Health Inequality: How Dental Care Access Divides Communities
Health inequality is a pressing issue in the United States. Despite the Affordable Care Act, which makes insurance more affordable and accessible for many Americans, millions still go uninsured. What’s more, having access to health insurance is not the same as having access to healthcare. That’s because many people live in areas where the specialized care they need may not be available, or because they have high deductible insurance plans that require excessive out-of-pocked expenditures before payments kick in. It’s a complicated situation, and it doesn’t stop with traditional healthcare.
Though the ACA requires insurance plants to provide dental coverage to children, most adults forego dental insurance because it’s expensive and doesn’t cover enough of what they need. In other words, while the ACA has helped expand access to medical care, dental care has been left out of the conversation.
The Dental Access Crisis
Surely if dental care was so important, health insurance would cover it, which raises the question: how important is access to dental care, really? The answer: extremely important. The division between dentists and traditional doctors is an historic one, rooted in the days of the surgeon-barber, and creating what have been called “luxury bones.” Many people can’t afford to take care of these bones – their teeth – yet poor oral care can lead to serious health issues.
Among the problems stemming from poor oral hygiene are heart disease, diabetes, atherosclerosis, or even respiratory problems. Bacteria from the mouth have a direct path to the heart, which is why tooth decay is closely linked to heart disease. Other concerns include faster bone loss and deterioration among those with gum disease, and more mundane issues like bad breath.
Leveling The Playing Field
Given the connections between oral health and more systemic issues, improving population-wide health starts with ensuring that people have equitable access to dental care. One way to approach this is by ensuring that children receive early dental care. This includes providing dental care before children start kindergarten to ensure that they’re healthy and ready to succeed. Young children lose a surprising number of school days to dental pain – pain that often lands them in the ER, where they can’t receive appropriate care, or can only access it at an even higher price.
While a handful of dental benefits providers are working to improve access to dental care, in some states laws restricting dental provider freedom threaten to drive prices up and reduce access. By restricting dentists’ ability to partner with administrative dental support organizations (DSOs), these laws make it more expensive for the practices to operate and reduce how much time they can commit to actually providing specialized care.
Ultimately, tooth decay is a condition that, though widespread, disproportionately impacts low-income and minority populations. That’s not just because these groups have less access to dentists, but also because they’re less likely to drink healthy, fluoridated water, are more likely to be exposed to degrading air pollution, and more likely to eat an unhealthy diet that can damage the teeth.
The biggest issue remains cost, though. In high income countries, dentistry is only 5% of overall health costs, but amounts to 20% of out-of-pocket costs. Both reducing costs and getting dentists into the communities where need is highest are vital to reducing harmful oral disease.
Dental care access is deeply unequal in a way that even typical medical care can’t compete with, but both are harmful to our country’s most vulnerable populations. As we try to navigate life on an uneven playing field, finding ways to remove access barriers should be a top priority.
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