Barriers to dental care persist for African-Americans

A new study provides insights into why African-Americans receive poorer dental care even when they have some dental insurance coverage, and suggests strategies to removing barriers to dental care (American Journal of Public Health, June 16, 2011).

Researchers at the Columbia University Mailman School of Public Health and the College of Dental Medicine surveyed African-American adults with recent oral health symptoms, including toothaches and gum disease.

They did a qualitative survey of 118 men and women intercepted on the street in Central Harlem. Although the majority (75%) of adults in the study reported at least some type of dental insurance coverage, this was largely limited to Medicaid (50%) rather than private coverage (21%) or other types of dental insurance (4%).

The findings indicated that insured participants reported insurance-related difficulties, such as insufficient coverage for needed treatments, inability to find a dentist who accepts their insurance, and having to wait for coverage to take effect, according to the researchers.

"For the 25% of respondents who reported having no dental insurance coverage, the costs of dental care and the lack of insurance coverage were consistently noted as critical barriers to obtaining quality dental treatment of their dental symptoms," said lead study author Eric Schrimshaw, PhD, an assistant professor of sociomedical sciences at the Mailman School of Public Health. "Even among those who had some dental insurance -- such as Medicaid -- it was often not enough to eliminate the obstacles to obtaining needed dental treatment."

The authors also report that even when participants were able to see a dentist with the limited insurance they had or while uninsured, many believed that they received poorer quality of care than did others because of their lack of private insurance.

The finding that participants on Medicaid reported a number of impediments is particularly important, according to the researchers, as this program is often promoted as a means to meaningfully reduce barriers to care and health disparities.

"Although Medicaid allowed some participants to obtain basic care such as dental cleanings, the barriers identified suggest that enhancements to the program would significantly improve many patients' ability to obtain treatment," Schrimshaw added.

He suggested that efforts to increase the number of dentists participating in Medicaid and to increase the types of services (for example, root canals rather than just tooth extractions) covered by Medicaid would improve individuals' ability to obtain needed treatment.

The researchers also noted that although publicly funded dental clinics would be one potential source of affordable dental care regardless of insurance status, all such city-funded dental clinics in the Harlem area were closed shortly after this study was completed because of city budget constraints, leaving only hospital-based emergency care.