Need for new dental clinic also highlights trouble with 'system'

Posted: Sunday, December 08, 2002

There's plenty of evidence that a dental clinic to serve Medicaid, uninsured and underinsured patients is needed on the central Kenai Peninsula.

The statistics hurt as much as a throbbing toothache for which one can't get treatment:

Since 1998, approximately one-third of the children from the central peninsula seen by a dentist traveled to Anchorage or Homer to obtain their dental care because of a lack of Medicaid providers closer to home.

Most low-income families unable to travel out of town do not receive dental care.

In July of 1999, 2,835 of the estimated 11,002 young people on the central peninsula (from newborns to the age of 20) were enrolled in Medicaid. Only 528 of them had a preventive dental visit in the preceding year.

On 1,125 low-income adults surveyed, 82 percent were eligible for Medicaid benefits, 100 percent of them needed ongoing routine dental care and 69 percent had untreated dental needs.

A community needs assessment identified a multitude of obstacles in gaining access to dental care, including: lack of local dentists taking new Medicaid patients; lack of financial resources for families to pay for dental care; lack of dental care for special populations, including the poor, the mentally ill and the developmentally disabled; lack of a resident pediatric dentist; lack of patient responsibility and dental education; difficulty in interacting with the Medicaid system for both those in need of dental care and the dentists; and lack of other resources, including transportation and baby-sitting services.

Something clearly needs to be done.

With the change in administration, the state's Division of Medical Assistance currently is exploring options other than the so-called "disproportionate share hospital payment program" to fund the clinic. That's a good thing. The complicated funding formula raised concerns among the board of directors of CPGH Inc., the nonprofit organization that runs the borough-owned hospital. The hospital's participation will be needed if the state decides the disproportionate share method is the most appropriate funding mechanism.

The hospital board, however, acted in the best interest of the community last week when it delayed action on a resolution to participate in the program. The payment program raised a multitude of questions.

While funding options are explored, the push for a dental clinic should not be seen as a failure or lack of compassion on the part of central peninsula dentists.

The dentists face their own obstacles in providing dental care to Medicaid and other low-income patients. Among those issues: Medicaid payments do not cover the actual costs of delivering a service; transportation problems often result in "no-shows" for scheduled appointments; Medicaid needs to do more in the field of preventive health care, including education on proper dental care; and audits by the Medicaid Fraud Unit have created barriers in getting dentists to participate in the Medicaid program.

The problems aren't unique to the central peninsula. Across the nation, there is a shortage of dentists to serve low-income needs. We suspect at least part of the problem is the red tape surrounding the bureaucracy of Medicaid and poorly written guidelines. Dentists and other medical professionals did not enter their chosen fields to spend their time bogged down in paperwork.

Ultimately, the need for a dental clinic in the central peninsula highlights the need for change in our health care and insurance systems.

Those changes should center on such issues as: How can health care be more affordable for everyone? Cost is an issue even for those people with good insurance. And with the skyrocketing cost of insurance, fewer people and businesses are able to afford good insurance, which, in turn, hampers their access to health care. How can preventive health care be more widely embraced so patients take more responsibility for their health and care costs are lowered? What can be done to simplify the system so Medicaid and the medical community work together to ensure those who need care receive it in a timely way?

Those questions can't be answered overnight, but they should be debated. A community is only as healthy as its citizens.

Meanwhile, as we search for answers to bigger questions, a dental clinic will be a way to serve needs not currently being met -- and the sooner, the better.

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