Dental News - Dentist shortage: New report from The Pew Charitable Trusts outlines two shortages limiting children’s access to care

Robert Selleck, DTA

Fri. 19 July 2013

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NEW YORK, N.Y., USA: A report released June 23 by The Pew Charitable Trusts concludes that a lack of access to dental care in the United States, especially among low-income children and families, is being compounded by uneven geographic distribution of dental services and dentists’ low Medicaid participation rates.

The findings are consistent with previous studies and analysis by Pew, which is a strong backer of the concept of expanding the role of midlevel providers of oral health care as a core strategy to improve access to dental care among underserved populations.

This latest analysis also warns of an impending likelihood that the access-to-care challenge will increase because of the number of dentists intending to retire soon and the number of children who will qualify for subsidized dental care through private or public insurance programs when provisions of the Patient Protection and Affordable Care Act take effect in 2014.

Drawing on data from the U.S. Department of Health and Human Services — Centers for Medicare and Medicaid Services, the American Dental Association and the U.S. Department of Health and Human Services — Health Resources and Services Administration respectively, a table in the Pew report provides a state-by-state snapshot of the converging challenges: the percent of Medicaid-enrolled children not receiving dental care in 2011; the percent of dentists more than 55 years of age as of 2009 (approaching retirement); and the percent of the state’s total population that is classified as being underserved in dental care and residing in areas designated as having a shortage of dental-care services as of 2013.

According to the report, more than 14 million children enrolled in Medicaid did not receive dental services in 2011. And in 22 states “fewer than half of Medicaid-enrolled children received dental care.”

By comparison, 2010 data shows that privately insured children were nearly 30 percent more likely to receive dental care than those insured through Medicaid or other government programs. The brief points out that studies show it's the former group that is at far greater risk for developing caries or encountering other oral health problems.

Complex problem

The Pew report describes the access-to-dental-care issue as a complex problem with numerous contributing factors. It advocates higher Medicaid reimbursement rates and streamlined administrative processes to make it more financially feasible for dental-service providers to work with Medicaid patients; but the report concludes that such steps alone aren’t enough to address the access-to-care gap.

The Pew analysis also downplays the value of an anticipated increase in the number of dental schools opening as having meaningful impact on countering the expected wave of dentists retiring. According to the analysis, the expectation is that new dentists will continue to open practices in heavily populated areas and primarily serve privately insured patients.

The report also quotes American Dental Association statistics looking at 2010 to 2030 that indicate an increasing number of dental-school graduates won't keep pace with overall population growth to check a continued decline in the overall ratio of dentists to patients.

Midlevel care providers supported

In the end, the report focuses on the expansion of a midlevel-provider workforce as the most likely access-to-care answer that won’t fall short.

“Midlevel providers can extend the reach of the dental team to areas where dentists are scarce,” the brief states. “They can also make it more financially feasible to provide care for Medicaid-enrolled children. Working under the supervision of dentists, these practitioners can improve the ability of safety-net systems to reach low-income communities, save states money on emergency room care and other costly alternatives, and ensure that more children and families get the care they urgently need.”

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