Serve the Underserved

In a two-part story last year, Inside Dentistry addressed the oral healthcare challenges faced by individuals with intellectual and developmental disabilities, which are profound. However, this is hardly the only US demographic facing issues related to oral health equity. This month, our September 2023 cover story examines the widening disparities in oral health outcomes and access to care that have been associated with income and race. Research indicates that the inability to pay for dental insurance leads many underserved individuals to avoid seeking dental care until they require a hospital emergency room visit, which saddles them with a disproportionate burden of oral disease and our healthcare system with increased costs. As you'll learn in the article, because oral health is a major component of overall health, many of the efforts to eliminate these disparities through changes to the Medicare and Medicaid programs are being driven by the finding that preventive care and earlier treatment will not only improve outcomes for the underserved but also reduce costs to our nation's healthcare system.

As with all dental insurance, Medicaid reimbursement rates have been dropping for many years, and costs are going up, which has resulted in many dentists deciding to no longer accept Medicaid. I used to accept it, but many years ago, the rates got so low in my state that I stopped. That being said, if Medicaid patients present to my practice with true emergencies and are in pain, I will render treatment to get them out of pain for free and then refer them to a Medicaid provider for further care. I see that as my obligation as a doctor. However, if Medicaid reimbursement rates were closer to 50% to 60%, I believe that many more dentists would accept it, myself included, which is why the work being done by legislators at the national and state levels is so vital to improving care for the underserved. For dentists whose practice models make accepting Medicaid prohibitive, there are other ways to help eliminate disparities in oral health, such as by donating time to provide treatment at free dental clinics and in other programs. Until our country's healthcare system has been revamped to place a greater emphasis on oral health from the top down, the onus is on dentists to do what we can to serve the underserved.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@broadcastmed.com