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The Challenges of Providing Low-income Children with Access to Orthodontic Care

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There was a time when the cost of undergoing orthodontic treatment was on par with purchasing a new car. Today, orthodontic treatment is available and affordable for most children and adults in this country. Payment plans, dental insurance that includes orthodontic benefits and Flexible Spending Accounts (FSAs) all help make orthodontic care more affordable. However, many hard-working American families do not have access to care due to their financial situations.

There is no question that the state of the economy over the last five years has affected the ability of families to afford orthodontic treatment. Many states have had to cut back on programs that provide orthodontic treatment to those in need. As a result, far too many children will never enjoy the personal, social and professional benefits of having a nice smile, let alone the dental health benefits. Orthodontic treatment not only leads to better dental health and overall oral function, but it also leads to an improvement in appearance and many patients subsequently experience increased self-esteem.

Conversely, a crooked smile can create a negative perception on a social, personal and professional level. In fact, a recent survey found that more than one-third of Americans who are unhappy with their smile believe they would have a better social life if they had better teeth. Of adults polled, 77 percent of women think crooked teeth are worse than a receding hairline in a potential love interest. And 78 percent of Americans perceive adults with crooked teeth to be unsuccessful.1

But much like other health service-related organizations and associations have done through access to care programs, there is an opportunity for the orthodontic care industry to help bridge this gap and make it easier for children in need to get the orthodontic treatment they need.

Financial Barriers to Orthodontic Treatment

In addition to the millions of Americans who don't have health insurance, many households face difficulties in providing health and dental services to their families, and this includes orthodontic care. Since the recession began in 2007, U.S. median household income has dropped by 7.3 percent.2

Some families - including dual-income households - see their resources consumed by basics like housing and food. Many families make too much money to qualify for state-sponsored programs, but not enough to cover the cost of orthodontic care.

Exacerbating the issue are two recent changes in legislation that could make this already limited access to care even more restrictive. The Medical Device Tax that went into effect this January, which places a 2.3 percent tax on the sale of medical devices, will eventually be passed down to consumers. While orthodontic fees have remained stable, this additional cost to be paid by medical device manufacturers will eventually be incurred by practitioners, and that additional overhead cost will eventually be passed on to patients.

The other issue is the cutbacks that Americans have seen on Flexible Spending Accounts, which many families use to pay for orthodontic treatment. According to a 2009 survey conducted by the American Association of Orthodontists (AAO), 65 percent of members reported that their patients use FSA money to fund all or part of their orthodontic treatment. However, FSAs that used to allow employees to set aside as much as $5,000 of their salary toward health-care service costs, are now capped at $2,500. This all makes it even more difficult for families that do not qualify for state assistance programs to cover the cost of orthodontic treatment.

How Can the Orthodontic Industry Address this Access to Care Issue?

Orthodontic treatment certainly isn't the only type of care to which low income families are lacking access. But how can we as orthodontists help address the access to care issue? Look no further than to what the American Dental Association (ADA) has done with its Give Kids A Smile program. The ADA has created a pro-bono access to care infrastructure that has attracted numerous sponsors and has been adopted by dentists across the country. Since the program's inception in 2003, nearly five million American children have received free oral health services as a result of the efforts of the ADA and its members.

Orthodontic treatment requires a much greater time commitment and dedication on behalf of both the doctor and the patient. However, creating a similar structure is not only a viable option, but a very real one.

The AAO has created a program that accomplishes just this. Launched in 2009 in conjunction with the Dental Lifeline Network, the AAO Donated Orthodontic Services (DOS) Program currently has approximately 400 patients undergoing treatment. The goal of the program is to serve children in need who do not qualify for other assistance programs and to provide them with the orthodontic care that they would not otherwise receive.

To date, 380 AAO orthodontists have volunteered their time and services to DOS in five states across the country - Illinois, Indiana, Kansas, New Jersey and Rhode Island. Parents apply by providing proof of need and the Dental Lifeline Network matches the patient with a volunteer orthodontist. Treatment is completed pro-bono and the only cost parents face is an administrative fee of $200 for acceptance into the program.

The AAO has developed an Access to Care Task Force, whose goal is to bring the DOS Program to all states where there is need. AAO orthodontists within the states where the program has been set up have willingly volunteered to be part of this network and treat participating patients pro-bono. The average cost of setting up the administrative part of the program is $7,000 per state.

So where does that money come from? The Northeastern Society of Orthodontists (NESO) has developed a business model to fund the expansion of the DOS Program nationwide. NESO, a constituent organization within the AAO, has partnered with private businesses to raise those funds. These organizations have generously donated sponsorship funds and portions of sales to raise the necessary funding.

With the support of the orthodontic care industry and corporate sponsors who rely on the orthodontic care industry, DOS has the potential to someday become an access to care program that meets the needs of children across the country who lack insurance coverage. Just look at what the ADA has been able to accomplish with Give Kids A Smile in 11 years. The initiative began as a one-day annual event and it has since blossomed into a successful nationwide program that consists of year-round events. If the orthodontic community commits to this cause, there's no reason why we too can't have an effective access to care program in place for this country's underprivileged youth.

References
  1. November 2012 study commissioned by the American Association of Orthodontists (AAO) and conducted by Wakefield Research
  2. Household Income Trends: February 2013, by Sentier Research, LLC

Author's Bio
Dr. Jack Kacewicz is a member of the American Association of Orthodontists (AAO) and a past president of the Northeastern Society of Orthodontists (NESO). He is a volunteer for Rhode Island's Donated Orthodontic Services (DOS) Program and Chair of the NESO DOS Program. Dr. Kacewicz is a graduate of the Boston University School of Dental Medicine and has a practice in East Greenwich, Rhode Island.
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