"This is good news because here's a program that has positively affected dental care access for North Carolina children," said Dr. Mahyar Mofidi, postdoctoral fellow at UNC's Cecil G. Sheps Center for Health Services Research. "We already have programs such as Medicaid that, for one reason or another, have not been successful in helping children from low-income families receive dental care. This has been a huge problem, both in our state and across the nation."
Although the study was limited to North Carolina, he said the findings may apply to the 15 other states that have developed comparable programs. Children in states without such programs might not have fared as well.
A report on the research appears in the June issue of the Journal of the American Dental Association. Besides Mofidi, the authors, all at the Sheps center, are Drs. Rebecca Slifkin, director of the Program on Health Care Economics and Finance; Victoria Freeman, senior fellow; and Pam Silberman, associate director for policy analysis.
In 1998, N.C. state lawmakers had the option to use federal funds to expand Medicaid enrollment or to create a separate health insurance program based on a private insurance model, Mofidi said. They chose the latter as an effort to improve access to general health services and to reduce disparities in health care, including dental care, for low-income families.
"This federal-state partnership -- the State Children's Health Insurance Program, or SCHIP -- which in North Carolina is called N.C. Health Choice, has expanded health-care coverage to millions of children who come from working families with incomes that are too high to qualify for Medicaid but too low to afford private insurance," he said.
The study involved sending a survey to parents of children participating in N.C. Health Choice a week after the children were first enrolled, he said. Researchers sent a second questionnaire to parents a year later to gauge their experiences in the interim. Questions focused on availability and use of dental services.
Among the findings was that only 8 percent of parents said that they could not find a dentist who accepted N.C. Health Choice for their children's treatment, Mofidi said. Under Medicaid, low-income parents frequently complained that dentists declined to treat their children.
Other findings with school-aged children were that prior to enrollment, 77 percent were reported to have a usual source of dental care, and 48 percent received dental services in the previous year. After enrollment, those figures climbed to 90 percent and 65 percent, respectively. Before enrollment, 43 percent of the children needed but could not get dental care in the previous six months, while afterward, only 18 percent who needed care could not get it.
One key to the program's success has been that it pays dentists at competitive rates for services they provide to children from low-income families, he said. Findings suggest that the SCHIP dental programs that resemble private insurance models and reimburse dentists at close to market rates can significantly reduce problems associated with access to dental care for poor children.
"Providing health coverage under SCHIP is not mandatory," Mofidi said. "We hope our findings encourage policy-makers to continue the program. We also need to get the word out to dentists across the state about the program, increasing their knowledge about it and encouraging their participation."
Left untreated, tooth decay can lead to persistent, severe pain, missed school, inability to eat, poor nutrition, a swollen face, diminished self-esteem and teasing by other children, he said.
The dental study was part of a larger project under Slifkin's direction evaluating the effect of the N.C. Health Choice program on children's use of health services generally. The larger effort was done at the Sheps center at the request of the N.C. Division of Medical Assistance.
Note: Mofidi can be reached at (919) 423-2394 or mahyarm@email.unc.edu, Slifkin at 966-5541.
By DAVID WILLIAMSON
UNC News Services
Journal
The Journal of the American Dental Association