ED dental care raises issues of access, costs in NJ

The use of emergency departments (EDs) for dental care -- especially by young adults in low-income communities -- is presenting New Jersey policymakers with a challenge, according to a new Rutgers report, which offers several remedies, including expanding hours at dental offices.

The analysis focused on ED visits for oral care not related to trauma from 2008 to 2010 in 13 low-income regions of the state with large numbers of Medicaid beneficiaries. The study aimed to identify regions where better access to dental services could reduce costs and prevent dental disease along with the long-term consequences of poor oral health.

"Emergency departments are poorly equipped to deal definitively with dental and oral health needs," said lead author Kristen Lloyd, a senior analyst at the Rutgers' Center for State Health Policy. "Still, many people seek care in emergency departments for nontraumatic dental and dental-related conditions, possibly indicating inadequate access to dental care in the community."

Young adults, ages 19-34, have the highest rate of visits to emergency departments for dental pain and infections, the researchers report. They also found great variation in ED visits for dental care across the low-income regions and in average annual costs for visits.

For example, residents of the Camden city region visited emergency departments for oral care at nearly nine times the rate of residents in the region that includes Union City, while average annual per person costs in the latter region were about one-twelfth of the cost as in the Atlantic City area.

Increases in dental insurance could potentially improve access to dental care, but there is no organized effort for such expansion, Lloyd noted. While New Jersey decided to expand its Medicaid program, which includes dental coverage under the Patient Protection and Affordable Care Act (ACA), oral care is not an essential health benefit for adults under the ACA.

The report authors recommend expanding off-hour and weekend access to dental offices in low-income communities, as well as implementing ED diversion programs, such as referring patients to new urgent care clinics or strengthening hospitals' relationships with safety net providers.

"Our findings are consistent with national data. Use of emergency departments for oral care in New Jersey is overwhelmingly an issue with young adults, especially those living in certain low-income areas," Lloyd said.

She also noted that frequent users of emergency departments for oral care were more likely to be uninsured than emergency department users coming for other reasons and were also disproportionately covered by Medicaid.

The study was funded by a grant from the Nicholson Foundation and marks the first collaboration between the Center for State Health Policy and the Rutgers School of Dental Medicine.

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