How Phantom Networks, Provider Qualities, and Poverty Sway Medicaid Dental Care Access: A Geospatial Analysis of Manhattan.

Destiny Kelley,Shipeng Sun

doi:10.3390/ijerph182312383

Abstract

Access to general dental care is essential for preventing and treating oral diseases. To ensure adequate spatial accessibility for the most vulnerable populations, New York State mandates a ratio of one general dentist to 2000 Medicaid recipients within 30 min of public transportation. This study employed geospatial methods to determine whether the requirement is met in Manhattan by verifying the online directories of ten New York managed care organizations (MCOs), which collectively presented 868 available dentists from 259 facilities. Our survey of 118 dental facilities representing 509 dentists revealed that significantly fewer dentists are available to treat Medicaid recipients compared to MCO directories. The average dentist-to-patient ratio derived from the MCO listings by the Two-Step Floating Catchment Area (2SFCA) method was 1:315, while the average verified ratio was only 1:1927. “Phantom networks”, or inaccurate provider listings, substantially overstated Medicaid dental accessibility. Surprisingly, our study also discovered additional Medicaid providers unlisted in any MCO directory, which we coined “hidden networks”. However, their inclusion was inconsequential to the overall dental supply. We further scrutinized dental care access by uniquely applying six “patient-centered characteristics”, and these criteria vastly reduced accessibility to an average ratio of merely 1:4587. Our novel evaluation of the spatial association between poverty, dental care access, and phantom networks suggests that Medicaid dental providers wish to be located in wealthier census tracts that are in proximity to impoverished areas for maximum profitability. Additionally, we discovered that poverty and phantom networks were positively correlated, and phantom providers masked a lack of dental care access for Medicaid recipients.

Highlights

Introduction published maps and institutional affilAccess to dental care is critical to maintain both oral and overall health
We found that some dental facility names and dental providers were repeated more than once across all insurance lists, in part because many dentists accepted more than one Medicaid insurance
The managed care organizations (MCOs) databases listed a total of 868 general dentists working at 259 facilities (Table 2)

Summary

Introduction

Access to dental care is critical to maintain both oral and overall health. Research links poor oral health to a multitude of diseases, such as diabetes [1], arthritis [2], cancer [3], and cardiovascular disorders [4,5,6]. The incidence of dental caries is virtually preventable with proper dental care [9], and long-term clinical studies have shown that periodontitis can be inhibited utilizing dentistry interventions [10,11,12]. In the U.S, inequalities in untreated cavities are historically higher among Hispanic and Black adults, with rates of poverty playing a key role in access to oral healthcare [14]. Medicaid recipients rely on state-contracted managed care organization (MCO) provider directories as a starting point in obtaining access to dental care.

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