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November 13, 2002

UCSF Researchers Find Flaws Identifying Dental Shortage

There are serious flaws in the methodology used by the federal government to
identify and designate areas with a shortage of oral health care providers and
areas of high unmet need, according to a UCSF study.

Researchers in the UCSF Center for California Workforce Studies and the UCSF
Center to Address Disparities in Children's Oral Health have challenged the
methodology of federal requirements for placement of dentists and dental
hygienists in underserved communities and have made recommendations for
modifying the Dental Health Professional Shortage Area (DHPSA).  The study was
published by the UCSF Center for California Work Studies.

In 1970 the federal government established the National Health Service Corps
program which placed professionals in areas designated as underserved.  To
qualify for the placement of  professionals and other federal assistance
programs, communities must apply for the DHPSA designation by documenting the provider shortage in the community according to federal standards.  Three
pieces of current legislation (CA, AB668 and AB982, Federal S1626) question the
use of these criteria and call for revising the methods for contemporary oral
health system needs.  The legislation supports the analyses done by the Center.

The UCSF researchers recommend modifying the DHPSA criteria to eliminate
methodological weaknesses including an over dependence on a
population-to-provider ratio which results in an inattention to indicators of
need.  Their recommendations are designed to inform policy makers, including
those involved in current legislative initiatives.

"When the original criteria were developed, the government was concerned with
the lack of oral health professionals in rural communities.  The theory was
that by educating more dentists and placing them in these underserved, rural
communities for a limited period of time that access to care issues would be
solved and disparities would be reduced," said Elizabeth Mertz, MPA, UCSF
project director at the Center for Health Professions.

"Today we know that just producing more dentists won't solve the problem and
that communities of need can be found even in otherwise heavily
dentist-populated urban areas. We need a better tool for identifying where and
what type of need exists and tailoring the distribution of government resources
to the actual need," said Mertz.

The lack of oral health professionals in disadvantaged rural and urban areas of
the U.S. and resulting lack of access to care for those populations contributes
to the striking oral health disparities that exist in our country, Mertz said.

"If we cannot adequately identify communities with a shortage of providers
based on high levels of unmet need, the very foundation for the programs and
policies which use this criteria is shaken," she said.

The report recommends six steps toward revising the methodology used to
designate areas as having a shortage of oral health professionals:

1. Increase the responsibility of state and federal agencies for defining oral
health professional shortage areas and thus decrease the substantial burden
placed on local communities;

2. Construct an Index of Dental Underservice (IDU) as a new measure for
shortage designations based on indicators of need as well as supply;

3. Use state licensure and renewal mechanisms to develop requisite data
collection methods and tools  to measure the supply, distribution, composition
and practice characteristics of the professions;

4. Include an alternative designation process for hard-to-measure areas or
populations that do not qualify under the IDU, such as institutionalized
elderly or people with disabilities;

5. Allow presumptive DHPSA eligibility for providers documented to serve
underserved populations (federally qualified health centers, public health
clinics, community health centers, migrant health centers, etc.)

6.  Develop rational service areas specific to the dental market rather than
rely on county divisions or rational service areas defined for medical services
as the de-facto guidelines for dental service provision.

The communities and populations with oral health disparities are generally
rural, poor and/or minority and tend to be the same communities that have
shortages of oral health professionals or are not adequately represented in
terms of race/ethnicity in the dental workforce.  Therefore, the researchers
said, any changes in federal methods and programs to address these issues are
of great importance to efforts to reduce oral health disparities.

Kevin Grumbach, MD, UCSF professor of family and community medicine, is
principal investigator of the study and Joshua Orlans, UCSF research associate,
is a co-author.

The study was supported by the National Institute of Dental and Craniofacial
Research through the UCSF Center to Address Disparities in Children's Oral
Health and by the Center for Information and Analysis, Bureau of the Health
Professions.  The study contents are the sole responsibility of the authors and
do not necessarily represent the official views of NIDCR or HRSA.

To review a copy of the report, please visit the web site:

Source: UCSF News Twink Stern


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