Assessing the contribution of the dental care delivery system to oral health care disparities

Abstract

Objectives Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentist. This approach overlooks the importance of other aspects of dental care delivery system such as personal and practice characteristics of dentists that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. Methods We merged the 2003 California Health Interview Survey and a 2003 survey of California dentists at the Medical Study Service Areas (MSSA). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. Results We found that some characteristics including higher proportion of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees in the MSSA inhibited access for low income and minority populations. Conclusions These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed dentist to population ratios. The findings identify specific aspects of the delivery system such as dentists’ participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender should be regularly monitored. These data will provide a better understanding of how the dental delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities.

Disparities in the Quality of Pediatric Dental Care: New Research and Needed Changes

“…Dental provider attitudes, knowledge, and behaviors, and their influence on oral health disparities have been studied much less than those of patients. Provider age, gender, ethnicity, and clinic size and busyness are related to providing care to publically insured patients (Pourat, Andersen, & Marcus, 2014). Discrimination and poor cultural competency are factors that negatively influence patient experience (Horowitz & Kleinman, 2012;Mofidi et al, 2002), while dentists' perspective of poverty (individualistic-deficit vs. socio-life course) may contribute to their willingness to accept public insurance and capacity to provide more empathetic care (Loignon, Landry, Allison, Richard, & Bedos, 2012;Loignon et al, 2010).…”

Barriers to Medicaid Participation among Florida Dentists

“…7 The extant literature shows that overall having a lower proportion of minority dentists in a given locale seems to inhibit access to dental care for low-income populations. 24 …”

Associations of Provider‐to‐Population Ratios and Population Health by County‐Level Rurality

“…In addition, characteristics of the provider and the care delivery system, such as provider participation in Medicaid, or full‐ or part‐time employment, may modify the effects of provider‐to‐population ratios on the provision of care to underserved communities . Studies of health care providers find that up to 25% of RNs and 13% of dentists work part‐time (<32 hours per week), and that the racial and ethnic composition of the health care workforce does not fully reflect the diversity of the population served .…”