No Shortcuts: Addressing Dental Disparities in Children

Tegwyn Brickhouse, DDS, PhD


July 08, 2011

Disparities in Child Access to Emergency Care for Acute Oral Injury

Bisgaier J, Cutts DB, Edelstein BL, Rhodes KV
Pediatrics. 2011;127:e1428-1435

Article Summary

In this study reported in the journal Pediatrics, researchers from the University of Pennsylvania surveyed a random group of dental practices located in Cook County, Illinois. Two phone calls (4 weeks apart) were made by a research assistant posing as a mother. The assistant followed a script describing a chief complaint of dental trauma affecting her child and requested an urgent dental appointment. The only difference in the 2 phone calls was the type of dental insurance coverage the family had.

For the 170 paired calls to 85 dental practices, a little more than one third of Medicaid beneficiaries received appointments, compared with 95.4% of Blue Cross-insured children. This means that children with Medicaid were greater than 18 times more likely to be denied appointments than their private insurance counterparts (95% confidence interval: 3.1 to infinity; P < .001).


There has been some success in improving utilization rates for the Medicaid population through policy reform; however, the issues for reducing disparities in access to care are complex, as this study illustrates. Addressing these issues will continue to demand the collaborative attention of policymakers and dental providers.

As with any governmental policy that is implemented by states, Medicaid reform affects some localities differently from others. This is expected, given the wide variations in racial, ethnic, cultural, and socioeconomic levels in counties and cities. The current research reflects the critical importance of ensuring sufficient reimbursement rates in addressing deficiencies in access to care among the Medicaid population in Cook County, Illinois.

Specifically, the researchers identified a significant gap in access among children insured by Medicaid/Comprehensive Health Insurance Plan, compared with children insured by the most widely accepted private insurance agency in this geographic area, Blue Cross Blue Shield. Although the results observed in Cook County (one of the most populated counties in the United States) may not generalize to other localities, the study describes sound methodology for assessing the dependence of access to care for children by type of insurance.

Furthermore, not only does it reinforce the importance of the reimbursement rates for Medicaid dental service, the study also showcases the inadequacy of the dental provider network's training and level of comfort in treating complex dental problems in children. It is possible that providers are not well prepared to treat children who may come from more vulnerable complex backgrounds.

In a season of economic uncertainty, policymakers will make difficult decisions on appropriations of public funds. However, this research serves as a helpful reminder that these very decisions will contribute to the overall health and well-being of America's children.



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