BLOG: How San Diego County serves its poor kids' dental needs
Sometimes good things get cut out of good stories. This happened on my editing watch recently, when a story by Jocelyn Wiener on poor kids’ dental health access in Sacramento grew too big and had to be pared back.
This is where blogs come in handy. I can reach in, restore and expand on a relevant piece of information that otherwise would be lost to the cutting room floor or, more accurately, the delete key.
What was lost? We reported that poor kids in Sacramento County’s managed care system have a slim chance of getting their dental needs met. OK, we asked ourselves, so where in the state do poor kids have a much better shot at dental access? We looked at the state-produced data and found San Diego near the top, by all indications doing a substantially better job than their Sacramento brethren of providing poor children with access and care. The county has one of the best usage rates in the state – almost 60 percent of the county’s Medi-Cal children saw a dentist last year, about twice Sacramento’s rate.
What does San Diego do and how do they do it?
I asked Dr. Harriet Selden, past president of the 1,900-member San Diego County Dental Society, what makes San Diego successful.
She said the county decided some time ago to expand capacity for children’s dental care. San Diego has a broad collaboration among stakeholders – consumer advocates, the local pediatric hospital, the county and the dental society, among others. And the secret is a simple one: they constantly talk to one another. “We have a lot of different groups that help, that represent patients, providers and the community in general so when there are problems we can work on things,” said Selden.
Still, the county isn’t dental paradise for poor children. After all, even though 60 percent have gained access to dental care, that leaves 40 percent who haven’t.
“There are a lot of people who don’t take very young children to the dentist – it’s a question of dental literacy,” Seldin said. “It’s people not realizing that the very young need treatment.”
Efforts are being made by the county to educate, but “the reality is that those kids who don’t have a (visible) problem don’t see a dentist early on,” she said.
“Plus, it used to be that the whole family came in to the dentist, but now, since the adult Medi-Cal benefit was cut, the kids don’t come either,” she said.
The other lurking issue, she said, is the low Medi-Cal reimbursement rate and the threat of further cutbacks. Many dentists in a fee-for-service system don’t take Medi-Cal kids, and the uncertainty about reimbursement reinforces their decisions not to participate.
For her part, Seldin thinks that in the dental world, fee-for-service works better than a managed care schema like Sacramento’s. “Private practice is the predominant mechanism in dentistry. Not many dentists participate in an HMO. That’s just the marketplace.”