Can racial/ethnic disparities in dental care be reduced by providing discounted care?

Research indicates that racial/ethnic disparities in oral health care may be attributable to access. Dental insurance policies with higher out-of-pocket costs may lead to foregoing dental care among the insured who can not afford these costs, including many low income and non-white groups. The uninsured seeking lower cost services can obtain care in community clinics with dental care capacity or identify private dentists who offer sliding scale fees. Since the majority (96%) of dentists are in private practice, availability of dentists offering discounts may be crucial in insuring affordability and subsequent access. This study examines if higher rates of private dentists who offer discounted care in an individual's Medical Service Study Area (MSSA) has an impact on foregoing needed dental care due to costs. Data from the 2003 California Health Interview Survey (CHIS) and a 2003 representative survey of California dentists were merged at the MSSA level. The percentage of dentists in an area that reported offering discounted dental care in their primary practice per MSSA was merged with CHIS data. Logistic models were used and included individual-level demographic and socioeconomic data as well as MSSA level data. All analyses were adjusted for CHIS and dentist survey design. The sample included 40,000 adults. Latinos (31%) and African Americans (22%) were more likely to forego needed dental care due to costs than Asian Americans (16%) and whites (14%). Preliminary findings indicate that the higher percentage of dentists who offer discounted care is associated with the lower likelihood (OR=0.68) of foregoing dental care due to costs in an MSSA, in an unadjusted model. However, the models controlling for individual level variables indicate that that this relationship is no longer significant. Rather, lack of dental insurance, low income, age, and gender are among individual variables that determine the likelihood of foregoing dental care due to costs. The findings indicate that availability of discounted dental care may be negatively associated with foregoing care, however, factors such as dental insurance are more important in insuring affordability of dental care. Insubstantial discounts are unlikely to change affordability. Recessions and budget cuts compound the financial difficulties of populations with the lowest socioeconomic status, many of whom are members of non-white racial/ethnic groups and reduce their ability to obtain dental care.