Improvig Access to Detal Care i Rural America: Policy Levers Available to State Legislatures Amy Brock Marti, Dr.P.H. Deputy Director & Research Associate Professor SC Rural Health Research Ceter Departmet of Health Services Policy & Maagemet Arold School of Public Health Uiversity of South Carolia South Carolia Rural Health Research Ceter Who we are South Carolia Rural Health Research Ceter 1 of 7 Rural Health Research Ceters fuded by the Health Resources ad Services Admiistratio Admiistratively located i the Arold School of Public Health at the Uiversity of South Carolia Missio: to icrease kowledge of the persistet iequities i health status amog populatios of the rural US, with a emphasis o factors related to socioecoomic status, race ad ethicity, ad access to healthcare services. South Carolia Rural Health Research Ceter 1
Presetatio Objectives Describe why oral health is importat to overall health (ad the health of your state Medicaid s budget ) Describe the shortages of detists i rural America Describe the policy levers available to state legislatures to address detal workforce shortages: Practice act modificatios Medicaid reimbursemet policies & admiistrative bureaucracy Recruitmet & retetio programs South Carolia Rural Health Research Ceter Why Oral Health Matters? Oral health disparities hurt everyoe! Marti, AB et al. Detal Health Access to Care Amog Rural Childre, 2008, icluded i CD, also available at http://rhr.sph.sc.edu/report/(7-2)%20detal%20health%20ad%20access%20to%20care%20amog%20rural%20childre.p df What are costly diagoses to your states Medicaid programs? u Those who come early Preemies Huck O, Teebaum H, Davideau JL. Relatioship betwee periodotal diseases ad preterm birth: recet epidemiological ad biological data. Joural of Pregacy, 2011, Article ID 164654. u Those who live log Demetia/Alzheimer s Maczak M, Reddy, PH. Abormal iteractio of oliomeric amyloid-beta with phosphorylated tau: Implicatios to syaptic disyfuctio ad euroal damage. Joural of Alzheimer's Disease 36(2), 2013, DOI:10.3233/JAD-130275. u Those who with chroic disease Diabetes & Cardiovascular Disease Leite RS, Marlow NM, Ferades JK. Oral health ad type 2 diabetes. America Joural of Medical Sciece. 2013 Apr;245(4):271-3. South Carolia Rural Health Research Ceter 2
Detal Health Professioal Shortage Areas, 2012 South Carolia Rural Health Research Ceter Persistet Whole Couty Detal Health Professioal Shortage Areas, 2009-2012 South Carolia Rural Health Research Ceter 3
Policy Lever 1: Expasio of Professioal Practice Acts Alterative detal hygiee models (e.g. detal hygiee therapists) Safety et practice/supervisio for detal hygieists* No-direct supervisio models for detal auxiliaries for prevetive services* *Described i, State Policy Levers for Addressig Prevetive Detal Care Disparities for Rural Childre, icluded i CD ad available at http://rhr.sph.sc.edu/report/state%20policy%20levers%20ad%20detal%20care%20disparities%2 0Executive%20Summary.pdf (State-specific data available.) South Carolia Rural Health Research Ceter Policy Lever 2: Medicaid reimbursemet & bureaucracy u Competitive detal reimbursemet rates u Easy to avigate provider erollmet & billig ifrastructure u No-detal cliicia reimbursemet policy for prevetive services, e.g. fluoride varish* F Special cosideratios for safety et providers such as commuity health ceters ad rural health cliics *Described i, State Policy Levers for Addressig Prevetive Detal Care Disparities for Rural Childre, icluded i CD ad available at http://rhr.sph.sc.edu/report/state%20policy%20levers%20ad%20detal%20care%20disparities%2 0Executive%20Summary.pdf (State-specific data available.) South Carolia Rural Health Research Ceter 4
Policy Lever 3: Recruitmet & Retetio Programs Natioal Health Service Corp u Ecourage FQHC detal expasios & site eligibility u Support outreach & educatio of studets u Coect with State Offices of Rural Health, Primary Care Offices, & Primary Care Associatios, State Divisios of Oral Health State-supported loa repaymet programs & other icetive packages South Carolia Rural Health Research Ceter Natioal Private Sector Oral Health Workforce & Public Health Resources South Carolia Rural Health Research Ceter 5
Summary Lack of access to detal care is pervasive i rural America State legislatures have some policy levers available to them to solve the problem Practice act expasios, Medicaid reimbursemet & admiistrative policies, ad recruitmet ad retetio programs are available to state legislatures to improve access but each has sigificat political pros ad cos with varyig degrees of impact. South Carolia Rural Health Research Ceter Cotact iformatio Amy Brock Marti, Dr.P.H. brocka@mailbox.sc.edu SC Rural Health Research Ceter 220 Stoeridge Drive, Suite 204 Columbia, SC 29201 803-251-6317 (telephoe) http://rhr.sph.sc.edu South Carolia Rural Health Research Ceter 6