title: The effect of dental insurance on dental care use and selection bias.
abstract: OBJECTIVE
  We examine the effect of dental insurance coverage on the probability of having a dental care visit in light of selection bias.
  
  
  METHODS
  We use data from the 2003 Medical Expenditure Panel Survey and use 3 different approaches to control for selection bias. First, we use a probit specification and include a rich set of independent variables that we posit control for unobserved attitudes toward risk and health care. Second, we use an instrumental variable model with family employment status as our instrument. Finally, we use a nonparametric approach to identify the upper and lower bounds of a dental insurance effect. We also ran a base probit model that did not include controls for attitudes toward risk and health care.
  
  
  RESULTS
  The base probit, the probit including measure of attitudes, and the instrumental variable models provided similar estimates of the effect of dental insurance on the probability to seek dental care. This may indicate that selection bias may not be a concern. All estimates were within the bounds obtained through the nonparametric approach.
  
  
  CONCLUSIONS
  Despite concerns of the potential endogeneity of dental insurance in models that estimate dental care use, we find evidence that these concerns may be unfounded.
authors.affiliation: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. philip.cooper@ahrq.hhs.gov
authors.forename: Philip F
authors.initials: PF
authors.lastname: Cooper
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Manski
authors.forename: John V
authors.initials: JV
authors.lastname: Pepper
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007347:Insurance, Dental / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D012111:Residence Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult