Health & Human Services

Communities Fill Dental-Coverage Holes

Rather than wait for lawmakers and insurers to provide adequate coverage, some dentists and public health advocates have taken it upon themselves to try to reduce the number of ER visits for dental problems.
by | March 2013

More and more, epidemiologists are uncovering the correlation between oral and overall health. Still, dental care is rarely included in health insurance, and when it is, there are stricter coverage limits and much higher deductibles than for other types of care. For those on Medicare or Medicaid, it’s even worse.

The reasons for this lack in coverage include health insurance’s evolutionary history, the differing ideologies surrounding medical and dental care and, of course, money, which insurance companies are loath to pay out for chronic and common health issues -- like bad teeth. But things are slowly changing. Along with the realization that it makes sense medically to provide oral health care, states are also finding that it makes financial sense.

In February 2012, the Pew Center on the States published a report describing the increase in emergency room visits for preventable dental conditions by low-income patients who are unable to afford routine dental care. The report stated that preventable dental conditions were the primary diagnosis in 830,590 visits to ERs nationwide in 2009 -- a 16 percent increase from 2006. A study of dental decay-related ER visits in 2006 found that treating about 330,000 cases cost nearly $110 million. Further research showed the average cost of a Medicaid enrollee’s in-patient hospital treatment for dental problems was nearly 10 times more expensive than the cost of preventive care delivered in a dentist’s office.

Read the March issue of Governing magazine.

Rather than wait for lawmakers and health insurance providers to address this issue, dentists and public health advocates in several communities have taken it upon themselves to try to reduce the number of people visiting the ER for dental problems. One example is Seattle’s Swedish Medical Center, which has started a dental clinic that treats complicated dental problems -- mostly extractions -- that normal clinics cannot handle.

The clinic had 810 visits in 2012, operating just two days a week, says Tom Gibbon, manager of the Swedish Community Specialty Clinic. “Our dentists pulled 2,163 teeth,” he says, a figure that could double this year as the clinic ramps up to five days a week. “We had one patient who went to the ER 11 times for the same tooth,” he reports, because the ER isn’t equipped to do extractions. “About 97 percent of these ER visits are being seen in the wrong place, but these people have no other place to go.” The program’s 40 volunteer dentists and oral surgeons provided the equivalent of $800,000 in typical dental office charges in 2012.

Another program, in Calhoun County, Mich., uses a unique pay-it-forward model. Forty-three volunteer dentists provide routine care to community members 200 percent below the poverty rate -- but only after the patients first volunteer with other organizations in the area. A group called the Calhoun County Community Dental Access Initiative created the program, which is administered by Community HealthCare Connections. CHC verifies that the patients perform their volunteer work at any nonprofit in the county; every four hours of service earns them $100 of treatment.

The program has given out more than $700,000 in free care, says CHC Executive Director Samantha A. Pearl. When the program began in 2007, the local ER treated 111 dental patients a month (at an average cost of around $1,500 per visit). That has decreased by about 80 percent, to about 30 patients a month. “And it has totally eliminated repeat visits to the ER,” Pearl says.

While advocates and legislators hash out the possibility of adding dental care to insurance coverage, it’s good to know that innovative interim solutions are improving the oral, physical and financial health of community health care.

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