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Proposed cuts to dental services: All pain, no gain

There is widespread agreement that the state’s budget shortfall will result in necessary, difficult and likely unpopular decisions. There is much less consensus on how to make cuts in a fair and equitable manner. Overall health-care costs are consuming more and more of both federal and state budgets for reasons — too many to discuss here. Dental expenditures as a percentage of total health costs are truly minuscule, representing, at most, four cents of the health-care dollar; they are even less for state-sponsored dental programs that cover the working poor; the unemployed, whose ranks are growing in size as the economy deteriorates; and the disabled. Yet Gov. Tim Pawlenty’s budget proposal to eliminate adult dental services for all but pregnant women, children and the disabled is astonishingly disproportionate, economically flawed and fraught with unacceptable short-and long-term consequences.

The governor’s solution to dental access for adults is hospital emergency rooms (ERs).  In the Twin Cities the cost of an ER visit for a toothache or dental infection averages $450 to $500. For this, the patient is seen by a physician and may be given a prescription for an antibiotic and a painkiller with no dental treatment rendered.

Estimates suggest that there were 20,000 dental-related ER visits in Minnesota last year. At Hennepin County Medical Center alone in 2008, there were 7,400 such visits to HCMC’s ER and Express Care, costing the state several million dollars in medical billings. This is cost-shifting at its worst, and leaves patients without definitive treatment of their dental problem. 

Expect more patients, more severe dental problems at ERs
Over 80 percent of these visits were by 20- to 50-year-olds, the very individuals being disenfranchised in the governor’s budget. Since they would have no access to preventive or routine clinical care, under the governor’s plan we could anticipate a dramatic increase in both the number of patients and severity of dental problems presenting to the ERs.

A growing number of patients with dental disease also have underlying chronic medical conditions such as diabetes, which increases their risks for complications. Recently, a diabetic patient spent three months in a surgical intensive-care unit due to infection caused by a tooth. The medical costs approached a million dollars. This could have been prevented by timely dental treatment. 

Another provision in the governor’s budget calls for the elimination of the Critical Access Dental Provider Program (CADPP), which would further devastate access to dental services. CADPP provides additional dollars to safety-net clinics and dentists serving substantial numbers of Minnesota’s under and uninsured patients and doing so at already greatly discounted rates. As access is further diminished, we could witness the dismantling of a vital safety net. To rebuild this infrastructure at some later date would be prohibitively costly.
   
Valuable clinical training
Less apparent, but of major significance, the safety net is where many of tomorrow’s dentists, dental specialists and allied health personnel receive valuable clinical training.  If we reduce our ability to educate Minnesota’s oral-health providers, we risk diminishing the quality of dental services for all Minnesotans. I do not believe that we either want or can afford such an outcome.
   
The entire dental community and numerous advocacy groups are working diligently to be part of the solution — seeking ways to reduce costs, improve efficiencies in delivering care and accommodating to the realities inherent in the current budget shortfall. We accept that we must shoulder our fair share of the burden; however we do not accept sacrificing the oral health and well-being of the most vulnerable of our citizens and compromising the education of future dental providers.
   
I, along with many of my dental and medical colleagues, urge the governor to reconsider his cuts in dental services for adults in Minnesota Health Care Programs and elimination of the Critical Access Dental Provider Program.
   
The “Minnesota Model” was once part of the national lexicon. It acknowledged Minnesota as a leader in many areas, chief among them the quality and innovation in the delivery of health care. We have lost our edge; are we in danger of losing our compassion as well?

Anthony J. DiAngelis, DMD, MPH, is chief of the Department of Dentistry, Hennepin County Medical Center.

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Comments (2)

  1. Submitted by Bernice Vetsch on 04/14/2009 - 06:17 pm.

    The governor has also found a way to mitigate (hah) the cost of the increased number of emergency room visits by uninsured persons this change will cause.

    He’s also cutting the budget for state payments that help hospitals survive in spite of the ever-growing number of Minnesotans with nowhere else to go for care.

    It doesn’t have to be this way. We do not have to balance the budget by increasing the suffering and want of the poor, the disabled, the mentally ill, the elderly, the unemployed who have lost their insurance coverage, et cetera.

    We can return to sanity in governance by raising income taxes on the top earners to the levels paid before the cuts of 1999-2000. It’s time to declare the anti-tax ideology favored by the governor as dead as Ayn Rand and Milton Friedman.

  2. Submitted by Lance Groth on 04/15/2009 - 07:09 pm.

    What a shock – Pawlenty once again dumps on the poor and powerless. Of course, that is a Republican trait. Compassion? They don’t know the meaning of the word.

    Mr. “I’m from blue collar roots” has forgotten all about those roots, and cares only for the rich Republicans who contribute to his election fund. He’s turned his back on the people he grew up with, and now hobnobs only with the tax-evading rich.

    This guy’s neglect of the people and business of the state of Minnesota amounts to misfeasance, if not nonfeasance. He needs to be ejected from public life in Minnesota at the earliest opportunity.

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