218714 Availability of dentists participating in Medicaid and SCHIP can impact access to dental care

Monday, November 8, 2010 : 12:30 PM - 12:45 PM

Nadereh Pourat, PhD , Department of Health Services, UCLA School of Public Health/UCLA Center for Health Policy Research, Los Angeles, CA
Ronald Andersen , Box 951772, UCLA School of Public Health, Los Angeles, CA
Marvin Marcus, DDS, MPH , School of Dentistry, University of California, Los Angeles, Los Angeles, CA
Dylan Roby, PhD , UCLA Fielding School of Public Health, UCLA Center for Health Policy Research, Los Angeles, CA
Gina Nicholson, MPH , Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA
The success of the Medicaid program in improving access to care of low-income populations depends on provider participation. Private practice dentists constitute about 96% of licensed dentists in the state and their participation in Medicaid in California is estimated at 40%. This low participation rate can pose a significant barrier to dental care access for Medicaid recipients. This study examines if higher rates of private dentist participation in Medicaid in an individual's Medical Service Study Area (MSSA) has an impact on the individual's annual dentist visit. 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. Adults (n=4,000) and children (n=2,800) who had public insurance were included in the analyses. The preliminary findings indicate that individuals who resided in MSSAs with a higher percentage of dentists accepting public insurance have higher odds of a dentist visit (1.45) for adults, in adjusted models. Among children, the odds of a visit in the past year were significant at 2.07 in unadjusted models and no longer significant in adjusted models. Our findings indicate that participation of dentists in public programs has a tangible impact on publicly insured adults' access to dental care. Among children, this relationship is mediated by race/ethnicity and age. Private practice dentists constitute the great majority of dentists in California and their participation in Medicaid and SCHIP programs is essential to the access of the beneficiaries of these programs. Only 40% of these dentists participated in the program in 2003. The latest cuts in adult dental Medicaid benefits in California are expected to further reduce dentist participation in these programs. Lower private dentists' participation in the Medicaid programs has been linked to low Medicaid payment levels and administrative burden of the program. Further erosions in participation of dentists in public programs will reverse advancements made in improving oral health and are likely to contribute to oral health disparities of underserved populations.

Learning Areas:
Public health or related research

Learning Objectives:
1. Identify system level barriers in access to dental care 2. Discuss the role of Medicaid and SCHIP participating dentists in annual dental visits by publicly insured populations 3. Discuss public health impact of budget cuts or populationís oral health

Keywords: Access to Care, Oral Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to preesnt because I serve as Principal Investigator on this research project and oversee all data analyses.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.