The effects of dental hygienist autonomy on dental care utilization.

autonomy dental care dental hygienist occupational licensing scope of practice utilization

Journal

Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780

Informations de publication

Date de publication:
27 Mar 2024
Historique:
revised: 07 03 2024
received: 17 10 2022
accepted: 09 03 2024
medline: 27 3 2024
pubmed: 27 3 2024
entrez: 27 3 2024
Statut: aheadofprint

Résumé

We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use with the 2001-2014 Medical Expenditure Panel Survey. We measure the strength of autonomy regulations by extending the Dental Hygiene Professional Practice Index to the years 2001-2014, allowing us to capture changes in regulations within states over time. Using a difference-in-differences framework applied to selected states, we find that relaxing supervision requirements to provide dental hygienists moderate autonomy results in an increase in total dental visits due to greater use of preventive dental care. However, the use of dental treatment decreases when states adopt the highest level of autonomy. Both sets of estimates increase in magnitude when we subset the sample to dental care provider shortage areas. In support of these findings, we show that dental visits shift to dental hygienists in shortage areas when states expand the scope of practice of hygienists, and that there is an increase in tasks performed by hygienists, such as cleanings and dental exams.

Identifiants

pubmed: 38536894
doi: 10.1002/hec.4832
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 John Wiley & Sons Ltd.

Références

Abdus, S., & Decker, S. L. (2019). Association between Medicaid adult nonemergency dental benefits and dental services use and expenditures. The Journal of the American Dental Association, 150(1), 24–33. https://doi.org/10.1016/j.adaj.2018.08.010
Aldosari, M. A., Bukhari, O. M., Ruff, R. R., Palmisano, J. N., Nguyen, H., Douglas, C. W., Niederman, R., & Starr, J. R. (2021). Comprehensive, school‐based preventive dentistry: Program details and students’ unmet dental needs. Journal of School Health, 91(9), 761–770. https://doi.org/10.1111/josh.13063
Alexander, D., & Schnell, M. (2019). Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health. Journal of Health Economics, 66, 145–162. https://doi.org/10.1016/j.jhealeco.2019.04.004
Alfsonso, Y. N., Leider, J. P., Resnick, B., Mac McCullogh, J., & Bishai, D. (2021). US public health neglected: Flat or declining spending left states ill equipped to respond to COVID‐19. Health Affairs, 40(4), 664–671. https://doi.org/10.1377/hlthaff.2020.01084
American Dental Association. (2014). Key differences in dental care seeking behavior between Medicaid and NonMedicaid adults and children. Available from https://www.ada.org/~/media/ADA/ScienceandResearch/HPI/Files/HPIBrief_0814_4.pdf?la=en. Accessed 30 September 2020.
American Dental Hygienists’ Association. (2020). Direct access states. Available from https://www.adha.org/resources‐docs/7513_Direct_Access_to_Care_from_DH.pdf. Accessed 30 September 2020.
Baicker, K., Chernow, M. E., & Robbins, J. A. (2013). The spillover effects of Medicare managed care: Medicare advantage and hospital utilization. Journal of Health Economics, 32(6), 1289–1300. https://doi.org/10.1016/j.jhealeco.2013.09.005
Barzel, R. & Holt, K. (Eds.) (2019). Promoting oral health in schools: A Resource guide (4th ed.). National Maternal and Child Oral Health Resource Center.
Buchmueller, T., Miller, S., & Vujicic, M. (2016). How do providers respond to changes in public health insruance coverage? Evidence from adult Medicaid dental benefits. American Economic Journal: Economic Policy, 8(4), 70–102. https://doi.org/10.1257/pol.20150004
Bureau of Labor Statistics. (2019). Professional certifications and occupational licenses: Evidence from the current population survey. Available from: https://www.bls.gov/opub/mlr/2019/article/professional‐certifications‐and‐occupational‐licenses.htm. Accessed 30 September 2020.
Bureau of Labor Statistics. (2020). Occupational outlook Handbook, dental hygienists. Available from: https://www.bls.gov/ooh/healthcare/dental‐hygienists.htm. Accessed 30 September 2020.
Cameron, C. A., & Miller, D. L. (2015). A practitioner’s guide to cluster‐robust inference. Journal of Human Resources, 50(2), 317–372. https://doi.org/10.3368/jhr.50.2.317
Centers for Disease Control and Prevention (CDC). (2023). School sealant programs. Available from: https://www.cdc.gov/oralhealth/dental_sealant_program/school‐sealant‐programs.htm. Accessed 17 January 2023.
Children’s Dental Health Project. (2013). Issue brief: Cost effectiveness of preventive dental services. Updated by Adam Lincoln and Shanté Alerté from materials developed by Shelly‐Ann Sinclair and Burton Edelstein. April 2013. Retrieved from https://www.cdhp.org/resources/163‐cost‐effectiveness‐of‐preventive‐dental‐services
Collins, J. (2017). Autonomously where the need is: Dental hygiene earns more self‐control with care in areas of need. RDH. Available from: https://www.rdhmag.com/patient‐care/article/16409896/autonomously‐where‐the‐need‐is‐dental‐hygiene‐earns‐more‐selfcontrol‐with‐care‐in‐areas‐of‐need. Accessed 25 January 2023.
de Chaisemartin, C., & D'Haultfœuille, X. (2020). Two‐way fixed effects estimators with heterogeneous treatment effects. The American Economic Review, 110(9), 2964–2996. https://doi.org/10.1257/aer.20181169
Decker, S. L., & Lipton, B. 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, 44, 212–225. https://doi.org/10.1016/j.jhealeco.2015.08.009
Goodman‐Bacon, A. (2021). Difference‐in‐differences with variation in treatment timing. Journal of Econometrics, 225(2), 254–277. https://doi.org/10.1016/j.jeconom.2021.03.014
Goodman‐Bacon, A., Goldring, T., & Nichols, A. (2019). Bacondecomp: Stata module for decomposing difference‐in‐differences estimation with variation in treatment timing. Available from: https://ideas.repec.org/c/boc/bocode/s458676.html. Accessed 9 June 2023.
Griffin, S., Naavaal, S., Scherrer, C., Griffin, P. M., Harris, K., & Chattopadhyay, S. (2016). School‐based dental sealant programs prevent cavities are cost‐effective. Health Affairs, 35(12), 2233–2240. https://doi.org/10.1377/hlthaff.2016.0839
Health Policy Institute. (2014). A ten‐year, state‐by‐state, analysis of Medicaid fee‐for‐service reimbursement rates for dental care services. Health policy institute research brief. American Dental Association. Available from http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_3.ashx. Accessed 29 May 2023.
Health Resources & Services Administration (HRSA). (2023). What is a health center? Available from: https://bphc.hrsa.gov/about‐health‐centers/what‐health‐center. Accessed 22 June 2023.
Kleiner, M. M. (2016). Battling over jobs: Occupational licensing in health care. The American Economic Review, 106(5), 165–170. https://doi.org/10.1257/aer.p20161000
Kleiner, M. M., Allison, M., Park, K. W., & Wing, C. (2016). Relaxing occupational licensing requirements: Analyzing wages and prices for a medical service. The Journal of Law and Economics, 59(May), 1–42.
Kleiner, M. M., & Krueger, A. B. (2013). Analyzing the extent and influence of occupational licensing on the labor market. Journal of Labor Economics, 31(S1), S173–S202. https://doi.org/10.1086/669060
Kleiner, M. M., & Kudrle, R. T. (2000). Does regulation affect economic outcomes? The case of dentistry. The Journal of Law and Economics, 43(October), 547–582. https://doi.org/10.1086/467465
Kleiner, M. M., & Park, K. W. (2010). Battles among licensed occupations: Analyzing government regulations on labor market outcomes for dentists and hygienists. NBER Working Paper w16560.
Koch, T. G., & Petek, N. (2019). The effect of nurse practitioner scope of practice on health care utilization and health: Evidence from law changes and patient moves. Working Paper Retrieved from http://www.nathanpetek.com/uploads/1/2/0/1/1201922
Koppelman, J., Kelly, V., & Simon, L. (2016). Expanding where dental therapists can practice could increase Americans’ access to cost‐efficient care. Health Affairs, 35(12), 2200–2206. https://doi.org/10.1377/hlthaff.2016.0844
Kurtzman, E. T., Barnow, B. S., Johnson, J. E., Simmens, S. J., Infeld, D. L., & Mullan, F. (2017). Does the regulatory environment affect nurse practitioners’ patterns of practice or quality of care in health centers? Health Services Research, 52(S1), 437–458. https://doi.org/10.1111/1475‐6773.12643
Langelier, M., Baker, B., & Continelli, M. (2016a). A dental hygiene professional practice index by state, 2014. Rensselaer, NY: Oral Health Workforce Research Center, Center for Health Workforce Studies, School of Public Health, SUNY Albany.
Langelier, M., Continelli, T., Moore, J., Baker, B., & Surdu, S. (2016b). Expanded scopes of practice for dental hygienists associated with improved oral health outcomes for adults. Health Affairs, 35(12), 2207–2215. https://doi.org/10.1377/hlthaff.2016.0807
Lee, J. Y., Thomas, J. B., Savage, M. F., & Vann, W. F., Jr. (2006). Examining the cost‐effectiveness of early dental visits. Pediatric Dentistry, 28(2), 102–105.
Lipton, B. 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, 75, 102404. https://doi.org/10.1016/j.jhealeco.2020.102404
MACPAC. (2015). Coverage of Medicaid dental benefits for adults. Chapter 2 of the June 2015 Report to Congress on Medicaid and CHIP. Available from https://www.macpac.gov/publication/coverage‐of‐medicaid‐dental‐benefits‐for‐adults/. Accessed 29 May 2023.
Manski, R. J., Hoffmann, D., & Rowthorn, V. (2015). Increasing access to dental and medical care by allowing greater flexibility in scope of practice. American Journal of Public Health, 105(9), 1755–1762. https://doi.org/10.2105/ajph.2015.302654
Markowitz, S., & Adams, E. K. (2021). The effects of state scope of practice laws on the labor supply of advanced practice registered nurses. American Journal of Health Economics, 8(1), 65–98. https://doi.org/10.1086/716545
Markowitz, S., Kathleen Adams, E., Lewitt, M. J., & Dunlop, A. L. (2017). Competitive effects of scope of practice restrictions: Public health or public harm? Journal of Health Economics, 55, 201–218. https://doi.org/10.1016/j.jhealeco.2017.07.004
McMichael, B. J. (2018). Beyond physicians: The effect of licensing and liability laws on the supply of nurse practitioners and physician assistants. Journal of Empirical Legal Studies, 15(4), 732–771. https://doi.org/10.1111/jels.12198
McMichael, B. J., Spetz, J., & Buerhaus, P. I. (2019). The association of nurse practitioner scope‐of‐practice laws with emergency department use: Evidence from Medicaid expansion. Medical Care, 57(5), 362–368. https://doi.org/10.1097/mlr.0000000000001100
Mertz, E. A. (2016). The dental–medical divide. Health Affairs, 35(12), 2168–2175. https://doi.org/10.1377/hlthaff.2016.0886
Meyerhoefer, C. D., Panovska, I., & Manski, R. J. (2016). Projections of dental care use through 2026: Preventive care to increase while treatment will decline. Health Affairs, 35(12), 2183–2189. https://doi.org/10.1377/hlthaff.2016.0833
Millsap, A. A. (2018). It's time to expand scope of practice laws. Forbes. Available from: https://www.forbes.com/sites/adammillsap/2018/06/19/its‐time‐to‐expand‐scope‐of‐practice‐laws/?sh=6709729d2c64. Accessed 19 June 2023.
NACHC and DentaQuest Partnership for Oral Health Advancement. (2020). Oral health value‐based care: The federally qualified health center (FQHC) story. https://doi.org/10.35565/DQP.2020.2013
National Association of Community Health Centers (NACHC). (2019). Health centers reach into America’s most underserved communities. Available from: http://www.nachc.org/wp‐content/uploads/2019/09/Americas‐Health‐Centers‐Updated‐Sept‐2019.pdf. Accessed 22 June 2023.
Negrusa, B., Hogan, P. F., Warner, J. T., Schroeder, C. H., & Pang, Bo (2016). Scope of practice laws and anesthesia complications: No measurable impact of certified registered nurse anesthetist expanded scope of practice on anesthesia‐related complications. Medical Care, 54(10), 913–920. https://doi.org/10.1097/mlr.0000000000000554
Okunev, I., Tranby, E. P., Jacob, M., Diep, V. K., Kelly, A., Heaton, L. J., & Frantsve‐Hawley, J. (2022). The impact of underutilization of preventive dental care by adult Medicaid participants. Journal of Public Health Dentistry, 82(1), 88–98. https://doi.org/10.1111/jphd.12494
Perry, J. J. (2009). The rise and impact of nurse practitioners and physician assistants on their own and cross‐occupation incomes. Contemporary Economic Policy, 27(4), 491–511. https://doi.org/10.1111/j.1465‐7287.2009.00162.x
Picard, A. (2009). Making the American mouth: Dentists and public health in the twentieth century (p. 226). Rutgers University Press.
Quinonez, R. B., Downs, S. M., Shugars, D., Christensen, J., & Vann, W. F., Jr. (2005). Assessing cost‐effectiveness of sealant placement in children. Journal of Public Health Dentistry, 65(2), 82–89. https://doi.org/10.1111/j.1752‐7325.2005.tb02791.x
Reinders, J. J., Krijnen, W. P., Onclin, P., van der Schans, C. P., & Stegenga, B. (2017). Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists. International Dental Journal, 67(1), 46–58. https://doi.org/10.1111/idj.12254
Spetz, J., Parente, S. T., Town, R. J., & Bazarko, D. (2013). Scope‐of‐Practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics. Health Affairs, 32(11), 1977–1984. https://doi.org/10.1377/hlthaff.2013.0544
Timmons, E., Hockenberry, J., & Durrance, C. (2016). More battles among licensed occupations: Estimating the effects of scope of practice and direct access on the chiropractic. Physical Therapist, and Physician Labor Market, Mercatus Research.
Timmons, E. J. (2017). The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care. Health Policy, 121(2), 189–196. https://doi.org/10.1016/j.healthpol.2016.12.002
Traczynski, J., & Udalova, V. (2018). Nurse practitioner independence, health care utilization, and health outcomes. Journal of Health Economics, 58, 90–109. https://doi.org/10.1016/j.jhealeco.2018.01.001
U.S. Department of Veterans Affairs (VA). (2023). VA dentistry – improving veterans’ oral health. Available from: https://www.va.gov/dental/. Accessed 17 Jan 2023.
Vujicic, M., Buchmueller, T., & Klein, R. (2016). Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Affairs, 35(12), 2176–2182. https://doi.org/10.1377/hlthaff.2016.0800
Wanchek, T. (2010). Dental hygiene regulation and access to oral healthcare: Assessing the variation across the US states. British Journal of Industrial Relations, 48(4), 706–725. https://doi.org/10.1111/j.1467‐8543.2010.00809.x
Wiener, C. R., Summerlin, T., Smith, L. D., Carrier, D. T., & Wiener, M. A. (2020). Dental care needs of male versus female children visiting a school‐based mobile dental facility in West Virginia. Journal of Dental Hygiene, 94(3), 48–55.
Wing, C., & Marier, A. (2014). Effects of occupational regulations on the cost of dental services: Evidence from dental insurance claims. Journal of Health Economics, 34(1), 131–143. https://doi.org/10.1016/j.jhealeco.2013.12.001
Wing, P., Langelier, M., Continelli, T., & Battrell, A. (2005). A dental hygiene professional practice index (DHPPI) and access to oral health status and service use in the United States. Journal of Dental Hygiene: JDH/American Dental Hygienists’ Association, 79(2), 10.

Auteurs

Jie Chen (J)

Aledade Inc, Bethesda, Maryland, USA.

Chad D Meyerhoefer (CD)

Department of Economics, Lehigh University, Bethlehem, Pennsylvania, USA.

Edward J Timmons (EJ)

Department of Economics, West Virginia University, Morgantown, West Virginia, USA.

Classifications MeSH