Georgia’s Children 2
Georgia’s Children—Insured but Underserved:
A Look at Access to Dental Care in Georgia’s Rural Communities
Susan Thomas
Quest Group #256
Covenant College
Lookout Mountain, Georgia
Georgia’s Children 2
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By Susan Thomas
Entitled: Georgia’s Children—Insured but Underserved: A Look at Access to Dental Care in Georgia’s Rural Communities
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Georgia’s Children 2
Abstract
This study was conducted to investigate the barriers surrounding access to dental care for Georgia’s children receiving government funded insurance. The purpose of the research was to consider possible solutions for improving parents’ ability to access dental care for their children. The study investigated parents’ opinions on the topic, specifically did they view this as a problem and would they be willing to bear a portion of dental care cost to improve their ability to find local care. A 16 question survey was developed. Nine questions asked parents their personal experiences with accessing dental care, and their views on what solutions they might consider. Additionally, there were four questions to qualify and categorize respondents, as well as, an income level question and two questions used to reference participants’ household in the body of the research. The survey was conducted at two separate dental facilities, one a private practice and the other a government funded practice. There were 37 surveys given out and respondents answered and returned surveys while in the office. The major finding of the research was that parents of children with state/federal funded insurance do view their access to dental care as a problem and are willing to participate monetarily in the cost of their children’s dental care in order to improve access to care.
Georgia’s Children 2
Table of Contents
Certification page 2
Abstract 3
Table of Contents 4
Chapter One: Introduction 6
Statement of Problem 7
Setting of Problem 7
History and Background of Problem 8
Purpose of Project 10
Importance/Significance of Project 11
Literature Review 12
Goals and Hypotheses 18
Chapter Two: Methodology 20
Participants 20
Materials 21
Procedures 22
Chapter Three: Results 24
Description of Data 24
Impact of Data on Hypotheses 31
Chapter Four: Discussion 35
Conclusions 35
Recommendations 38
Reflections 40
References 42
Appendix A: Survey Instrument 44
Appendix B: Summary of Data 47
Georgia’s Children 2
Chapter One: Introduction
Jason playfully runs ahead of his mother after picking out his much awaited prizes. Another successful trip to the dentist and all of his cavities have finally been removed and filled. Jason’s mother is not excited, but disappointed after receiving the news her child’s insurance will no longer be accepted in this office. Jason started out being scared to come to the dentist, but after a few visits he loves coming to see Dr. X, and now they have to start all over somewhere else. And the nearest office that will take his state insurance is 45 miles away. She can barely afford the gas to drive into town let alone two towns away. The staff feels badly at having to turn Jason and his mom away but three price deductions in a year is more than the practice can bear.
A few hours later Abbey arrives looking so cute in her Abercrombie shirt and Guess jeans announcing that her new $300.00 cell phone was just ruined by getting wet. A puzzled staff wonders how she can possibly have the same insurance as Jason. Abbeys’ mom asks if she can pay the difference between her Wellcare and the office fees in order to continue coming to the office. The staff explains that unfortunately that is illegal, as the practice is required to accept only what the insurance pays.
Later in the day another mother expresses her disappointment at the practices’ decision to no longer accept their state funded insurance. Justin’s mother then announces she will continue to bring Justin to the office and will just use the insurance she has for him through her employer. The office is happy to keep Justin as a patient but puzzled how Justin can be eligible for state funded insurance when he has insurance elsewhere.
These are just the tip of the iceberg when considering the complexities involved with government funded insurance programs. To the observer there appears to be far too much disparity in income levels between recipients of the same category of aid. Most health care providers choose their profession because they truly want to help people and the decision to exclude any group, especially children from their practice is really a difficult choice. The difficulties facing the government programs are making this a reality for far too many of our children. This is especially true in the more rural areas where health care providers are few and far between.
Statement of Problem
This study explores attitudes and perspectives of Georgia residents currently enrolled in government funded insurance programs concerning limited access to dental care, particularly in rural areas. Of primary concern are the children who often are most in need of care, yet become the most underserved. This issue is intensified by the continued decrease in reimbursement by government programs while the cost of operating a dental practice is ever increasing, causing providers to withdraw from the program altogether. One observation of dental service providers is what would seem to be a large discrepancy between income levels of those on the same government funded programs. The result of this inconsistency would cause families who truly need aid to be grouped with those who may merely need access to insurance. Unfortunately, all too often this leaves those families most in need, having no local access to dental care.
Setting of Problem
The local setting is in rural America. More specifically, this study will focus on an area in the southeastern part of the country, in the foothills of the Appalachian Mountains. Blairsville and Blue Ridge, Georgia are both small “country” communities that like many areas are becoming a melting pot of cultures. These two towns are in different counties, Union and Fannin respectively. While 20 miles apart, in an area such as this, they are considered just a stones throw away. The picturesque beauty of the area, with the Blue Ridge Mountains and local lakes is attractive to those who enjoy all sorts of outdoor activities. Also the state parks, local culture including flea markets, antique stores, festivals and craft shows, makes the area a tourist attraction for vacationers who frequently decide this is the place to put down roots. This has created an interesting clash in cultures with those who have family roots tracing back many generations. The population in both counties is currently around 20,000 to 22,000 each, with Fannin being slightly higher than Union. While there are approximately 15 to 20 local dentists between the two counties, considering the population, they all stay busy and many are no longer taking new patients. More importantly for this study, few practices accept patients with government funded insurance, or at least limit the number of these patients in their practice. The surveys will be done in two separate locations. The first is a private practice in Blairsville, just under two years old. The office is in a prime location just off the town square. It has a very fresh modern appearance with all new equipment. Patients are put at ease by the cheerful, relaxed atmosphere. The second location is a federally funded health care facility with locations in Blue Ridge and Ellijay. The organization has provided health care services for over 15 years to the underserved population in the area, and more recently, approximately four years ago added a dental facility. The office the survey will be conducted in is clean and neat, but with somewhat less atmosphere.
History and Background of Problem
From the earliest beginnings of culture, man has dealt with the issue of what to do with the poor. Is society responsible to care for those who are unable or unwilling to care for themselves? To what extent? What responsibility do the poor bear as members of society? This debate has been cross cultural throughout history and many historical figures have devoted their entire life’s work to changing cultural thought and implementing programs to aid the poor. It is a topic that can quickly become quite heated in political, religious, and even family circles.
In the United States, government funded health care was implemented in 1965 by the creation of the Medicaid program through Title XIX of the Social Security Act. The program provides health care insurance for low-income children, parents, seniors, and those with disabilities. More recently the State Children’s Health Insurance Program, or SCHIP, was created as part of the Balance Budget Act of 1997. This federal program gives support to states providing insurance for families whose income does not qualify them for Medicaid yet have uninsured children. Georgia’s program known as PeachCare for Kids, helps families with income up to 235% of the FPL (federal poverty level) have access to low cost insurance. While these programs are regulated and partially funded by the federal government, each participating (states are not required to participate, but they all do) state is responsible for setting up the parameters and guidelines for their individual state program. In 2007, the Georgia program, along with the traditional Medicaid program provided health and dental coverage for over 700,000 children throughout the state. In 2006, the programs went to a managed care system known as Georgia Families. Georgia Families operates as a partnership between the Georgia Department of Community Health and private Care Management Organizations (CMO’s). The servicing of claims have been subcontracted to three different CMO’s—Amerigroup, Peach State Health Plan, and WellCare. Providers were reassured at that time that no significant change in payments would occur. However, Georgia Families have had serious financial problems this year, which have been well publicized. In an effort to save the program, cuts have been made in several ways. Services have been eliminated and provider reimbursements decreased. In addition individuals even one day late with insurance premiums have been dropped from the program; providers attempting to join the program have found it next to impossible to maneuver through the maze of bureaucratic red tape. Those providers speaking out against the cuts have been dropped from the program altogether, leaving Georgia’s children insured but without a place to go.
For some providers, their concern for offering quality care and keeping a viable practice
has resulted in the unfortunate decision to discontinue accepting any of the federally funded insurances. In rural areas such as north Georgia, where dental providers are limited to begin with, and participating providers even more so, this decision will be felt by the local population, as they may need to travel 50 miles or more to find a provider. For families already struggling financially and the rising cost of gasoline, their ability to provide dental care for their children would certainly seem to be in peril.
Purpose of Project
The purpose of this project is to consider solutions to promote better access to dental care for Georgia’s children with government funded insurance. Healthcare cost for these children makes up a very small percentage of overall government expenditure for healthcare, yet, can provide a lifetime of benefit. By providing better access to care that promotes education and self awareness, these children have an opportunity to become an educated, productive member of their community. Research will include data collected from those with children participating in Georgia’s government funded insurance programs. A comparison of income levels and willingness to participate in cost of care will be looked at as a possible factor in reorganizing the benefit structure.
Importance/Significance of Project
Providing creative solutions that promote better access to dental care for Georgia’s children will improve the lives of these children and their parents/caregivers on a family level, as well as teachers, healthcare providers and communities on a wider scope. Many times these children have significant amounts of tooth decay. Left untreated, this chronic problem can affect all aspects of the child’s daily life including their ability to concentrate in school. In addition, the dental health education received at routine visits during this important juncture in their lives provides the best opportunity for their future health. For parents, having local dental providers that accept their child’s insurance may be the only way they can afford that care for their child. It is heart wrenching for a parent to have a child with a toothache and nowhere to take that child. Improved access to care will allow more parents to seek emergency and routine dental care that will impact their child long term.