California’s children aren’t getting the dental care they need, and a recent initiative in Los Angeles holds some clues as to how the state can address the problem, according to a December article in the magazine Health Affairs.
An initiative sponsored by First 5 LA and led by UCLA aimed to address one of the major stumbling blocks in children’s access to dental care: a lack of integration of medical and dental services at Federally Qualified Health Centers (FQHC), medical clinics that provide a safety net for underserved communities.
Even though there are approximately 886 FQHCs across California, only a little more than a third of them have a dental clinic on site. And those that do often serve only a fraction of their young primary care patients because their dental and medical services aren’t integrated.
The UCLA-First 5 LA Oral Health Program aimed to integrate medical and dental services at 20 clinics in Los Angeles County that offer both services on site. The project saw impressive results: a twofold increase in diagnostic and treatment services for young children, and a threefold increase in preventative services after two years, according to Dr. James Crall, chair of Public Health and Community Dentistry at the UCLA School of Dentistry, who leads the initiative.
“There were 10,000 kids under the age of six who were coming to medical centers at 12 FQHCs in Los Angeles County [in 2013] and not receiving dental services,” observed Crall. Last week, Crall, together with the Oakland-based advocacy group, Children Now, released a policy brief based on his findings.
Crall highlighted the need to change policy so FQHCs can prioritize providing dental care for their young patients.
He said that for them to be successful in providing more children with recommended preventive oral health services, policymakers must address “systemic barriers and augment support for FQHCs.”
Health care advocates say not all parents realize the important link between oral and physical health.
“Tooth decay is an often-overlooked health problem that can impact every facet of a child’s life—often leading to poor academic achievement, deteriorating overall physical health and social isolation,” Children Now President Ted Lempert said, noting: “We must provide more support to California’s FQHCs so that they will be better able to prevent and address tooth decay in young children, which will improve life outcomes for California’s most vulnerable kids.”
Crall pointed out that what’s happening in California is emblematic of what’s happening in the rest of the nation. National data indicate that only half of children ages two to 17 had a dental visit in 2011, the most recent year for which data is available.
The Institute of Medicine has long suggested integrating oral health and primary care as a way to expand access to recommended treatments and promote better health overall, given that oral diseases may be associated with such health issues as respiratory disease, cardiovascular disease, obesity and diabetes.
This population-based approach would meet the need for preventive services for high-risk patients and help avoid expensive restorative and surgical care.
“Certain populations are more at risk for tooth decay than others,” Crall said.
California’s low reimbursement rates for providers in the network of Medi-Cal (the state’s name for Medicaid, the health insurance program for low-income people) – among the lowest in the nation -- has augmented the problem for children enrolled in the program. There are a limited number of dentists in the network, creating long waits for many patients who need dental care.
But the state is taking some steps to improve dental care for children enrolled in Medi-Cal. It is about to launch the Dental Transformation Initiative (DTI) – a $750 million five-year pilot program that offers financial incentives for dental providers who deliver preventive care and treatment for low-income children.
Crall says the financial incentives would fall within three domains: increased preventative dental services, risk-based care and continuity of care.
He acknowledged that the DTI is not going to fix the shortage of dentists in the Denti-Cal problem, but it is a “good first step” for a better oral health care program for low-income children.
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