Project Summary This proposed study seeks to determine if ambulatory surgical centers (ASCs) offer a less costly setting for delivering high-quality pediatric dental surgical procedures than hospital outpatient departments (HOPDs). For reasons related to underlying health conditions (e.g., intellectual and developmental disabilities), access to care, and disease burden, some children require dental surgical procedures under general anesthesia. The expansion of ASCs may offer opportunities for improving access and reducing the cost of pediatric surgical dental procedures while maintaining the delivery of high-quality care. Although prior research generally suggests that procedures conducted in ASCs are less costly and have better or comparable quality to procedures conducted in HOPDs, these studies have focused on adult and elderly populations and many have not used rigorous methods for causal inference. Using three data sources, this proposed study will compare cost (measured by payments by payers and patients, out-of-network bills, and charges) and quality, as measured by receipt of timely care (measured by time from diagnosis to procedure and distance to care), safe care (measured by inpatient stays following procedures, emergency department visits, and hospitalizations), and equitable care (assessed by examining if quality differs by setting of care for historically vulnerable groups, defined by low socioeconomic status, Medicaid enrollment, minority race/ethnicity, and rurality). Use of three datasets, namely the universe of procedures paid by Medicaid, a sample of procedures paid by commercial insurers in all states, and the universe of procedures in Florida, will enable examination of this question in both publicly and privately insured populations, as well as enable the comparison of cost and quality in ASCs and HOPDs by payer. Additionally, to address concerns that results may be driven by the fact that studies suggest that ASCs may treat healthier patients on average, this proposed study will utilize multiple approaches to risk- adjustment, including using propensity score weighting and exploiting differential access to ASCs across states.