We Are Done With "Access to Care"

We Are Done With "Access to Care"

Howard W. Taylor, D.D.S.*:

“Access to care” is a great term. We have used “access to care” whenever an initiative has been planned or started that was focused on meeting the need for dental health care for a person who qualified as “underserved”.
All of us involved in providing dental health care are acutely aware of the complex nature of addressing the needs of the underserved. It is a multi-faceted problem. Initially the access issue was focused on the limited number of providers in the outlying regions of our state. As study results came in, it became quite clear that the number of dentists in Minnesota was very adequate for the population. However, we did have a problem with the distribution of dentists. Over time it became clear that access to care was also inhibited due to government programs that did one of two things: (1) had reimbursement rates so low in some situations that the reimbursement did not meet the costs of providing the service, or (2) did not provide coverage, or adequate coverage, for some of the more vulnerable segments of the population.

Over an extended period of time, organized dentistry worked more closely with multiple state agencies and the legislature in an effort to provide more comprehensive dental care to the underserved and vulnerable populations. Over that same period of time, several of the agencies and the legislature had members who simplified the problem back to one of “not enough dentists”.

Currently, the Minnesota Dental Association is committed to a more intentional approach to finding solutions for the underserved. In an effort to facilitate communication and find viable solutions, the MDA’s House of Delegates at its September 2010 meeting adopted a resolution aimed at using more accurate terminology. “Access to care” has become too general a term, as it allows for too much flexibility in interpretation. The accepted terminology uses the word “barrier”.
There are many barriers to care. Easily recognized categories include:
• Financial barriers
• Geographic barriers
• Governmental barriers
• Personal barriers
There are, for instance, many examples of “financial barriers”. Among the more obvious ones would be inadequate personal funds to pay for dental care or insurance with limited coverage combined with inadequate personal funds.

“Geographic barriers” commonly would relate to a dental provider being located within an “acceptable” distance from the individual seeking care. This would include the person with special needs who must have a provider who has any special facilities he or she may require.

“Governmental barriers” describes a wide category, including but not limited to low reimbursement rates to providers, programs with limited coverage, and the state closed-panel coverage system.

“Personal barriers” may be the largest category. Examples range from the persons who habitually miss appointments to the severely fearful individual to persons seeking only immediate care and those with language and transportation barriers.

The term “barrier” is not a solution. However, the use of the term “barrier” provides a system to find a meaningful solution.

First, the use of the term “barrier” allows for identification of the barrier that is keeping an individual from receiving dental care.

Second, once a particular barrier is identified, the conversation can be directed to a meaningful solution to that particular barrier.

Third, the solution should clearly provide a resolution for the population being identified.

It is possible that had this system been recognized and utilized, the legislation regarding the dental therapist could have developed a health care provider that would more effectively reach the underserved in the outlying regions of our state. The possibilities for providing care to the underserved have a much better prospect for finding solutions when the terminology redirects the discussion to the barrier that limits the affected group from receiving care.

Be a part of the solution. Use the terminology of “barriers” in your own conversations. Find the common ground of identifying the barrier to dental care - and then search for the solution to the barriers.

*Dr. Taylor is a general dentist in private practice in Saint Anthony, Minnesota. Email is taylor...hwt@gmail.com

ADA House of Delegates Passes MDA-Sponsored Resolution
As an outgrowth of the Minnesota Dental Association House of Delegates in September, the MDA put forth a resolution to the American Dental Association attempting to reframe terminology used in discussing care needed for the underserved. “Dental access” is the term commonly used to label the topic of care to the underserved. Unfortunately, the connotations of this term have come to imply that there is a problem with finding dentists who will treat this population. This is an inaccurate interpretation. There are many barriers to care, and a large number of these individuals experience more than one of them. As a result, the MDA has proposed an immediate change in how the profession talks about this issue, replacing the term “access to care” with “barriers to care”. When discussing the problems the underserved have finding dental treatment, referencing “barriers to care” more accurately represents the sources of the problem, and thereby leads to more meaningful solutions. The MDA resolution, as adopted, reads, “Resolved, that the ADA in communications regarding dental access issues, emphasize barriers to care including, but not limited to: (a) financial barriers, (b) geographic barriers, (c) governmental barriers, (d) personal barriers, (e) cross-cultural barriers, and (f) language barriers”.