• Heather L Taylor, Ann M Holmes, Nir Menachemi, Titus Schleyer, Bisakha Sen, and Justin Blackburn.
• Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Ste 6185, Indianapolis, IN 46202. Email: hhavens@iu.edu.
• Am J Manag Care. 2024 Feb 1; 30 (2): e39e45e39-e45.

ObjectivesTo examine the relationship between preventive dental visits (PDVs) and medical expenditures while mitigating bias from unobserved confounding factors.Study DesignRetrospective data analysis of Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resources Files.MethodsAn instrumental variable (IV) approach was used to estimate the relationship between PDVs and medical and pharmacy expenditures among Medicaid enrollees. The instrument was defined as the number of adult enrollees with at least 1 nonpreventive dental claim per total Medicaid enrollees within a Census tract per year.ResultsIn naive analyses, enrollees had on average greater medical expenditures if they had a prior-year PDV (β = $397.21; 95% CI, $184.23-$610.18) and a PDV in the same year as expenditures were measured (β = $344.81; 95% CI, $193.06-$496.56). No significant differences in pharmacy expenditures were observed in naive analyses. Using the IV approach, point estimates of overall medical expenditures for the marginal enrollee who had a prior-year PDV (β = $325.17; 95% CI, -$708.03 to $1358.37) or same-year PDV (β = $170.31; 95% CI, -$598.89 to $939.52) were similar to naive results, although not significant. Our IV approach indicated that PDV was not endogenous in some specifications.ConclusionsThis is the first study to present estimates with causal inference from a quasi-experimental study of the effect of PDVs on overall medical expenditures. We observed that prior- or same-year PDVs were not related to overall medical or pharmacy expenditures.

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