2020

Study shows large gaps in access to oral health care for poorest Californians


Low-income residents, even those with insurance, see dentists less often, according to work by UCLA Fielding School of Public Health researchers.

close-up of dentist

A new policy brief from the UCLA Fielding School of Public Health shows that low-income California adults are less likely to receive timely dental care like regular checkups and are more likely to visit the dentist for specific problems than those with higher incomes — a fact that holds true even for low-income residents who have dental insurance.

“Our findings indicate that dental insurance improves access to dental care for all, just as the rising tide lifts all boats, but income disparities in access still remain,” said Nadereh Pourat, professor-in-residence of health policy and management and lead author of the study. “Oral health is an integral part of overall health, and the lowest-income individuals have the least access and suffer the consequences. It is important to break down silos that perpetuate disparities in access to dental care. We can start by promoting parity in dental insurance.”

The study, published by FSPH's UCLA Center for Health Policy Research, found that among those adults with the lowest incomes, 59% had seen a dentist within the last year, compared with 80% for higher-income residents. The disparity persisted even for those with private dental insurance, with 75% of the lowest-income adults and 85% of higher-income residents having had a dental visit in the past year.

The findings are based on an analysis of 2017 and 2018 data from the center’s California Health Interview Survey that looked at how disparities in income and insurance status may affect adult Californians’ access to oral health care. Those with incomes at or below 138% of the federal poverty level were considered to be in the lowest-income category, while higher-income residents had incomes at or above 250% of the FPL.

The researchers found that among the lowest-income adults, 64% had public dental insurance through Medi-Cal, 16% had private insurance and 20% had no insurance at all. While having dental insurance alleviated some disparities for those with the lowest incomes, the type of insurance also appeared to play a role in access, the authors say. Those with Medi-Cal, for instance, were less likely than those with private insurance to have visited a dentist in the past six months (41% vs. 56%) and were more likely to have seen a dentist for a specific problem (43% vs. 31%).

The authors stress that dental care and dental insurance are not affordable to all Californians. The Affordable Care Act does not consider dental care an essential benefit, many employers do not include dental benefits in their employment-based health insurance plans and private dental policies are costly. Furthermore, many dentists don’t participate in Medi-Cal due to lower provider reimbursement levels.

Among their recommendations, the authors suggest that policies be established to include dental care as an essential health benefit and to promote the availability of affordable dental insurance options.

Other key findings of the policy brief include:

  • 41% of adults in the lowest-income group visited the dentist for specific problems, verus 23% in the higher-income group.
  • 69% of higher-income adults have private health insurance, while only 16% of the lowest-income adults do.
  • 28% of uninsured lowest-income adults saw a dentist in the past six months, compared with 57% of uninsured higher-income residents.

“The study aligns with others that show that individuals with low incomes have fewer checkups and less access to timely care than people in higher income groups,” said Maria Ditter, co-author of the study and a research analyst at the center. “It is evident that we need policies that improve the availability of dental insurance. We need to ensure fair and equitable access to services, regardless of income.”

The authors note, however, that the economic effects of the coronavirus pandemic may make enacting these policies and achieving parity challenging.

“These disparities could broaden with the COVID-19 pandemic because of the rising rates of unemployment and loss of employment-based dental insurance,” Pourat added. “The loss of tax revenues will also have a negative impact on coverage, particularly for the lowest-income adults who are Medi-Cal beneficiaries, because Medi-Cal dental benefits are optional.”

The study is accompanied by an infographic (PDF) that shows access to dental care among California’s older adults, a group which tends to lose their dental insurance after retirement.

Faculty Referenced by this Article

Nadereh Pourat
Nadereh Pourat
Health Policy and Management
Read Faculty Profile
Emily Abel
Emily Abel
Health Policy and Management
Read Faculty Profile
Roshan Bastani Headshot
Roshan Bastani
Health Policy and Management
Read Faculty Profile
Leah Vriesman
Leah Vriesman
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Barbara Berman
Health Policy and Management
Read Faculty Profile
Clifford Ko
Clifford Ko
Health Policy and Management
Read Faculty Profile
Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
Read Faculty Profile
Image of Dr. Susan Ettner
Susan Ettner
Health Policy and Management
Read Faculty Profile
Galper, Michael
Michael Galper
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
Read Faculty Profile
Dr. Jennifer Wortham
Jennifer Wortham
Health Policy and Management
Read Faculty Profile
Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
Read Faculty Profile
Dr. Aria Fallah
Aria Fallah
Health Policy and Management
Read Faculty Profile
Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
Read Faculty Profile
Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
Read Faculty Profile
Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
Read Faculty Profile
Michael Ong
Michael Ong
Health Policy and Management
Read Faculty Profile
Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
David Hayes-Bautista
Health Policy and Management
Read Faculty Profile
Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
Read Faculty Profile
Dr. Dylan Roby
Dylan Roby
Health Policy and Management
Read Faculty Profile
Vilsa Eliana Curto
Vilsa Eliana Curto
Health Policy and Management
Read Faculty Profile
Moira Inkelas
Moira Inkelas
Health Policy and Management
Read Faculty Profile
Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
Read Faculty Profile
Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Alan Tomines
Health Policy and Management
Read Faculty Profile
Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
Read Faculty Profile
Laura Erskine
Laura Erskine
Health Policy and Management
Read Faculty Profile
Paul Chung
Paul Chung
Health Policy and Management
Read Faculty Profile
Diana Hilberman
Diana Hilberman
Health Policy and Management
Read Faculty Profile
Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
Read Faculty Profile
Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Arlene Fink
Health Policy and Management
Read Faculty Profile
Burt Cowgill
Burt Cowgill
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Brennan Spiegel
Health Policy and Management
Read Faculty Profile
silhoette
Ty Robbins
Health Policy and Management
Read Faculty Profile
Dr. Thomas Rice
Thomas Rice
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Steven Teutsch
Health Policy and Management
Read Faculty Profile
Jack Needleman
Jack Needleman
Health Policy and Management
Read Faculty Profile
Dr. John Lu
Z. John Lu
Health Policy and Management
Read Faculty Profile
Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Thomas Priselac
Health Policy and Management
Read Faculty Profile
Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
Read Faculty Profile
Robert Kaplan
Robert Kaplan
Health Policy and Management
Read Faculty Profile
Freund, Deborah
Deborah Anne Freund
Health Policy and Management
Read Faculty Profile
Dr. William McCarthy
William J. McCarthy
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
Read Faculty Profile
Comanor, Bill
William Comanor
Health Policy and Management
Read Faculty Profile
Dr. Xi Zhu
Xi Zhu
Health Policy and Management
Read Faculty Profile
Vickie Mays
Vickie Mays
Health Policy and Management
Read Faculty Profile
Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
Read Faculty Profile
James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
Read Faculty Profile
Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
Read Faculty Profile
Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
Read Faculty Profile
Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
Read Faculty Profile
Gordon headshot
Thomas D. Gordon
Health Policy and Management
Read Faculty Profile
Avram Kaplan
Avram Kaplan
Health Policy and Management
Read Faculty Profile
Balgrosky headshot
Jean Balgrosky
Health Policy and Management
Read Faculty Profile
Olivia Jung
Olivia Jung
Health Policy and Management
Read Faculty Profile
Dr. Beth Glenn
Beth Glenn
Health Policy and Management
Read Faculty Profile
Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
Read Faculty Profile
Mangione, C
Carol Mangione
Health Policy and Management
Read Faculty Profile
Patricia Ganz
Patricia Ganz
Health Policy and Management
Read Faculty Profile
Dr. Alice Kuo
Alice Kuo
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Mark Litwin
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Robert Brook
Health Policy and Management
Read Faculty Profile
Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Annette Maxwell
Health Policy and Management
Read Faculty Profile
Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
Read Faculty Profile
Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
Read Faculty Profile
Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
Read Faculty Profile
Gerald Kominski
Gerald Kominski
Health Policy and Management
Read Faculty Profile
Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Emmeline Chuang
Health Policy and Management
Read Faculty Profile
Dr. Kristen Choi
Kristen Choi
Health Policy and Management
Read Faculty Profile
Ron D. Hays
Ron D. Hays
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Lori Pelliccioni
Health Policy and Management
Read Faculty Profile
Jeanne Miranda
Jeanne Miranda
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Jose J. Escarce
Health Policy and Management
Read Faculty Profile
Davidson - headshop
Pamela Davidson
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Neal Halfon
Health Policy and Management
Read Faculty Profile
Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
Read Faculty Profile
Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
Read Faculty Profile
Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
Read Faculty Profile

Related Content

dark silhouette of a figure with their head in their hands
June 25, 2020
Nearly 2 million California adults don’t get needed mental health care

UCLA researchers recommend expansion of Proposition 63 services to address unmet needs.

Source: UCLA Newsroom Read Full Article
person smoking
June 30, 2020
Study shows surge in e-cigarette and marijuana use among state’s young adults

UCLA researchers found more than a third of all Californians between the ages of 18 and 25 reported smoking cigarettes, vaping or using marijuana in 2018. The researchers, led by UCLA Fielding School of Public Health professor Ninez Ponce, found an alarming 48% of e-cigarette users and 40% of marijuana users are underage.

Source: UCLA Newsroom Read Full Article