FUTURE OFDENTISTRY
impetus to increasing utilization among Medicaid-
eligible children.
The state of Michigan, in an attempt to secure access
to dental care for its underserved children, made the
bold step of removing the financial and administrative
barriers from its program. The Healthy Kids Dental
Program is administered by private dental benefits
companies with rules, regulations and reimbursement
schedules similar to those offered in the private sector.
In a 22-county experiment in Michigan, conversion of
the Medicaid program for children to private adminis-
tration paying UCR fees, resulted in more than a 50%
increase in the number of children receiving treatment
in just the first 4 months of operation, and a 40%
increase in the number of dentists providing care, com-
pared to the same 4 months in the previous year
(Michigan Department of Community Health, 2000).
The Healthy Kids Dental Program has been ex-
tremely successful. Children enrolled in the pro-
gram now have access to dental care which is
approaching that of children in the private sector.
Other states looking to secure marketplace access
for patients enrolled in their programs should look
carefully at this example. Longer-term results from
this program should be followed closely.
Other Potential Barriers
AVAILABILITY
According to the United States General Account-
ing Office (GAO), "while several factors contribute
to the low use of dental services among low-income
persons who have coverage for dental services, the
major one is finding dentists to treat them."
According to this report, "some low-income people
live in areas where dental providers are generally in
short supply, but many others live in areas where den-
tal care for the rest of the population is readily avail-
able." (United States General Accounting Office, 2000.)PERSONAL FACTORSSome observers have identified individual factors
that create barriers to care. For example, many
immigrants do not speak English; this can lead to
communication problems with the providers of care
and may result in more difficult access. Knowledge
of appropriate dental care––and when to seek
it––may be less developed among subpopulations.
Finally, apprehension about going to the dentist may
discourage use. While these factors may influence
utilization and expenditures, evidence of their quan-
titative impact on access is not conclusive.GEOGRAPHIC BARRIERSPeople who live in areas where there are few, if any,
dentists nearby must overcome circumstances to receive
regular dental care, but there are no comprehensive
data to quantify the effect of this barrier.SPECIAL NEEDS POPULATIONSIndividuals with physical, sensory and develop-
mental disabilities that limit mobility or are accom-
panied by exceptional treatment needs, face special
challenges in receiving regular dental care, as they
do with many aspects of everyday life. The skills
and experience required to treat some of these indi-
viduals is sometimes beyond the capabilities of the
average dentist. The costs involved also may be
beyond the means of the affected families.Financing of and Access to Dental ServicesA primary determinant of access to dental care is
having the financial resources to purchase services.
The availability of resources is highly dependent on
the overall growth of the economy. Dentistry has
clearly benefited from the robust economy over the
past two decades. Greater wealth has resulted in
large increases in dental services utilization and total
national expenditures.
These gains in purchasing power have affected all
segments of the population, but as expected, the
poor and near-poor have less purchasing power
than the wealthier segments of society. Although
oral health and access to care have improved signif-
icantly among the disadvantaged during the past 30
years, these individuals do not utilize dental services
to the extent of the general population. For some
Americans with special problems, such as individu-
als with disabilities, those with congenital conditions,
non-ambulatory individuals, and people in nursing
homes, obtaining dental care remains difficult.
The most effective way to give the poor greater
purchasing power is to subsidize their access to care