ADA report addresses financial barriers to access

The ADA has released the third in a series of papers that examines the challenges and solutions to bringing good oral health to millions of Americans who, for multiple reasons, lack access to regular dental care.

"Breaking Down Barriers to Oral Health for All Americans: The Role of Finance" explores how the availability of financing affects people's oral health, various methods of paying for care, and recommendations for improving the system.

"Lack of access to oral healthcare can result in delayed diagnosis, untreated oral diseases and conditions, compromised health status, and, occasionally, even death," said ADA President William Calnon, DDS, in a press release. "Unfortunately, access to oral healthcare eludes many Americans. While certainly not the only factor, financing is a major factor in people's ability to access health care."

Increased funding alone cannot "fix" a dental financing system that is rife with inefficiencies and shifting policies and that is overly tilted toward costly surgical intervention in disease that could have been prevented, according to the ADA.

Acknowledging this, the new paper provides eight recommendations that aim to eliminate unnecessary, costly, and preventable dental disease over time:

1. The government can use tax policy to encourage small employers and individuals to purchase dental benefit plans in the private sector or develop cooperative purchasing alliances, such as the state exchanges created by the Patient Protection and Affordable Care Act. Cost sharing (copayments) should be eliminated for diagnostic, preventive, and direct restorative procedures. Necessary care should not be subject to unreasonably low yearly maximums on coverage.
2. Maximum plan benefit fees should be set in an open and transparent manner, with appropriate scrutiny from attorneys general, insurance commissioners, and providers.
3. Medicaid and CHIP should reimburse for dental care minimally at rates that are acceptable to sufficient numbers of dentists practicing in the covered area to provide care to those eligible patients who seek it, as consistent with federal law. State programs should base these rates on the ADA Survey of Dental Fees or an equivalent database.
4. Preventive care reduces the disease burden, thereby reducing the need for restorative care, thereby yielding improved health and cost savings. Dental plans should cover 100% of the cost for preventive services.
5. State health exchanges should offer reasonably priced dental coverage to adults, especially the vulnerable elderly.
6. States should implement administrative reforms to cut red tape that impedes dentists from delivering care and patients from receiving it. In many cases, this may involve carving out the dental portion of Medicaid and dedicating health department staff exclusively to running the dental portions of their Medicaid and CHIP programs.
7. State Medicaid programs should be broadened gradually to include adults, beginning with coverage for urgent care that otherwise drives them to hospital emergency departments.
8. Federal and state governments should expand programs that provide incentives for dentists to establish practices in underserved areas. Such programs are proven to work, and are especially attractive to new dental school graduates, who carry an average debt load of $200,000, and who increasingly are interested in loan forgiveness arrangements.

"We realize that the ongoing economic crisis dramatically reduces the likelihood of major increases in funding for the dental safety net in the short term," said Dr. Calnon. "But the economy will recover; Americans will return to work, and state and federal governments will be under less pressure to cut or underfund essential services."

Future ADA papers will address disease prevention, oral health education, and why patients do or do not utilize available services.