger than 21 were obtained and analyzed for fiscal years 1994 and 1995. Dental providers were categorized according to their practice type: general practice (GP), pediatric (PD) and public health (PH) dentists. Each type of practice was categorized as practicing in a Metropolitan, Urban, Rural or Completely Rural location and evaluated for percentages of preventive, diagnostic, and corrective services provided.Results: The number of procedures …