Did you know that tooth decay is the most common chronic disease affecting children in this country?
Pain from tooth decay can cut down on a child’s school attendance, and untreated dental disease can lead to infection, tooth loss and malnutrition. Although the disease is preventable and easily treated, many low-income children are vulnerable to tooth decay but do not receive adequate treatment for it.
For over 100 years, some of New York City’s neediest children have received dental care in school- and community-based clinics through the city’s Oral Health Program. But funding for OHP has been cut for several years, and the OHP clinics were officially targeted for elimination in Mayor Michael Bloomberg’s preliminary budget for fiscal year 2010.
The city’s Department of Health and Mental Hygiene argues that the closings are necessary because agencies must trim their budgets, also claiming that the OHP clinics are inefficient and duplicate services available elsewhere.
The reality? There are few alternatives available for the families that benefit from OHP; low productivity is due to DOHMH policies rather than program administration; and cost savings are in fact achievable that will help keep the program alive.
It doesn’t make sense to cut a program that provides cost-effective care to the population that needs it most.
In its current state the OHP provides dental care, with no out-of-pocket costs, to 17,000 children at 41 school and community-based dental clinics, as well as five community health centers. In Queens alone, OHP dental clinics received 5,011 visits from children in fiscal year 2008.
Alternatively, low-income families whose children are not serviced by OHP can take them to clinics in public hospitals and health centers; or, if they are eligible, to private dentists who accept payment through Medicaid or CHIP, the Children’s Health Insurance Program. However, dental clinics in public hospitals are not free, and patients are often required to pay according to a sliding scale.
To evaluate these alternatives, my office surveyed the private dentists who accept Medicaid or CHIP, and Health and Hospital Corporation dental clinics, assessing relevant data.
We found that there are nearly 40 percent fewer dentists in the city willing to accept new Medicaid patients than estimated by the DOHMH. Only 12 percent who do accept Medicaid could provide an appointment within 24 hours — the mandated time frame for urgent care — and barely one-third of the HHC clinics had waiting times of less than three months for filling a cavity.
Our Queens findings were particularly troubling. In a random sample survey of 20 Queens dentists who accept Medicaid, only 16 were willing to accept new patients and only three could provide an appointment within 24 hours.
DOHMH claims that the OHP is not cost-effective. Yet our research shows that the average annual per capita cost for the children it treated was $147 — half the cost of dental care for the average Medicaid enrollee nationally.
It is imperative that the DOHMH keep its existing clinics open. Budget constraints are real, but I propose that the agency explore new sources of revenue to support the program. For example, DOHMH could be more aggressive in seeking insurance reimbursement. Many families of OHP patients are covered under Medicaid or CHIP plans, and OHP would recoup significant costs if it took additional steps to collect insurance from a greater percentage of parents.
It’s not easy for children whose families are Medicaid recipients or are uninsured to get the care they need. OHP works for them, and it comes at a relatively low cost to the city and has proven to be cost-effective. DOHMH must find a way to maintain it.
Betsy Gotbaum is the New York City public advocate.