Can dentists and doctors cope with the increased patient traffic since the Affordable Care Act took effect?
University of Michigan professors Dr. Thomas Buchmueller and Dr. Sarah Miller researched the question, given that more than 20 million Americans are expected to buy private health care insurance on exchanges. They found out how dentists could meet this sudden demand without working unreasonably long hours. But in some states, the solution may also mean a policy change.
[Photo: Dr. Thomas Buchmueller]
“The concern out there, and what motivated our research, is that we’re going to overwhelm doctors and facilities,” said Dr. Buchmueller, a member of U-M’s Institute for Healthcare Policy and Innovation and professor of health management and policy at the U-M School of Public Health. “But for the most part, we didn’t see that in our study.”
Dr. Buchmueller, who is also a professor of business economics and public policy at the U-M Ross School of Business, served as an economist on the President’s Council of Economic Advisers and helped implement the ACA.
Drs. Buchmueller and Miller analyzed states that added adult dental coverage to their Medicaid plans. It is a good basis to study a sudden influx of patients because states often go back and forth on adult Medicaid dental coverage depending on their budgets. And the frequency of dentist visits and primary care visits are similar.
“It’s also the same population, poorer adults, who gain coverage under the ACA, so there are a number of meaningful overlaps,” Dr. Miller said.
Dentists met the increased demand by making more efficient use of auxiliary professionals, such as hygienists and technicians. They hired more and, where possible, delegated more work to them. State regulations dictating what services a hygienist can provide turned out to be a key factor influencing how dental offices were able to respond to the increase in demand. In states that allowed hygienists to perform more work, there was no increase in wait times. States with more restrictive rules on hygienists saw an increase in wait times.
States have similar varying regulations in place for nurse practitioners and physician assistants, which means a policy prescription may be in order to handle the influx of newly insured patients.
“There are a lot of services that dental hygienists, nurse practitioners, and physician assistants are perfectly qualified to perform, and what’s keeping them from doing it isn’t training or ability, but regulation,” Dr. Miller said. “Delegating work to these providers appears to be a way that dentists have accommodated the higher number of insured patients.”
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