Barriers to care are any sort of obstacle that limits or prevents people from receiving adequate health care, including dental care. In many cases, multiple barriers to care may be involved. Common barriers to care include:
- Financial hardship
- Geographic location
- Lack of insurance
- Poor oral health literacy
- Language, education or cultural barriers
A Health Professional Shortage Area (HPSA) is an area within the United States with a shortage of health care professionals. Federal regulatiobns stipulate that, in order to be considered as having a shortage of providers, an area must have a population-to-provider ratio of a certain threshold. For dental care, the population to provider ratio must be at least 5,000 to 1 (4,000 to 1 if there are unusually high needs in the community).
As of September 30, 2022, there were 7,192 total dental HPSA designations within the US, which would require an additional 11,896 dental providers to meet this need.
ASDA does not support the use of midlevel providers
to solve the barriers to care issue. ASDA defines midlevel providers as an individual who may perform irreversible procedures on the public, but is not
a dentist with four years of post-collegiate education (three years in the case of University of the Pacific School of Dentistry). Some states have adopted legislation permitting midlevel providers to practice in that state. Many states cite barriers to care issues and reducing oral health disparities as primary reasons midlevel providers are necessary. However, data has not demonstrated that midlevel providers help reduce untreated dental decay.
ASDA believes that dental students should be involved in the reduction of barriers to care, and that evidence-based measures should be employed:
- H-1 Student Involvement to Address Barriers to Care: The American Student Dental Association encourages the participation of interested dental students in efforts to impact the oral health of the public through projects, education, internships, externships and outreach to underserved populations.
- H-2 Evidence-Based Solutions for Barriers to Care: The American Student Dental Association supports evidence-based measures that are efficacious and sustainable in reducing barriers to care in underserved communities. These measures include, but are not limited to, early intervention, Medicaid expansion and co-location of health services.
What can we do?
ASDA supports the following measures, among others, as ways to address barriers to care issues:
- Oral health education
- Medicaid expansion
- Children’s Health Insurance Programs
- Emergency Room referral programs
- Student loan forgiveness programs for working in rural or underserved areas
ASDA members are very active in supporting initiatives that address barriers to care. Many chapters are involved in projects like Give Kids a Smile
and Missions of Mercy
, which provide dental care to patients who may otherwise go untreated.
What Has ASDA Done?
Students and dentists have lobbied members of Congress in support of several bills addressing Barriers to care at ASDA and the ADA’s annual Lobby Day in Washington, D.C.
- The Medicaid Dental Benefit Act. This bill would require comprehensive dental care for adults to be part of all state Medicaid programs. ASDA lobbied for this bill at Lobby Day 2022 and 2023.
In July 2022, ASDA signed onto a letter to Senate and House leaders in support of this bill.