Some research, that was done “undercover”, reveals something unsettling about what influences dental offices to accept patients. The research shows that there is a tendency for dentists to resist taking patients who use Medicaid, in favor of taking patients who have private health insurance. This particular study specifically focused on patients who were children.
The research was published online in the journal Pediatrics. The research was conducted in Illinois, but was done by researchers from the University of Pennsylvania.
They had women pretend to be the mother of a fictional ten year old boy, who had just fractured his front tooth. This type of injury is a common one in children, but it is also very serious. A fractured tooth causes a lot of pain, can lead to infection, and is also a cosmetic problem. In other words, these moms were trying to get a dentist appointment for an urgent, traumatic, injury.
Research assistants called 85 different dental practices. Some were Medicaid- enrolled dental offices, and some were not enrolled with Medicaid. These practices were randomly selected. Each practice was called once, and then called again four weeks later. The purpose was to find out what the impact of insurance status was on how each dental practice decided to schedule an appointment for an urgent injury, like a fractured front tooth.
The results showed that the type of insurance that is covering a child has an influence on whether or not the child will get offered a dental appointment, even if the child has a serious dental situation going on. The “moms” were giving the same information to all the dental offices about the fractured tooth. The only difference was the type of insurance that they said their child was covered by.
Out of the dentist offices that were Medicaid-enrolled, only 68% of the children who were said to be covered by the Illinois Medicaid/Children’s Health Insurance plan were able to get an appointment. Nearly 95% of the moms who said their child was covered by Blue Cross, a private insurance company, got an appointment. The dental offices that were not enrolled with Medicaid only offered appointments to 7% of the “moms” in the study who said that their child was covered by Medicaid.
If you combine the data from both types of dental offices, things become more clear. 95.5% of the fictional children in the study who were said to be covered by Blue Cross were able to get a dental appointment. Only 36.5% of the fictional children who were said to be covered by Medicaid were able to do the same.
It is possible that the reason is due to Medicaid’s reimbursement rates to dentists. In Illinois, where the research was conducted, dentists are only reimbursed for 53% of the median cost of their usual fees. The national average level of reimbursement is 60.5%. Emergency care also requires follow up work, which the dentists would not be equitably reimbursed for, either. Some dentists agreed to see the fictional child in the study if the mom was willing to pay in cash, instead of using Medicaid.
Image by Donovan Graen on Flickr