The Effects of SCHIP on Dental Care Access and Use

Objectives: To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for lower-income children. Methods: The study design is based on variation in the timing of SCHIP implementation across states and among children observed prior to and after implementation. Six years (1997-2002) of the National Health Interview Survey data were used in two analyses. The first estimated the total effect of SCHIP availability on dental care access (unmet need for dental care due to cost in the past year) and dental services use for any lower-income (<300%FPL) child using county and time fixed effects models. The second analysis estimated changes in dental care access and use among those who gained public insurance (mainly SCHIP and spillover Medicaid coverage) due to SCHIP using instrumental variables regressions to control for selection bias. Both analyses controlled for child and family characteristics. Results: SCHIP availability for more than one year reduced the likelihood of unmet dental care needs for a lower-income child by 2.8%. It increased the probability of having a dental visit within 6 months or in the past 6-12 months by 2.2% and 0.9%, respectively. Compared with their uninsured counterparts, those who obtained public coverage from SCHIP implementation were less likely to report unmet need by 11.6%, and more likely to have visited a dentist within 6 months or in the past 6-12 months by 31.0% and 35.7%, respectively. Older children (6-17 yrs.) fared better than younger ones. SCHIP program type (Medicaid expansion, separate, combined) had no differential impacts. Conclusions: Consistent results from two analytical approaches provide solid evidence that SCHIP implementation significantly reduced financial barriers for dental care and increased use of dental services for lower-income children in the U.S. Further study of SCHIP effects on young children is needed.