Access to quality healthcare services is important in promoting and maintaining health, preventing and managing the disease, reducing disability and premature death, and achieving health equity for all Americans (Access to health services, 2019). Though oral healthcare is necessary for everyone yet, there are several barriers that affect its accessibility. Therefore, reduced access to oral care has become a major problem in the US. Reduced or limited access to health care needs impacts the overall physical, social and mental health status and quality of life (Access to health care, 2019).
Throughout the country, there exists a significant disparity between those who have easy and direct access to oral health care and those who have limited or non-existent access (Kennedy, 2005). Access to healthcare varies based on race, ethnicity, socioeconomic status, age, sex, and location. According to statistics, the groups who experience the most difficulties in accessing oral health care are young children, pregnant women and older adults (Bersell, 2017). Populations in rural areas of the lower socioeconomic class are also disproportionately affected by a lack of sufficient access to oral health care.
The biggest barrier to oral care is the lack of access. This disparity in access leads to decreased dental care services and increased oral diseases thus, making a lack of access to oral health care a public health challenge. More than half of the population does not visit the dentist each year. This can be due to inadequate insurance or a limited supply of providers (P.C., 2007).
The 2008 Government Accountability Office report highlighted the difficulties faced by the low-income population in accessing dental care. It was reported that though there was an increase in dental services among children who were Medicaid and CHIP beneficiaries, children still visited the dentist less often than privately insured children (Healthy people 2020, 2019).
Research by the National Health and Nutrition Examination Survey revealed that children suffer the most with dental caries due to the least access to oral health care. However, disparities in access to oral health do exist among low income, and low education populations, and individuals who are physically and medically impaired, elderly, homeless and homebound (Access to Oral Health Care Services: Workforce Development, n.d.).
Some of the barriers that influence the accessibility are the unreasonably high costs associated with oral care; inability to obtain oral insurance; shortage of dentists; low rate of Medicaid provider participation; insufficient professional training regarding evidence-based guidelines; lack of interdisciplinary collaboration; inadequate dental safety nets, and a complex oral health system that can be difficult to navigate (Bersell, 2017).
One of the biggest factors that affect access to oral care is poverty. The low-income population is the ones to suffer most due to the lowest access to oral health care. A 2012 Senate investigation revealed that about 17 million children from low-income families do not receive any preventive care and around 130 million Americans lack dental insurance (Bersell, 2017). Combined with poor health knowledge and low self-efficacy, the problem of limited access has a disproportionately stronger effect on lower-income populations.
The rural areas are also one of the most affected ones with maldistribution of dentists and a limited number of Medicaid providers. The people residing in these areas also have inadequate public transportation that makes access difficult. Therefore, the population in these areas have a higher prevalence of caries and tooth loss. Therefore, more than 49 million people residing in these areas are affected with reduced accessibility (Bersell, 2017).
One way to improve oral health in these populations and to decrease the disparity in overall oral health care is to improve access to preventive care. Preventive care is a service that comes in many forms and can be an effective tool in improving oral health in a community and limiting oral health disparities; especially in individuals from low socioeconomic backgrounds and rural areas of the country (P.C., 2007).
Action for Dental Health Act (2015)
The issue involving the access to adequate oral care is of such importance that a federal bill H.R. 539 – 114th Congress (2015-2016), entitled Action for Dental Health Act (H.R. 539, 2015), was introduced in 2015. This Action for Dental Health (ADH) act bill seeks to amend the Public Health Service Act to reauthorize oral health promotion and disease prevention programs through FY2020. The main objective of the bill is to support initiatives that have the greatest impact on dental access disparities and improve essential oral health care for lower-income individuals by breaking down barriers to care, and for other purposes (H.R. 539 Bill, 2015).
The bill was introduced by Ms. Kelly of Illinois, for herself and Mr. Simpson, in January 2015, who referred the bill to the committee on energy and commerce. This bill intends to reach out to more than 181 million Americans who do not visit a dentist even though they suffer from oral diseases (H.R. 539 Bill, 2015). Also, this bill would allow organizations to qualify for Centers for Disease Control and Prevention (CDC) oral health grants to support activities that improve oral health education and dental disease prevention. The grants would also be used to develop and expand outreach programs establishing dental homes for children and adults, including the elderly, blind and disabled (Fisher, 2015).
The Centers for Disease Control and Prevention (CDC) may award grants or enter into contracts to obtain portable or mobile dental equipment and pay operational costs for the provision of free dental services to underserved populations (Summary H.R. 539, 2015).
Also, the awards granted by the CDC may allow the contracts to collaborate with state, county, or local public officials and other stakeholders to develop and implement initiatives to improve oral health education and dental disease prevention, make the health care delivery system providing dental services more accessible and efficient through the development and expansion of outreach programs that facilitate the establishment of dental home, reduce geographic, language, cultural, and similar barriers in the provision of dental services, reduce the use of emergency departments by those who seek dental services more appropriately delivered in a dental primary care setting and facilitate the provision of dental care to nursing home residents who are disproportionately affected by lack of care (Summary H.R. 539, 2015).
ADH act 2015 would also work to deliver care now to people already suffering with the dental disease, strengthen and expand the public/ private safety net, and bring dental health education and disease prevention into underserved communities (Fisher, 2015).
It would also aim at reducing the visits to the emergency room for a dental condition. As per the Journal of the American Dental Association, the dental emergency room care costs more than regular care by oral health professionals (Fisher, 2015). Between 2008 -2010 the cost of emergency room care is estimated to be nearly $3 billion. Also, most emergency room visits only provide patients with pain medication and don’t treat the underlying problem (Fisher, 2015).
The ADH act would also work towards expanding access to care for the vulnerable elderly in nursing homes (Fisher, 2015) as the residents are often unable to travel and therefore it is important to provide care where they live. Also, the act will ensure that more Americans have access to fluoridated drinking water and strengthen collaborations with other health professionals and organizations (Fisher, 2015).
The major stakeholder would be CDC and the Health and Human Services who would provide opportunities and grants to several state or local dental association, a state oral health program, an education program that provides dental or dental hygiene training, or postdoctoral dental education, volunteering dental projects and a community-based organization that partners with an academic institution. However, these entities must be tax-exempt and offer free dental services to under-served populations (House Bill H.R.539, 2015).
The bill directs the Secretary of Health and Human Services to award grants to or contract with entities that would obtain portable or mobile dental equipment, or that cover the operational costs of free dental services to underserved populations (House Bill H.R.539, 2015). Also, the secretary could provide grants for state, county or local public officials to improve oral health education, dental disease prevention, and make the dental health care delivery system more efficient (House Bill H.R.539, 2015).
This bill represents a bipartisan collaboration between sponsor Rep. Robin Kelly (D-IL) and lead cosponsor Rep. Mike Simpson (R-ID), which also has the support of 50 cosponsors — comprising 39 Democrats and 11 Republicans (House Bill H.R.539, 2015).
American Dental Association (ADA) also urges to co-sponsor the Action for Dental Health Act 2015. As per the President of ADA, the bill will not add any additional burden to the taxpayers, instead, it will redirect the existing resources to the kinds of programs that are already proven to reduce and eliminate the barriers that prevent millions of Americans from achieving good oral health (Fisher, 2015). Also, this act is expected to help create healthier communities by breaking down barriers to oral healthcare and will ultimately help reduce unnecessary healthcare costs by minimizing and eliminating dental diseases in their early stages.
However, some of the US community does feel that the federal government shouldn’t be involved in financing or organizing free dental services They feel it is the work at the state level, therefore, the state and local entities should find funding on their own. Also, they fear that the taxpayer money will be used for this (Hose Bill H.R. 539, 2015). However, dental care is as much essential as overall healthcare. Also, preventive care is one of the best ways to improve oral health in underserved populations at a lower cost. Therefore, to decrease the disparity in overall oral health care it is essential is to improve access to preventive care.
Also, the overall healthcare wouldn’t be complete without dental. We need both for a healthy country therefore, access to care being the first step towards a healthy community should be given equal importance. Provision of access to oral healthcare would help us remove the barriers pertaining to population overall health and will help us attain health equity. Thus, for a good cause I think the bill needs to be properly handled, instituted, managed, and passed.
However, providing access does not ensure that the service is being used. Some individuals might not know when and how to obtain dental services. Therefore, outreach activities and efforts that coordinate oral health care with other health care services needs to be thought off to ensure increased use of service.