Oral Health Access: A National Issue and A Madison Perspective

Findings

As part of the Health Quest community health improvement process, access to health care was designated as the number one health priority theme. Included in this priority was access to dental care, a major unaddressed health problem for Madison. To learn more about the scope of the problem, the Madison Department of Public Health selected dental access as the strategic health care access issue.

To determine the demand and unmet need for dental services, existing community data along with several surveys (e.g., random sample dentist survey, school nurse survey, etc.) were used to identify a "picture of need" for the Madison community. The findings indicate that Madison has a major dental access problem.

1. Oral health has a profound impact on overall health, but the association of poor dental health with disease is largely overlooked. Oral health is part of one’s total health and the mouth is part of one’s body, but in terms of access issues, insurance status and health policies, oral health is looked at separately.

2. There is a critical need for dental health care by low-income and vulnerable populations in the Madison community. A significant percentage of Madison’s preschool and school children have untreated dental disease. Individuals make hundreds of telephone calls each month, looking for dental care.

3. Community dental resources have insufficient capacity to meet the demand for dental care for low-income and vulnerable populations.

4. Only 26% of eligible Medical Assistance (MA) recipients are receiving dental services in Dane County.

5. There is an ample supply of dental providers to serve Madison residents, but an inadequate supply of dentists serving uninsured and MA patients. The small number of MA patients who receive dental care are seen by a handful of dentists.

6. Despite the fact that Dane County exceeds dental provider ratio standards, south central Madison has been designated as a dental Health Professional Shortage Area (HPSA).

7. As a designated dental HPSA site, the Harambee Dental clinic is eligible to employ National Health Service Corps (NHSC) personnel, but has insufficient funds to pay for an NHSC dentist.

8. There is an insufficient supply of pediatric dentists, only four in Madison, and only three of these four dentists are accepting new MA children.

9. Patients and providers face numerous obstacles to using MA for dental care. Obstacles to be overcome include a lack of patient knowledge about MA benefits and about the importance of dental care. Other obstacles for providers are the MA reimbursement rates, billing system red tape, and the number of no-show appointments.

10. A third of Dane County residents do not have dental insurance; therefore, a third of Dane County residents are more likely to use episodic dental care and are less likely to utilize preventive services.

11. There is inadequate utilization and understanding of the value of preventive dental care.

12. Dental disease is a chronic problem among low-income populations. In addition to
    socio-economic barriers, minority status is a significant barrier to receiving dental care.

13. Dental access is a national problem with a very real local impact. Community-wide solutions are needed to address the dental access problem.

Access to Dental Care . . . A Community Problem

Access to dental care is a national and state problem with a very real local impact.

Who owns this community problem? We all do. Who can solve this community problem? We all must!  Hopefully, this report will mark the beginning of that community-wide solution.