Calif. program of bundled dental care for children gets a checkup

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

About 18 years ago, California implemented a program of “geographic managed care” for children’s dental coverage in Sacramento. Now, in partnership with The Sacramento Bee, Jocelyn Wiener of CHCF’s Center for Health Reporting provides an exhaustive report card on the program and its outcomes.

In her centerpiece, Weiner writes that “the state pays private dental plans in Sacramento County a monthly fee – currently about $12 – for each Medi-Cal child assigned to them. The amount paid is the same whether or not the child sees a dentist.”

Last year, Wiener writes, the state paid almost $20 million to the five plans it works with in the capital city. In exchange, “The plans are obligated to provide 24-hour emergency care for children with severe dental problems, to schedule all other appointments within a month, to see at least 38 percent of enrolled patients each year and to report that data to the state.”

State data may be skewed, some of Weiner’s sources said, because Sacramento dentists are less likely to overtreat, and less likely to report when they do treat, since they get paid their lump sum regardless. Nonetheless, the numbers that are out there paint a discouraging picture.

In fiscal year 2010-11, only 30.6 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office. That year, the county ranked third worst in terms of the percentage of kids who got care in the state – above only rural Alpine and Trinity counties. During the three previous years, it was the state’s lowest performing children’s dental system, state numbers show.

The state is working on ways to improve the program, but for now long times and access issues persist. For more context, see Richard Kipling’s piece on how San Diego county is succeeding in providing dental care to children despite similar geographic challenges.

National crisis in oral health

A hearing and a report released this week by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging, put a spotlight on dental health and the lack of access and care many Americans experience. According to “Dental Crisis in America (PDF):”

  • More than 47 million people live in places where it is difficult to access dental care.
  • About 17 million low-income children received no dental care in 2009.
  • One-fourth of adults in the United States ages 65 and older have lost all of their teeth.
  • Low-income adults are almost twice as likely as higher-income adults to have gone without a dental checkup in the previous year.
  • Bad dental health impacts overall health and increases the risk for diabetes, heart disease, and poor birth outcomes.
  • There were more than 830,000 visits to emergency rooms across the country for preventable dental conditions in 2009 – a 16 percent increase since 2006.
  • Almost 60 percent of children ages 5 to 17 have cavities – making tooth decay five times more common than asthma among that age group.

In a statement prepared for the hearing, Sen. Jay Rockefeller (D-W.Va.) said he is “working on legislation to make affordable dental care for our seniors a reality once and for all.”

Cover this topic for AHCJ

This is just the kind of story and report that AHCJ will be tracking and writing about as part of its new “core topic” on oral health. We’re currently looking for a journalist to lead the oral health core topic, a job that will include writing and assigning tip sheets and stories about the subject as well was writing regular blog posts to help journalists cover this important topic.

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