ADA Health Policy Institute's methodology overestimates spatial access to dental care for publicly insured children

Abstract

Objective: This article discusses the sources of overestimation of spatial access as recently provided by the Health Policy Institute (HPI) of the American Dental Association.

Methods: Sources of overestimation of access included estimation of Medicaid participation and capacity and limitations of the access measurement approach.

Results: While the HPI analysis used a 30% Medicaid acceptance rate for Florida, 10.2% of dentists accepted ≥100 Medicaid patients in 2015. The nationwide median number of Medicaid-enrolled children per provider ranges from 36 (Nebraska) to 265 (Florida). HPI estimated that 94% of publicly insured children in Georgia lived within 15 minutes of participating dentists. More rigorous modeling for access estimated that 23% of the total child population do not have access within the state access standards in Georgia.

Conclusions: The estimates provided by HPI substantially overestimate access for children with public insurance. The overestimation comes from both the data limitations and the shortcomings of the methodology employed.

Keywords: Medicaid; preventive dental care; spatial access; two-step floating catchment area.