Game Changers in Dentistry: 2013 and Beyond

Marjorie Jeffcoat, DMD


December 17, 2012

In This Article

Access to Care

As a dentist, I have felt rather left out (for better or worse) of this year's discussion of healthcare reform in the United States. Access to dental care is a genuine problem for many Americans, not only for those with limited financial resources but also for those living in rural or otherwise underserved areas. The Affordable Care Act (ACA) includes dental care for children in the coverage that must be offered by insurers but is largely silent about the general adult population. As the ACA pushes responsibility for dental care for individuals with the least ability to pay onto the states (through Medicaid or the Children's Health Insurance Program), the access problem is likely to remain with us.

The trend toward government payment of medical costs, one way or another, seems to be inexorable.[1,2]Although the per capita costs of dental care are far lower than for other medical care, the visibility of these costs as out-of-pocket expenses can be expected to attract growing attention in future political debates. Whether the outcome will be positive, from the point of view of the public or the profession, is anybody's guess.

Some look to new dental schools, founded with the express mission of providing dentists who will care for patients in rural areas or those with limited ability to pay, to fill the provider gaps. Unfortunately, graduates of these schools have not consistently chosen to practice in locations that would serve the patients in greatest need. I fear that in the long run, the maldistribution of dentists will persist in the absence of coercion, perhaps in the nature of "strings" attached to grants and loans. I can't begin to predict how the situation will ultimately sort out, although I suspect that it will wind up in the political arena.