The Effects of Dental Hygienist Autonomy on Dental Care Utilization

Because of the limited supply of health care providers relative to the demand for health care services, increases in provider autonomy are believed to improve access to health care by reducing barriers to the provision of certain services. However, research on the impact of scope of practice laws for health and dental professionals is limited. We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use and expenditure using 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, we find that relaxing supervision requirements to provide dental hygienists greater autonomy results in higher levels of dental care utilization in areas with a shortage of dental care providers. Moreover, expanding dental hygienist autonomy increased the use of many services that dental hygienists perform, such as cleanings, fluoride treatments, sealant applications, and fillings. We also find that greater autonomy reduces costs associated with dental treatment for both individuals and third-party payers.