Access to care is an issue that the Department of Public Health (DPH) has been working on for decades. What does access to care involve? Is it people in the community needing access to care? Is it too few providers taking state insurance? Is it limitations on how many patients a practice will see? Is it a transportation issue? In this article, we will explore the multiple factors that affect access to care for providers and patients.
Bridging the gap between need and access to care has been an important issue at the DPH for a long time. Working to increase the number of offices that accept state insurance, increasing the number of state-insured patients offices will see each month, and decreasing patient transportation issues are all concerns.
Increasing the number of offices and patients seen
As a public health-care worker, I have found that private dental offices are hesitant to take state insurance because of the high no-show rate with these appointments. It becomes a financial burden on offices when patients frequently break appointments. To alleviate this problem, offices may double-book in hopes that one patient will show up if the other one breaks the appointment. But sometimes both patients show up. Dental workers are then overworked, stressed, and don’t want to work in that type of environment. Quality of care decreases because of the fast pace and shortened appointments this situation creates. This also increases patients’ wait time, creating stress and irritation for everyone.
Some offices take only a certain number of state patients a month. The reimbursement rate is low, and it may be harder to get reimbursed from state insurance. As a result, offices often choose not to accept this insurance. This also creates long waits to get appointments at the offices that do participate, and frequently patients must travel farther to be seen sooner.
Patients often go to an emergency room at a hospital because they waited too long, couldn’t afford to get care, or were unable to travel to the appointment. Educating private dental offices on the benefits of accepting state insurance and explaining reimbursement for services will hopefully increase the number of offices willing to participate in these plans and decrease the number of dental-related emergency room visits. When patients use the emergency room for problems that can be treated in the dental office, this increases tax dollars for everyone as well.
Transportation can be a huge barrier for people who can’t drive, or don’t have money to pay for a taxi, or can’t use city transit to get to appointments. Medical cabs can help alleviate this barrier, but there are limitations to this service, which creates an access to care issue. Sometimes medical cabs are late and patients cannot be seen because they are too late for their appointments. Education on scheduling processes, understanding the time frame needed for these appointments, and proper use of medical cabs are important for creating an efficient workflow. Patients should understand the limitations of medical cab coverage so they don’t rely on a service that doesn’t apply to the appointment and end up canceling last minute or just not showing up.
Bridging the gap
Having walk-in clinics and quick-care centers that accept this insurance would also increase access to care. Private practices can decrease the number of broken appointments by informing patients of a broken-appointment fee and dismissing patients who miss a certain number of appointments.
Patients do not always understand their insurance coverage or costs associated with treatment. As a result, they may avoid seeking the care they need because they think their insurance doesn’t cover it or it will be too expensive. This could be due to a language barrier, patient negligence in accessing this information, or fear of the unknown. How do we change this? Communication and education are key. If people don’t ask and health-care workers don’t educate, patients are left with uncertainty and dental neglect.
Improving communication and integrating care
Some public health settings have a language line available to enable communication when there is a language barrier. This helps with treatment-plan acceptance and compliance with appointment follow-through. Also, some community health centers have integrated health records. When patients are in for medical care and need dental treatment, medical providers can help schedule them for dental care. Dental hygienists can provide fluoride treatments when patients finish their medical appointments, and nurses can provide diabetic treatment, etc. when patients finish their dental appointments. This helps maximize patients’ visits and decreases overtreatment with medications and procedures.
Patients may have insurance that provides free treatment and still not take advantage of it. People oftentimes simply don’t have access to care even though they have insurance. Some patients are unaware that they have coverage or assume that there will be a high copay associated with the visit. Education by public health workers and having patient access to care centers to find out about their options can help increase insurance usage and early detection and decrease emergency care.
Educate, communicate, be kind
Access to care is a difficult and complicated issue but I believe that education and effective communication can help bridge the gap. Public health is a hard and rewarding field to work in, but when challenges arise, some of the most creative and intuitive solutions come to life. We can all do our part— educate, communicate, and be kind. Those three concepts are very powerful and contagious—our world would do well with more of this!
Katie Melko, MS, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016. She has practiced dental hygiene since 2009.