IOM Recommends Increased Dental Care Access for Underserved

Rosemary Frei, MSc

July 15, 2011

July 15, 2011 — A report was released on July 13 by the Institute of Medicine (IOM) and the National Research Council of the National Academies that focuses on how to improve access to oral healthcare for vulnerable underserved populations. The 243-page document provides a guide for significantly bolstering care to these individuals through changes in the education, financing, and regulation of oral healthcare.

"The current system leaves about a third of the population out. And if we keep on 'keeping on,' we're not going to fix it," said Shelly Gehshan, MPP, in a news conference about the report. Gehshan is director of the Pew Children's Dental Campaign, Pew Center on the States, Washington, DC, and a member of the IOM Committee on Oral Health Access to Services.

The 10 recommendations laid out in the report include the development of a set of oral health competencies for non-dental-healthcare professionals in an effort to better integrate oral healthcare into overall healthcare. They also call for all dental students to participate in community-based education rotations and for the Centers for Medicare and Medicaid Services to fund and evaluate state-based demonstration projects that cover essential oral health benefits for Medicaid beneficiaries.

It is a difficult task to propose all the solutions to fixing the dental care crisis in the United States, and the committee's charge was made even more challenging by the dearth of cost-effectiveness studies on improving dental care access.

"The [IOM] focuses on what the evidence is behind recommendations. We looked for cost-benefit and cost-effectiveness evidence behind these recommendations [in our report]. Unfortunately, the data...are pretty limited," admitted committee chair Frederick P. Rivara, MD, MPH, Seattle Children's Guild endowed chair in pediatrics and professor of pediatrics, School of Medicine, University of Washington.

The committee members were also aware of the need to make their recommendations easy to implement, particularly given the current climate of limited healthcare resources. This charge is reflected in several ways. For example, they recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for Medicaid beneficiaries, with the goal being to provide evidence for having dental benefits for all Medicaid beneficiaries, noted the committee members.

"Medicaid [currently] is paying for the care of these patients, but in the wrong place and the wrong way.... [There is a lack of] preventive and restorative care," said Dr. Rivara. "By redirecting those resources to care earlier on, we may actually be able to save money in the long run."

The report emerged from a request to the IOM and the National Research Council by the Health Resources and Services Administration and the California HealthCare Foundation to convene a committee of experts and advise them on how to improve access to oral healthcare in America for underserved populations. One group undertook the assessment of the current oral healthcare delivery system and outlining ways to improve oral healthcare access. Another IOM subcommittee focused on the role of the US Department of Health and Human Services in improving oral health. Together, they held 5 meetings and 1 public workshop and engaged in other activities that resulted in the creation of the report.

The areas in which the joint committee made recommendations are integrating oral healthcare into overall healthcare, creating optimal laws and regulations, improving dental education and training, reducing financial and administrative barriers, promoting research, and expanding capacity.

"The recommendations support the creation of a diverse workforce that is competent, compensated, and authorized to serve vulnerable and underserved populations across the life cycle. Implementation of these recommendations will be a critical next step in increasing access to oral healthcare, reducing persistent oral health disparities, and improving oral health outcomes among vulnerable and underserved populations," the committee members conclude in their report.

The report was supported by the Health Resources and Services Administration and the California HealthCare Foundation via grants from the National Academy of Sciences. The members of the IOM's Committee on Oral Health Access to Services have disclosed no relevant financial relationships.

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