Serving the Dentally Underserved

American Dental Association (ADA) President Dr. Ronald Tankersley recently testified before an Institute of Medicine Committee on Oral Health Access to Services, outlining the ADA’s efforts to address ways to improve access for ‘underserved populations’.

Dr. Tankersley also took the committee to task for its decision to exclude private practice dentists from two panels it is convening at the behest of the U.S. Department of Health and Human Services to study oral health care delivery and access. Private practice dentists represent almost 92 percent of all professionally active dentists in the US, Dr. Tankersley said, and their input is crucial to addressing the oral health care access issue.

“I urge the committee again to reconsider its decisions to conduct its business behind closed doors and exclude the private practice community from representation. The latter is tantamount to forming a panel on air traffic safety and excluding pilots.”

In the US, Health Professional Shortage Areas (HPSAs) may be designated as having a shortage of primary medical care, dental or mental health providers. They may be urban or rural, population groups or medical or other public facilities. As of Q3, 2009, there were:

4,230 Dental HPSAs with 49 million people living in them. It would take 9,642 practitioners to meet their need for dental providers (a population to practitioner ratio of 3,000:1).

Underserved Populations in Canada

A number of diverse populations are identified as potentially underserved by the Canadian health system. These populations include Aboriginal people, official language minorities, those of alternative sexual orientations (gay, lesbian, bisexual, two-spirited, transgendered and transsexual) immigrants, refugees, ethnically and/or racially diverse populations, persons with disabilities, the homeless, sex trade workers, and low-income segments of the population. These categories of underservice are not exclusive. Individuals may belong to more than one underserved population and face additional access difficulties related to socio-economic status, gender, or residence in an underserved region.

In the autumn 2008 edition of the University of Toronto Magazine, writer John Lorinc wrote a memorable line: “Canada’s Universal Health-Care System stops, for a series of complicated and unpalatable reasons, at the gum line…”

Should Canadians have universal dental care built around a government insurance system? No, say you, the CDA and the ADA.

“Private dental benefits work. Benefits should be administered by independent companies, selected in the open market. Experience in other countries has shown that a single-payer system would stifle access, innovation and reduce the quality of patient care.

Universal dental coverage mandates will not solve the access to care problem. Many dental diseases and conditions are preventable with patient compliance and are inexpensive in relation to cost of treatment, therefore developing federal and state government programs that address not only funding but also non-economic barriers to care are necessary. The great majority of Americans already have access to dental care, and millions can afford care without having dental benefits. The government can use tax policy to encourage small employers and individuals to purchase dental benefit plans in the private sector or develop cooperative purchasing alliances for the segment of the population with privately-funded care.”1

All I’ll say is health care is a fundamental right of all. DPM

1. From the ADA Government and Public Affairs Division, March 9, 2009. govtpol@ada.orgw