HPI Statement

HPI Statement

The Health Policy Institute (HPI) congratulates the authors on this publication that builds upon our analysis of geographic access to dental care
November 28, 2018
https://www.ada.org/en/science-research/health-policy-institute/geographic-access-to-dental-care

For each state, HPI analyzed geographic proximity to dentists for the entire population and specifically for publicly-insured children. Our analysis is based on publicly available data, including Medicaid provider rosters submitted to the Centers for Medicare & Medicaid Services (CMS) by each state Medicaid agency. HPI is very clear, in our methodology, our scholarly articles, and in presentations of these data, that we are only able to count enrolled Medicaid or CHIP providers. There are many different measures of provider participation with no widely accepted “gold standard.” The authors do a great job of showing how different definitions yield different conclusions. For example, according to 2016 data submitted by Florida’s Agency for Healthcare Administration to CMS, 30% of Florida dentists are enrolled as Medicaid providers. The authors take that a step further to analyze which of those dentists are accepting new patients, and which are seeing 100 or more unique Medicaid beneficiaries in a year. These are all alternative definitions of provider supply that measure different things. In our view, they are complementary and the most powerful policy insights are gleaned comparing these measures side by side, just as the authors have done. For example, it is clear that a significant share of Medicaid providers in Florida are not accepting new Medicaid patients. In other states, like Connecticut, you get a very different conclusion with the vast majority of Medicaid providers offering timely appointments. Getting more kids in for dental visits, thus, is likely to require very different policy interventions in Florida versus Connecticut. In fact, the policy interventions needed are likely to vary within different parts of any given state. This is the power of analyses like HPI’s and these authors’.

It is also important to note that HPI’s analysis produced 11 statistics and 4 maps for every state. We did this because there is no empirically backed “gold standard” or single definition of geographic access to dental care providers. For example, in developing our methodology, we quickly realized state Medicaid agencies were using a wide variety of travel time cutoffs or population-to-provider ratios as their benchmarks. Given this, we did not feel comfortable picking a single population-to-provider benchmark and therefore present a wide variety of geographic access measures in our reports. The authors have chosen to focus on one of these measures – the percent of Medicaid beneficiaries living within a 15 minute travel time of at least one Medicaid provider. We do not recommend this at all. When HPI presents these results to policy makers, we are careful to go through the multiple measures and multiple maps, explaining carefully what our analysis does and does not measure.

HPI’s geographic access analysis is a starting point for improving our understanding of the supply of Medicaid providers available to Medicaid beneficiaries. It is based on publicly available data, and we openly and very transparently recognize the shortcomings. We applaud these authors’ efforts to build on our analysis and advance the policy discussion in Florida and Georgia. The Health Policy Institute is currently collaborating with government agencies in several states on a much more refined analysis of access to and utilization of dental care services among publicly insured children and adults, based on detailed administrative and claims data as well as innovative primary data we are helping to collect. We will continue to help advance this important area of health policy research, including collaborating with outside researchers, and welcome additional feedback on our work as it evolves.

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