Oral health assessment of children in rural Pa. demonstrates disparities

UNIVERSITY PARK, Pa. — While the overall supply of dentists in Pennsylvania is sufficient to meet the current demand when assuming equal access for all residents, geographic access to oral health services is not equal across rural and urban areas. In a report, researchers in the Pennsylvania Office of Rural Health (PORH) at Penn State found that urban rates of dentist supply are nearly twice that of rural rates, and that inequalities exist between areas of higher socioeconomic status and those of lower socioeconomic status.

The research, funded by the Center for Rural Pennsylvania, a legislative agency of the Pennsylvania General Assembly, documented access to and utilization of oral health services among lower income children in Pennsylvania. The researchers evaluated the oral health care delivery system for lower income children in Pennsylvania, exploring insurance availability, provider distribution and the school oral health program. The research findings were utilized to inform policy recommendations which could promote oral health equity.

The state’s Medicaid program, known as Medical Assistance (MA), is the largest insurer of children in Pennsylvania. The PORH team found that there were relatively large, contiguous rural areas that did not have MA dental services in 2017. These areas were located in the northern tier, along the New York State border, and extended through the center of the state in an area sometimes referred to as the rural “T.” Difficulty accessing oral health services could explain why children insured by MA have lower annual rates of dental utilization than children insured by commercial (private) insurance plans. Overall, dental care utilization for all children has increased over the past decade.

“Having to travel long distances to obtain access to oral health care can be a challenge for rural families,” noted Kelly Braun, dental delivery services coordinator at PORH and one of the lead authors of the report. “Geographic barriers and reduced access to oral health providers to treat low-income children can have a direct impact on the overall health of this vulnerable population. Schools serve as an important part of overcoming some of these barriers.”

The oral health component of the school health program mandates dental examinations or screenings for all students entering the public school system and again in grades 3 and 7. School districts may fulfill this requirement by selecting the Mandated Dental Program or the Dental Hygiene Services Program. Both programs encourage students to obtain a dental examination from their family dentist and provide an examination or screening in school for students who do not visit or do not have a family dentist. This program is available to almost all children across the commonwealth, regardless of geographic location or income level.

While the school health program can serve as an entry point into the oral health care system, it typically does not serve as a “dental home,” or a location for the delivery of on-going comprehensive oral health care. The researchers recommend inclusion of preventive oral health services and oral health education in the school setting, facilitating equal opportunity for all children to access these routine services. Currently, the Dental Hygiene Services Program provides preventive oral-health services to students; however, fewer than 10 percent of public school districts have chosen this program.

The oral health care delivery system for low-income children is extremely complex, which can make the system difficult for families to navigate. The managed care delivery system of the two major insurers for low-income children, MA and the Children’s Health Insurance Program (CHIP), while generous in their benefits, do not provide a full complement of services and are difficult to navigate. The team made recommendations to simplify the managed care delivery system.

Lisa Davis, director of PORH and outreach associate professor of health policy and administration at Penn State who served as principal investigator of the project noted, “This project supports longstanding national and state data demonstrating challenges with access to care in rural areas, especially for vulnerable populations such as low-income children. State programs designed to address these issues have removed some barriers, but continued emphasis needs to be placed on ensuring access to quality health care across Pennsylvania, regardless of geographic location.”

The team, which also included Research Consultant Myron Schwartz, presented research and policy recommendations to the Pennsylvania General Assembly and could lead to increased access to oral health services for lower-income children residing in rural Pennsylvania.

PORH was created in 1991 to enhance the health status of rural Pennsylvanians and strengthen the delivery and quality of care in the communities in which they live. Located administratively in the Penn State Department of Health Policy and Administration, the organization compiles, analyzes and disseminates information to health providers, educators, policymakers and administrators; develops new and strengthens existing networks of rural providers, planners and advocates; develops, implements and assesses strategic rural health projects and programs; and serves as a liaison between academia, government, professional associations and the public in order to increase awareness of rural health issues throughout the commonwealth.