Prevention, Health Promotion and Education
Prevention, health promotion and education clearly represent the most cost-effective means to improving New Hampshire’s oral health. Not all individuals and populations are at the same risk for oral diseases, therefore the Coalition’s plan is to target intensity and types of interventions to match the levels of risk. Initiatives such as early intervention, disease management and risk based interventions need to be directed to the individuals and populations at highest risk.
Workforce
Currently there are just under 900 licensed dentists in the state, the majority of whom, like the population, are concentrated in the southern tier, although within that geography there are populations who are relatively underserved. Of that number, two-thirds are general dentists, and one-third, specialists. Almost 50% of the New Hampshire Dental Society’s members are over 50 years old. The number of dentists is projected to begin declining over the next five years, as the number of dentists graduating from dental schools is outstripped by those retiring from active practice. As there are no dental schools and few residency training slots in New Hampshire, recruitment remains a significant challenge, as dentists commonly locate their practices near where they are educated. The number of dentists who actively treat New Hampshire’s highly vulnerable populations—children, developmentally disabled, the elderly, and those with HIV/AIDS – is relatively small.
Financing
Financing for oral health services in New Hampshire comes from a number of sources—commercial dental insurance, individual payment, Medicaid (traditional fee for service, as well as voluntary managed care) and the State Children’s Health Insurance Program (SCHIP). Benefits under Medicaid are federally mandated for children, with treatment for adults limited to emergency care for pain and infections.
Safety Net
The safety net was defined by the Coalition as those care providers who have a priority commitment to deliver affordable oral health services to vulnerable and underserved populations. They noted that because both state and private funding is limited, resources for care are often constrained. The result is that the safety net is as vulnerable as many of its patients and cannot function as a true system, where care is integrated and coordinated among the various providers.
Integrating Functions
The Coalition reflected at length on the importance of a “system” of oral health care services. The ideal system would provide a continuum of services—from prevention and health promotion through restorative care—and would enable a user to move seamlessly among its components, regardless of his or her point of entry. Comprised of a variety of programs and clinicians—school based screenings, private practitioners, community health centers, etc.—these components would be integrated through care coordination, reporting and accountability.
The group differentiated between disease management—managing the risk for and process of a disease; and care coordination—assisting an individual to receive necessary services, such as social, medical, educational, transportation, and translation by linking that individual with provider(s), so that he or she can function within a community at an optimal level. The importance of integrating oral health into the health and human services system—for care coordination as well as service delivery has received much discussion.
Advocacy, Policy and Politics
There is a clear need to build constituencies concerned and committed to improving New Hampshire’s oral health—within the general public, the dental and medical professions, and the legislature, as well as among advocacy groups who are already skilled in promoting the goals of their constituents. Supporting and shaping public policy to recognize the importance of oral health care as part of overall health is critical to the well being of New Hampshire’s citizens.
