Abstract: This dissertation explores inequality in access to dental and vision care. It includes three chapters. The first chapter examines the impact of vision coverage on vision health and vision care utilizations using nationally representative Behavioral Risk Factor Surveillance System (BRFSS) data. It also examines the trend in cost/insurance barrier to access vision care. I found significant evidence suggesting positive relationship between vision insurance and vision care utilization. This finding confirms the findings of previous studies on the same topic. Examining the cost/insurance barrier to access vision care, I have found evidence suggesting increase in the barrier to access vision care in recent years. The second chapter analyzes the effect of the early Medicaid expansion under the Affordable Care Act (ACA) on dental care utilization among U.S. adults using nationally representative BRFSS survey data for the years 2006 to 2012. Childless adults, who were not eligible to be covered in Medicaid before the implementation of the ACA except through 1115 waiver or state/locally funded programs, were made eligible for mainstream Medicaid through the ACA. In this chapter, I examine whether the early implementation of the Medicaid eligibility expansion to childless adults during 2010-2012, gave rise to increase in dental care utilization of this group. Using differences-in-differences model for the analysis, I find no significant evidence of changes in dental care utilization of childless adults in the post expansion period. Also, I find evidence of no (very small) significant change in dental care utilization of childless adults compared to parents in the post eligibility expansion period as Medicaid payment to dentist’s increase. The third chapter analyzes income related inequality and inequity in dental care utilization among adults in New York state using data from the BRFSS survey. To my knowledge, this is the first paper which tries to estimate income related inequality in adult dental care utilization in New York state. I improve on existing inequality literature by using multiple imputation to deal with the problem of calculating income inequality using interval-censored and top-coded income data. This paper calculates inequality using the corrected concentration index proposed by Erreygers which has not been commonly used in previous literature to estimate inequality in dental care utilization. In decomposition of inequality, I allow for heterogeneity in the utilization with respect to need using the procedure proposed by Van de Poel, Van Doorslaer and O’Donnell (2012) and thereby allow for violation of the assumption of vertical equity which is an implicit assumption in decomposition of inequality in previous literature analyzing inequality in dental care. I find evidence of pro-rich inequality and inequity in dental care utilization. The findings suggest that conventional horizontal inequity index overestimates the need-justified index of inequity for the state of New York.
Keywords: Dental care,Income,Inequality,Insurance,Medicaid, Vision care