Economics, geography and a number of health system- and provider-level forces determine the distribution of health care providers and availability of health care services. The federal Health Resources and Services Administration (HRSA) quantifies provider-to-population imbalances by designating certain areas as health professional shortage areas (HPSAs). HRSA calculates provider-to-population imbalances for dental providers, known as dental HPSAs. The National Health Service Corps develops HPSA scores to determine priorities for the assignment of clinicians. The higher the score, the greater the priority.
Dental HPSAs generally have higher rates of public insurance coverage and poverty, which can complicate efforts to address oral disease in underserved areas. People in these areas struggle to access oral care for various reasons, including transportation, insurance coverage, language barriers or lack of oral health knowledge.
State legislators can use HPSA data or the HPSA designation to inform state policy decisions. State and federal policymakers seeking to improve the oral health of their residents may consider a range of policy options to help address dental provider shortages.
- Loan repayment programs for dental providers. The federal government assists all 50 states, the District of Columbia and Puerto Rico with loan repayment programs for underserved populations, especially programs serving rural areas. There are a number of federal programs for which oral health providers are eligible.
- Teledentistry. At least 19 states have adopted policies related to teledentistry (e.g., allowing reimbursement or eliminating provider type restrictions).
- Integrating oral health into the traditional health care system, such as in primary care settings.
- Developing an oral health workforce to provide preventive services in the community.
Communities designated as a dental HPSA face unique challenges and it is important for policymakers to identify those challenges in order to pursue effective oral health policy solutions.
Sources: Practice Ownership Declining Among Dentists, ADANews, the American Dental Association. Oral Health Care in Rural America, National Conference of State Legislatures LegisBrief, 2017.