Use of emergency departments for conditions related to poor oral healthcare: implications for rural and low-resource urban areas for three states

Abstract

Persistent and worsening shortages of oral healthcare providers in rural areas, combined with limited acceptance of Medicaid and State Children's Health Insurance Programs, have left many patients without adequate access to dental care. Evidence suggests that such patients seek treatment in emergency departments (EDs) for problems that might have been prevented given adequate oral healthcare. This finding has public policy questions that are explored by this study. To investigate these questions, the State Emergency Department Databases available as part of the Healthcare Cost and Utilization Project and Area Resource Files were used, along with communication with state Medicaid offices for three diverse states: Utah, Vermont, and Wisconsin. While overall patterns of oral healthcare-seeking among the three states are similar, our research discovered important differences with implications for healthcare policy: In states with less generous Medicaid reimbursements, Medicaid beneficiaries in rural areas have ED care-seeking patterns like those of the uninsured. In more generous states, they seek care more like the privately insured. This suggests that Medicaid policy is one important tool in providing low-income and other vulnerable populations with access to higher-quality dental care.