Assessing the contribution of the dental care delivery system to oral health care disparities

摘要: Oral disease is a significant health problem in the U.S. and burden of oral falls more heavily on poor racial/ethnic minorities who have less access to care.(1, 2) These populations experience disparities dental care, including fewer dentist visits, this lower utilization has been linked poorer health.(2–4) Disparities are partly due lack insurance, leading policies promote by providing public insurance directing federal funds low-cost providers shortage areas. Yet, difficulties care for underserved exist inadequacies delivery system.(2, 5, 6) Efforts improve often focus increasing supply providers, frequently measured as presence licensed dentists an area.(7, 8) efforts based assumption that availability will increase everyone. But general measures fall short evaluating true capacity underserved. A comprehensive evaluation should examine characteristics such part-time employment, size staff operatories, accepting coverage or reduced fees, multilingual practices. The dearth information hinders development effective address systemic barriers lead disparities. Studies role using limited licensure professional association membership data provide broad overview but sufficient detail.(7) Other studies system slowly emerging. Dental areas designated age dentist, number hours works (full-time equivalent FTE), allied personnel practice.(9) Two indicated dentists’ were provision publicly insured patients. Specifically, busy, pediatrician, African American, Latino likely see Medicaid patients, non-solo, female, older do so.(10, 11) Another study found bilingual/multilingual practice, acceptance discounted multiple practice locations, shorter appointment times, operative, periodontic, surgical positively associated with patients.(5) However, few available directly assessed range particular. We developed analytic framework (Figure 1) care. This complements Andersen’s conceptual developing contextual indicators (12) builds another identify service dentists.(13) In study, we propose overall include safety net private (e.g., ratio full-time per 5,000 population settings). further consists personal sex, years practice), their structure work assistants, how busy), financial payer source), cultural competency non-English capacity). Access general, particular, determined setting, these effects modified population’s predisposing, enabling, level need. our analyses, anticipated promoted population. Also, accept fees access, particularly Alternatively, inhibited when older, newly graduated, specialist, white, not busy overworked smaller practices (no hygienists, longer wait time visit) locations. We examined if differed race/ethnicity income. Figure 1 The assessing