chas issue brief: a growing problem: oral health coverage, access and usage in colorado

7/29/2019 CHAS Issue Brief: A Growing Problem: Oral Health Coverage, Access and Usage in Colorado

1/12

AbstractFormer Surgeon General David Satcher has described oraland dental disease as a persistent but silent epidemic.1 Whileaccess, coverage and aordability issues in health care arewell-documented and discussed, oral health issues are notas common in the public policy dialogue on health carereorm.

The 2011 Colorado Health Access Survey (CHAS) providesdetailed inormation about the growing problem o oral healthinsurance coverage and access in Colorado. These datashow the aordability challenge o accessing needed dentalcare. CHAS uncovers the reasons or lacking dentalinsurance and presents a demographic portrait o Coloradans

without dental insurance. It also provides insights concerningtrends among dierent populations.

Much o this inormation is compared and tracked withbaseline data gathered in the 2008-2009 ColoradoHousehold Survey (COHS).

These are the key ndings:

The number o Coloradans without dental insuranceincreased 17 percent to 2.1 million in 2011 rom 1.8million in 2008-2009.

Nearly our in 10 Coloradans, or 39.9 percent, lackeddental insurance in 2011. This compares with 37.0

percent in the earlier survey. Coloradans were 2.5 times more likely to be without

dental insurance than without health insurance (15.8percent).

Nearly one in our Coloradans (22.9 percent orapproximately 1.2 million) did not get needed dental carein the 12 months beore the survey, citing cost.

More than a third (36.6 percent) o those Coloradans whosaid they didnt get needed dental care because o costhad dental insurance.

Coloradans were more likely to orego dental care due tocost than all other types o care.

Seniors 65 and older had the highest rate o dentaluninsurance among the age groups (60.6 percent orabout 324,000).

Although lower-income Coloradans are more likely to beuninsured 54.2 percent o those under the FederalPoverty Level (FPL) did not have dental insurance nearly one in our Coloradans with incomes above 400percent o FPL did not have dental insurance.

More than hal (52.8 percent) o HispanicColoradans didnot have dental insurance in 2011, an 11 percent

increase rom 2008-2009 when 47.6 percent o Hispanicslacked dental insurance.

An additional 66,300 children ages 0-18 had dentalinsurance in 2011 compared to 2008-2009. Even so, thenumber o children who visited a dental proessional sawa statistically signicant decline o nearly 41,500 duringthe same time period.

Twice as many Coloradans with a usual source omedical care reported seeing a dental proessionalcompared to those without a usual source o care.

The highest percentages o Coloradans who did not visit

a dental proessional lived in rural regions.

CHAS Issue Brief2011 DATA SERIESNO. 4 A Growing Problem: OralHealth Coverage, Access

and Usage in ColoradoPrepared for The Colorado Trust by the Colorado Health Institute

December 2012

NOTE:Unless otherwise noted, the data andanalyses presented in all tables and graphs in this

brief come from the 2011 Colorado Health Access

Survey and/or the 2008-2009 Colorado Household

Survey.


2/12

A GROWING PROBLEM: ORAL HEALTH COVERAGE, ACCESS AND USAGE IN COLORADO

2

IntroductionProblems with access, coverage and aordability in health care are well documented, but these same issues or oral health are notalways included in the public policy dialogue on health care reorm. Yet good oral health is strongly tied to an individuals overall health.

Oral disease can cause pain and speech problems in children. Poor oral health can be a complication o diabetes, and may be linked toother chronic diseases as well. In addition, the mouth oten reveals problems that aect other areas o the body. Despite these linksbetween oral and systemic health, dental care remains largely separate rom health care in nancing and insurance.2,3

Insurance is important. People are more likely to seek dental services i they have dental insurance,4,5 and preventive dental care canresult in lower overall costs.6 When people do not have dental coverage or are unable to receive cost-eective preventive care,they may use costlier care settings or dental problems.7 A recent national study estimated that preventable dental conditions werethe primary diagnosis in approximately 830,600 visits to emergency rooms in 2009 up 16 percent rom 2000.8

Dental disease is not reversible, but it is preventable. Regular preventive care helps people avoid the pain and cost associated withmore invasive acute dental care. The Colorado Department o Public Health and Environment has identied oral health as one o its 10Winnable Battles, aiming to increase the percentage o the population with fuoridated water, o inants who get a dental checkup byage one and o third-graders with dental sealants.9

Foundations and provider groups are working to increase awareness and use o dental services, and communities are starting tounderstand the importance o access to oral health. The CHAS data provide insight into Coloradans access to oral health care,and a baseline rom which to track the progress o strategies designed to improve access.

Access to Oral Health Care: Identifying BarriersIn 2011, 63.4 percent o Coloradans visited a dental proessional, down rom the 66.3 percent with a visit in 2008-2009 amarked decrease in the use o dental services. Oral health care is infuenced by many actors, including social and culturalinfuences, personal preerences, geography, provideravailability and aordability o care.10 The traditionalseparation o the dental and medical delivery systems canalso limit access to oral health care, because moreColoradans have access to health insurance than dentalinsurance. I they were integrated, more people might havedental coverage.

This brie provides insight into three actors that aect oralhealth care: access to dental insurance, the cost o dentalcare and residence in a rural area.

Dental InsuranceDespite the coverage limitations o many dental insuranceplans, having dental insurance does aect access, especially orlower-income Coloradans. Use o dental services is stronglyassociated with having dental insurance, and the CHAS ndingsrefect this association (see Graph 1). O Coloradans withdental insurance, 76.9 percent visited a dental proessional.By comparison, 44.5 percent o Coloradans without dental

insurance visited a dental proessional.Still, more than one-third o Coloradans who did not get neededdental care because o cost had dental insurance. So, althoughdental insurance coverage does not guarantee access, it mayameliorate some aordability concerns. Coloradans withoutdental insurance were twice as likely to skip needed dentalcare due to cost as Coloradans with dental insurance.

The number o Coloradans without dental insurance grew to 2.1 million in 2011 rom 1.8 million in 2008-2009. This was a statisticallysignicant increase in the rate, to 39.9 percent without dental insurance in 2011 rom 37.0 percent without dental insurance in 2008 -2009CHAS ndings show that 36.3 percent o employed working-age adults lacked dental insurance in 2011, up rom the 33.2 percentwithout dental insurance in 2008-2009. By comparison, 18.6 percent o employed working-age adults lacked health insurance in 2011.

Graph 1. Percentage of Coloradans, by InsurancStatus, Who Visited a Dental Profession

Colorado, 2011

PercentofColoradans

Dental Insurance Status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Had

dental

insurance

No

dental

insurance

76.9%

44.5%


3/12

COLORADO HEALTH ACCESS SURVEY

ABOUT THE SURVEYThe Colorado Health Access Survey (CHAS) is an extensive survey o health care coverage, access and utilization in

Colorado. It is a ollow-up to the 2008-2009 Colorado Household Survey (COHS) and is administered every other year

via a random-sample telephone survey o more than 10,000 households across the state. The CHAS provides detailed

inormation that is representative o the fve million-plus Coloradans.

A program o The Colorado Trust, the CHAS provides inormation to help policymakers, as well as health care, business a

community leaders, more ully understand health care challenges and advance shared solutions to improve health covera

and care or Coloradans.

The Colorado Health Institute (CHI) managed the data collection and analysis o the survey.

More than 2.5 times the number o Coloradans werewithout dental insurance in 2011 (39.9 percent) thanwere without health insurance (15.8 percent) (seeGraph 2). This is a dierence o 1.2 millionColoradans.

During the same period, there was a decrease in thenumber o Coloradans who used dental services.

The percentage o Coloradans who visited a dentalproessional in the 12 months beore the survey ellrom 66.3 percent in 2008-2009 to 63.4 percent in2011, a statistically signicant decrease o 2.9percentage points, or 10,500 Coloradans. Given theconnection between dental insurance and use, thistrend is concerning but not surprising.

Coloradans with dental insurance were more likelyto use dental services than uninsured Coloradans,especially among those with lower incomes (seeGraph 4).

CHAS also provides insight into how the lack o

dental benets in public health insurance might impact use o dental services. Coloradans covered under Medicare (no dentalbenet) and Medicaid (no benet or enrollees over age 20) had lower rates o visits to a dental provider than Coloradanscovered by employer-sponsored insurance, private insurance or Child Health Plan Plus (CHP+).

Even among Coloradans with dental insurance, ewer used dental services in 2011 than in 2008-2009, suggesting that thereare other barriers to receiving dental care, including the cost o care and availability o dental providers.

Cost of Oral Health CareIndividuals with dental insurance are oten responsible or signicant out-o-pocket expenditures due to the limits and capscommonly ound in dental insurance plans. The CHAS highlights the aordability challenge o dental care. Coloradans weremore likely to orego dental care due to cost than any other type o care (see Graph 3 on page 4).

Approximately 1.2 million Coloradans, or 22.9 percent, did not receive needed dental care due to cost. The Coloradans who

did not receive needed dental care were more likely to have incomes below 250 percent o the Federal Poverty Level (FPL).Also, about a third (36.6 percent) o the Coloradans who did not receive needed dental care because o cost had dentalinsurance. This may refect the cost o dental care and the limitations o dental coverage.

Nationally, 41.6 percent o the $102.2 billion in total expenses or dental services in 2009 were paid by the patient, not by apublic or private insurer.3 The Colorado Department o Public Health and Environment estimates that more than $1 billion isspent on dental services in Colorado each year.11

The CHAS asked how much was spent on out-o-pocket dental and vision care. The percentage o Coloradans with out-o-pocket expenses or these types o care decreased rom 72.4 percent in 2008-2009 to 70.2 percent in 2011. This may meanthat more people are oregoing dental and vision care, nding it unaordable.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

37.0%

13.5%

39.9%

15.8%

No dental insurance

No health insurance

2008-2009 2011

Graph 2. Comparing Dental and Health Insurance StatusColorado, 2008-2009 and 2011

PercentofColo

radans

Health & Dental Insurance Status


4/124


Cost o care does not always prevent an individual rom seeing a dental proessional. Some may visit a dentalproessional and then decide to orego additional needed high-cost care such as permanent crowns or prosthetics orextracted teeth. These services are oten not covered by dental insurance. In 2011, 15.2 percent o Coloradans whovisited a dental proessional did not receive additional needed dental care because o cost.

0%

5%

10%

15%

20%

25%

30%

12.0%13.3%12.5%

22.9%

6.6%

Did not fill

a needed

prescriptionfor medicine

Did not

get needed

specialist care

Did not

get needed

doctor care

Did not

get needed

dental care

Did not

get needed

mental healthcare

71.0%Had incomesbelow 250% FPL

36.6%Had dental insurance

Graph 3. Percentage of Coloradans Who Did Not Receive Needed Care Because of Cost, Colorado, 2011

PercentofColoradans

No Necessary Care Due to Cost

Gaps in Dental Coverage underPublicly Financed Health Insurance

Programs

Traditional Medicare does not provide adental beneft, although some Medicare

Advantage plans may include a beneft.

Colorado Medicaid limits dental benefts toenrollees ages 20 and younger.

CHP+ provides a capped dental beneft orchildren under the age o 18 who do notqualiy or Medicaid but who live in amilies

with incomes at or below 250 percent FPL.The annual maximum beneft is $600.

UNDERSTANDING DENTAL INSURANCE

Dental insurance coverage purchased through the commercialmarket can be employer-sponsored or individual.

The prevalence o employer-sponsored dental insurance hasbeen diminishing, peaking in 1984 with 77 percent o ull-timeprivate U.S. workers having dental coverage to 57 percent oull-time private workers in 2011.12

Private health insurance plans oten exclude dental coverage.Approximately 98 percent o Americans with dental coveragehave a policy separate rom their medical insurance policy.13,14

Dental insurance typically costs less per month than healthinsurance but may have high levels o cost-sharing andmaximum benet caps.

The relatively limited nature o dental benets and the

potential or signicant out-o-pocket expenditures even withdental coverage may infuence the decision to obtain dentalinsurance. While lack o dental insurance is more commonamong lower-income individuals, 22.8 percent o Coloradanswith incomes above 400 percent FPL did not have dentalinsurance.


5/12


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

72.2%

35.1%

70.2%

45.9%

77.4%

50.5%

84.4%

64.1%

Had dental insurance and

visited a dental professional

No dental insurance and

visited a dental professional

0%-133%

FPL

134%-250%

FPL

251%-400%

FPL

> 400%

FPL

Graph 4. Visit to a Dental Professional by Income andInsurance Status, Colorado, 2011

PercentofColoradans

Income and Insurance Status

Location and WorkforceThe decision to access dental services canbe infuenced by the availability o oral healthproviders. The distribution o Coloradosdental workorce varies across the state.Twenty two counties are either ully orpartially designated as a geographic DentalHealth Proessional Shortage Area (DHPSA)and twenty seven counties have ull or partiadesignation as a low income DHPSA.15

CHAS ndings show that Coloradans livingin rural communities did not visit a dentalhealth proessional in the last 12 months asoten as those in urban areas (see Map 1).Many o these counties are designated asDHPSAs, and many are the same places thathave a shortage o other health careproessionals.

Coloradans in these areas have diculty

getting access to dental care not onlybecause o cost but because there are notenough proessionals to provide theservices. This may be one reason that

Map 1. Percentage of Coloradans Who Reported Not Visiting a Dental Health Professional, by HealthStatistics Region, Colorado, 2011


6/126


Coloradans o all income levels with a usual source o medicalcare more oten reported seeing a dentist than those who didnot have a usual source o care; areas with more healthproessionals also tend to be the areas with more dentalproessionals. Overall, twice as many Coloradans with a usualsource o medical care reported seeing a dental proessionalas those without a usual source o care. Other possiblereasons or this are that those who seek regular medical caremay be more likely to seek regular dental care as well, or thatthe usual source o care provider encourages patients tohave dental care and reers their patients to a dentist.

CHAS identied regional variations in dental insurance across Colorado, with the highest concentration o people withoutdental insurance in the southwest (see Map 2).

The higher rate o Coloradans without dental insurance in the western part o the state aligns with the higher percentages ohealth uninsurance rates in these communities, possibly due to the number o small employers and seasonal or lower-wageworkers in these areas.

The regions along the Eastern Plains have some o the higher rates o health insurance, but the rate o dental uninsuranceexceeds 50 percent. It is possible that many in this area are covered by Medicare, which does not cover dental services. Thisnding may also be due to the types o employment available in these areas such as sel-employed armers, ranchers, small

business owners and low-wage positions.

36.3%Percentage of employed Coloradans ages19-64 without dental insurance in 2011,

an increase from 33.2% in 2008-2009.

Map 2. Dental Uninsured Rates, by Health Statistics Region, Colorado, 2011


7/12


Colorados Dental Uninsured: A PortraitCHAS ndings illustrate the dental uninsured rate in Colorado, including demographic and geographic characteristics. Thesedata can inorm program and policy decisions to help increase access to dental care or Coloradans.

Age 0-18

Age 19-34

Age 35-54

Age 55-64

Age 65+

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1

25.6%22.1%

43.0%48.6%

35.0%41.6%

39.5%

41.4%

57.7%60.6%

2008-200

2011

Graph 5. Dental Uninsured Rates by Age, Colorado, 2008-2009 and 201

AgeGroups

Percentage o Dental Uninsured Coloradans

More than400% FPL

301%-400%FPL

201%-300%FPL

101%-200%FPL

0%-100%FPL

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

22.2%22.8%

26.9%

27.7%

37.7%

36.9%

48.0%53.6%

52.6%

54.2%

2008-20

2011

Graph 6. Dental Uninsured Rates by Income as a Percentage ofFederal Poverty Level, Colorado, 2008-2009 and 2011

Inco

meLevel


Graph 7. Dental Uninsured Rates by Race/Ethnicity, Colorado, 2008-20and 2011

RaceandEthnicity


White

Black

Hispanic

Other

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1

36.4%

39.1%

22.0%

29.9%

47.6%

52.8%

29.5%

33.5%

2008-20

2011

AgeRates o dental insurance decreasedor all age groups except children 18

and under rom 2008-2009 to 2011(see Graph 5).

Seniors in the 65+ age group had thegreatest percentage o dental uninsuranceo all age groups, with 60.6 percent, orapproximately 324,000, without dentalinsurance. This is important becauseColorados senior population is projectedto increase by 125 percent rom 555,000in 2010 to 1.2 million in 2030.16 Inaddition, as oral health continues toimprove and more people retain their

natural teeth, greater numbers oolder adults will need dental care.

Young working-age adults between 19and 34 have the highest rates o healthuninsurance among all age groups. Thishigh rate o uninsurance extends todental coverage or this age group, withnearly 50 percent lacking dentalinsurance, second only to seniors.

IncomeThe increase in dental uninsurance rom

2008-2009 to 2011 was concentratedamong lower-income Coloradans.

More than hal o Coloradans withincomes below 200 percent FPL did nothave dental insurance in 2011, slightlylower than the estimated 59 percent othis group nationally (see Graph 6).13

Coloradans may be choosing to oregodental coverage or they may not haveaccess to employer-sponsored dentalcoverage. Nearly one in our (22.8percent) o higher-income Coloradans

(above 400 percent FPL) said they didnot have dental insurance. Only 3.7percent o the same Coloradans saidthey did not have health insurance.

Race and EthnicityMost races and ethnic groups showed anincrease in the number o dentaluninsured rom 2008-2009 to 2011. Still,a majority o most racial/ethnic groupshad dental insurance (see Graph 7).


8/128


The majority o Hispanics, however, did not have dental insurance, moving rom below 50 percent in 2008-2009 to above 50percent in 2011.

Among both kindergarten and third grade children, there were more Hispanic children with at least one cavity compared toblack or white children. Among children in kindergarten, 55 percent o Hispanic children had one or more cavities, comparedto 38 percent o black children and 31.9 percent o white children. Among children in kindergarten, the prevalence ountreated tooth decay was higher among Hispanic children (18.5 percent) compared with Black (16.8 percent) or White (11.4percent) children.9

Childrens Oral HealthTooth decay is the most common chronic disease ochildhood. Preventive dental care, including annual dentalvisits, is essential or optimal oral health. Colorado childrenneedlessly miss hours o school due to mouth pain. CHASndings show that approximately 66,300 additional childrenhad dental insurance in 2011 than 2008-2009. Even so,approximately 41,500 ewer children accessed dentalservices. This suggests that dental insurance, whileimportant, is just one actor aecting childrens access to

oral health care.The percentage o Colorado children living at the lowest levelo income and without dental insurance decreased rom 31.6percent in 2009 to 24 percent in 2011, a decline oapproximately 20,400 children (see Graph 8). This may bedue to eorts to increase enrollment in public programs oreligible children.

Although coverage increased, the percentage o Coloradochildren who visited a dental proessional saw a statisticallysignicant decrease rom 75.9 percent in 2008-2009 to 70.9percent in 2011 (see Graph 9).

According to the Colorado Department o Health Care Policy and Financing, 45 percent o children covered by Medicaidreceived preventive dental services.17 Many actors may infuence utilization o dental care by children, including parental useo dental services and oral health literacy as well as availability o dental providers who accept public insurance or renderaordable services. Only one in our practicing dentists in Colorado accepts Medicaid.18

Graph 9. Visited a Dental Professional, Ages 0-18, Colorado, 2008-2009 and 2011

24.1%

NO

75.9%

YES

70.9%

YES

29.1%

NO

2008-2009 2011

Graph 8. Dental Uninsured Rate, Ages 0-18,Colorado, 2008-2009 and 2011

More than

400% FPL

251% to

400% FPL

134% to

250% FPL

0% to

133% FPL

0% 10% 20% 30% 40% 50% 60% 70% 8

17.4%

16.5%

25.5%

19.6%

25.2%

25.7%

31.6%

24.0%

2008-2009 2011

Federal

PovertyLevel

Percentage o Age 0-18

Dental Uninsured


9/12


Policy Implications and OpportunitiesIntegrating Dental and Health InsuranceIntegrating dental and health insurance may increase access to dental care. CHAS data show that more people have healthinsurance than dental insurance, so making them one integrated package may increase access. However, bringing separatedental and medical insurance plans together poses a challenge or commercial health insurers. Insurers have dierent claimspayment processes, provider networks and benet structures such as deductibles, cost-sharing and benet maximums.15

Beginning in 2014, the Aordable Care Act requires that individual and small group insurance plans oer a package o healthcare services, including pediatric dental care. These oral health services may be oered through a medical plan or in aseparate dental policy.

Expanding Coverage to Address CostDental insurance coverage in its current orm does not cover the costs o dental care, but it is a start. CHAS ndings point tothe cost barrier acing all Coloradans in accessing dental coverage and care a barrier that can be unsurmountable or thosewith lower incomes. Although not a guarantee o access, dental insurance coverage is an opportunity to address costconcerns.

While the majority o state Medicaid programs provide coverage or emergency dental services, there is wide variation amongstates in the types o dental services and degree o coverage oered to adults under Medicaid, with ewer than hal o statesproviding coverage or non-emergency dental care.19,20 Colorado currently provides no dental benet or adults enrolled in

Medicaid or pregnant women covered by CHP+, creating an opportunity or the state and stakeholders to develop ameaningul, cost-eective benet. This would increase short-term costs to the state, but providing coverage or specicpopulations, including pregnant women and low income parents, may yield downstream savings through improved oral healthstatus among children. Eorts that expand public dental coverage should assess the long-term impact in the overall health obeneciaries and the potential or cost savings to the state.

For people who do not receive dental benets under Medicaid or CHP+, there may be opportunities to increase access todental coverage through the Colorado Health Benet Exchange (COHBE). Families with incomes up to 400 percent FPL willbe eligible or subsidies to purchase oral health coverage or their children through COHBE. In addition, supplemental dentalinsurance or adults and non-essential pediatric oral services or children may be included among COHBEs coverage optionsor the individual and small employer markets.21

Developing an Accessible and Integrated Oral Health WorkforceColorados dental workorce may be unable to meet the oral health needs o Coloradans. Colorados DHPSAs have some othe highest rates o Coloradans who did not visit a dental health proessional. Low-income Coloradans ace additionalchallenges, not only in locating a dental provider but nding aordable care.

There are public and private initiatives underway with the health care workorce in Colorado to improve access to oral healthcare or underserved communities. Many o these eorts could be expanded or brought to scale to increase their reach.Examples include:

The Colorado Health Service Corps loan repayment program provides incentives or qualied dentists and dentalhygienists to practice in underserved communities.

Saety net clinics, including community-unded clinics, school-based health centers and Federally Qualied HealthCenters, are providing dental care or low-income and uninsured Coloradans.

Cavity Free at Three, a partnership between state agencies and private oundation and education partners, trains

physicians, nurses, physician assistants and dental proessionals about the oral health needs o children ages 0-3. Thistraining, designed to increase the number o children ages 0-3 who have a dental home, is also extended to medical,dental and nursing students.

Supporting medical practices in their transition to becoming medical homes may make dental care more accessible.Medical home recognition and accreditation programs include requirements to provide resource lists that include dentalservices22 or to acilitate patient access to care, treatment or services or oral health care.23 While there are ew medical orhealth home models that ully integrate dental care, a variety o approaches rom ull integration or co-location oproviders to virtual linkages or acilitated reerral can make dental care more easily accessible.


10/12


10

ConclusionMore than two million Coloradans lack dental insurance, a CHAS nding that has serious consequences or Coloradans oralhealth. CHAS results show that dental insurance coverage is associated with utilization o dental services. There are manyopportunities and policy options to increase access to dental coverage and care.

The CHAS results also tell us that dental insurance coverage alone does not guarantee that people will receive dental care.Coloradans both with and without dental insurance are putting o needed dental care due to cost. Dental coverage must

continue to be aordable but must be more substantive in order to protect subscribers rom high out-o-pocket expenses.Balancing these competing issues will be challenging, especially with the current structure o dental benets. Additionally,dental providers must be willing to accept public and private dental insurance. Colorado could address options to makeMedicaid viable or providers by looking at reimbursement rates and also supporting saety net providers already providingdental services to vulnerable populations.

State leaders and health care providers could also examine whether the distribution o the existing oral health workorce inColorado is adequate. Increasing access to dental care may require new models o care. Supporting eorts to integrate dentacare with medical care can be coupled with addressing potential payment barriers and regulations that limit providers in thetypes o care and services they are able to oer.

The success o initiatives intended to improve Coloradans oral health status depends on increasing public understanding thatpreventive care begins at birth, and helping people navigate the oral health care system. Inormation on the saety, ecacyand cost savings o water fuoridation can inorm community-level decisions about oral health. Health care providers

understand the impact o poor oral health and should be encouraged and supported in their eorts to incorporate education,prevention, detection and reerral to an appropriate, aordable source or dental treatment into their patient-centeredpractices.

MethodologyThe 2011 Colorado Health Access Survey (CHAS) is a program o The Colorado Trust. The Colorado Health Institute (CHI)manages the data collection and analysis o the CHAS.

The survey was conducted via a random-digit-dialing, computer-assisted telephone interview by Social Science ResearchSolutions, an independent research company between May 10 and August 14. A representative sample o 10,352 householdsparticipated in the survey.

O the 10,352 interviews, 1,214 were conducted with respondents who owned only a cell phone. This compares with arepresentative sample o 10,090 households surveyed rom November 12, 2008, through March 13, 2009, or the 2008-09COHS. (Note: The name o the survey was changed or the 2011 version and will remain the Colorado Health Access Surveyin uture surveys.) In the 2008-09 survey, 400 interviews were conducted with respondents who owned only a cell phone.

Interviews were stratied by 21 Health Statistics Regions in Colorado to ensure adequate representation within each o them.These are the 21 health statistics regions developed by the Colorado Department o Public Health and Environment (CDPHE)or public health planning purposes. Regions with sucient numbers o Arican American households were oversampled toensure an adequate sample o Arican Americans comparable to their proportion in the Colorado population.

Survey data were weighted to 1) adjust or the act that not all survey respondents were selected with the same probability,and to 2) account or gaps in coverage in the survey rame. Because o this weighting process, CHI reers to the people whoanswered the questions as respondents. But when discussing results, which have been weighted to the Coloradopopulation, CHI reers to Coloradans.

All statistical signicance tests were run using an alpha o 0.05. Tests that resulted in a p-value o less than 0.05 wereconsidered to be statistically signicant ndings. I a dierence is ound to be statistically signicant, it is unlikely that thechange occurred by chance or sample selection. Statistical signicance tests were not run on all ndings cited in the brie.


11/12


Endnotes1 Oral Health in America: A Report o the Surgeon General. Rockville, MD: U.S. Department o Health and Human Services, National Institute o

Dental and Cranioacial Research, National Institutes o Health.http://www2.nidcr.nih.gov/sgr/sgrohweb/home.htm. 2000.

2 Snyder A, and Gehshan S. State Health Reorm: How Do Dental Benefts Fit in? Options or Policy Makers. National Academy or State HealthPolicy.http://nashp.org/sites/deault/fles/options_dental.pd?q=Files/options_dental.pdApril 2008.

3 Committee on an Oral Health Initiative, Institute o Medicine. Advancing Oral Health in America. Washington, DC: The National AcademiesPress. 2011.

4 Kenney G, McFeeters J, and Yee J. Preventive Dental Care and Unmet Dental Needs Among Low-Income Children. Am J Public Health. 2005;95(8): 1360-1366.

5 Manski RJ, Brown E. Dental Use, Expenses, Private Dental Coverage, and Changes, 1996 and 2004. Rockville (MD): Agency or HealthcareResearch and Quality; 2007.http://www.meps.ahrq.gov/mepsweb/data_fles/publications/cb17/cb17.pd. Accessed February 27, 2012.

6 Moeller JF, Chen H, Manski RJ. Is Preventive Dental Care a Good Investment or the Medicare Population, A Preliminary Analysis. Am J PublicHealth. 2010; 100(11): 2262-2269.

7 Wallace NT, Carlson MJ, Mosen DM, Snyder JJ, Wright, BJ. The Individual and Program Impacts o Eliminating Medicaid Dental Benefts in theOregon Health Plan. Am J Public Health. 2011; 101(11): 2144-2150.

8 Pew Childrens Dental Campaign. A Costly Dental Destination. The Pew Center on the States.http://www.pewcenteronthestates.org/uploadedFiles/A%20Costly%20Dental%20Destination.pd. Published February 2012.

9 Colorado Department o Public Health and Environment. Childrens Oral Health Screening Colorado, 2011-2012. Colorado Department oHealth and Environment. October 2012.

10 Improving Access to Oral Health Care or Vulnerable and Underserved Populations. Washington, DC.: National Academy o Sciences. 2011.http://www.iom.edu/Reports/2011/Improving-Access-to-Oral-Health-Care-or-Vulnerable-and-Underserved-Populations.aspx.

11 Colorado Department o Public Health and Environment. The Impact o Oral Disease on the Health o Coloradans. http://www.cdphe.state.co.us/pp/oralhealth/impact.pd. Published May, 2005. Accessed March 14, 2012.

12 Bureau o Labor Statistics. Employee Benefts Survey, Health Care Benefts 2011. United States Department o Labor. http://www.bls.gov/ncs/ebs/benefts/2011/ebbl0048.pd. Accessed March 26, 2012.

13 Haley J, Kenney G, Pelletier J. Access to Aordable Dental Care: Gaps or Low-Income Adults.http://www.k.org/medicaid/7798.cm.Published July 25, 2008. Accessed on February 29, 2012.

14 NADP/DDPA. Oering Dental Benefts in Health Exchanges: A Roadmap or Federal and State Policymakers. Delta Dental.http://www.deltadental.com/ExchangeWhitepaper.pd. Published September, 2011. Accessed on March 14, 2012.

15 Dental Health Health Proessional Shortage Areas. Colorado Department o Public Health and Environment web site. http://www.cdphe.state.co.us/pp/primarycare/shortage/dhpsa.pd. Accessed April 5, 2012.

16 Garner, E. The Age Wave in Colorado.http://www.colorado.gov/cs/Satellite/DOLA-Main/CBON/1251593240528. State Demography Ofce

Publications and Presentations. Published September 2011. Accessed April 2, 2012.17 Colorado Department o Health Care Policy and Financing. Healthy Living Initiatives Perormance Measures. Healthy Living Initiatives.http://

www.colorado.gov/cs/Satellite/HCPF/HCPF/1251607707486. Updated January 19, 2012. Accessed March 26, 2012.

18 Colorado Health Institute analysis o 2011 data rom the Department o Regulatory Agencies and Peregrine Management Corporation.

19 Dental Crisis in America: The Need to Expand Access. Washington, DC.: U.S. Senate Committee on Health, Education, Labor & Pensions.2012. http://www.sanders.senate.gov/imo/media/doc/DENTALCRISIS.REPORT.pd.

20 McGinn-Shapiro, M. State Health Policy Monitor: Medicaid Coverage o Adult Dental Services. National Academy or State Health Policy. 2008.http://nashp.org/sites/deault/fles/Adult%20Dental%20Monitor.pd?q=fles/Adult%20Dental%20Monitor.pd.

21 Fontana, J. Healthcare reorm: What about dental? Milliman. http://publications.milliman.com/publications/healthreorm/pds/healthcare-reorm-dental.pd. Published March 2012.

22 Patient Centered Medical Home 2011, Part 2 Standards 4-6.http://www.ncqa.org/LinkClick.aspx?fleticket=LD8Ada0Jotc%3d&tabid=109.National Committee or Quality Assurance. Accessed March 27, 2012.

23 Approved Standards and Elements o Perormance or The Joint Commission Primary Care Medical Home Option. The Joint Commission.http://www.jointcommission.org/assets/1/18/Primary_Care_Home_Posting_Report_20110519.pd. Published May 19, 2011.


12/1212

Copyright December 2012. The Colorado Trust. All rights reserved. The Colorado Trust is pleased to have organizations or individuals share its materialswith others. To request permission to excerpt rom this publication, either in print or electronically, please contact Christie McElhinney, Vice President oCommunications & Public Aairs, [email protected].

1600 Sherman Street PHONE 303-837-1200

Denver, CO 80203-1604 TOLL FREE 888-847-9140

www.coloradotrust.org FAX 303-839-9034

www.COHealthAccessSurvey.org

chas issue brief: a growing problem: oral health coverage, access and usage in colorado

Documents