Program Overview

• The Dental Reimbursement Program (DRP) under Part F of the Ryan White CARE Act was intended to help accredited dental schools and post-doctoral dental education programs cover their non-reimbursed costs of providing oral health care to individuals with HIV.
• The data illustrated here are those for which 2001 program funds were used to cover the non-reimbursed oral health services delivered during the 1999 - 2000 service year.
• A total of 74 institutions applied for reimbursement, and their data are illustrated in these slides.

Purpose

• To assist with covering the rising non-reimbursed costs faced by dental education institutions providing care to individuals with HIV.
• To improve access to oral health care for individuals with HIV.
• To ensure that dental students and residents (and dental hygiene students, as of FY 2001) receive proper training in the management of oral health care for individuals with HIV.
  

Characteristics of Applicants

• The 74 DRP applicants who submitted data were located in 24 states, the District of Columbia, and Puerto Rico. Of these programs:

  32 were Dental Schools
  Institutions of higher learning that educate and train students in the field of dentistry and provide oral health services to patients, including those with HIV, for educational and training purposes.

  42 were Postdoctoral Dental Education Programs
  Schools of dentistry, hospitals, or public or private institutions that offer training in the specialties of dentistry, advanced education in general dentistry, or are sites of general dental practice residencies.

Program Attributes

Several of the programs have special attributes that distinguish them from other dental programs:

• Over half (54%) of the grantees included community-based rotations for their students and residents as part of their training curricula. Most of these were located in the parent institutions.
• DRP students and residents provided care in various community settings, such as community health centers, rural health clinics, psychiatric hospitals, nursing homes, correctional facilities, tribal health centers, clinics that care for the homeless, children, farm workers, and patients with cancer.
• Some of the programs have devised innovative ways to reach patients with special characteristics: such as with multicultural and multilingual staff or translators, including ASL (American sign language); transportation or travel assistance to appointments; offering child care services for patients with dental appointments.
• Others are adjusting their services to meet the special needs of their patients, such as extended treatment hours (e.g. such as early morning, late evening, and Saturday dental appointments), accredited trauma and 24-hour emergency services, in-patient consultation services, and offering drop-in or walk-in appointments.
• Collaboration with programs that provide prenatal care and dental services for women, methadone treatment, and services in foster care facilities.
• Services for or targeting or to benefit special populations with high health care needs and limited access, such as Haitian and Caribbean immigrant communities. Some operate mobile dental vans to serve hard-to-reach individuals, or have on-site patient advocates for HIV positive patients, while some operate dedicated youth clinics to better outreach to HIV positive adolescents.
• Other ways to engage staff and residents in the provision of care: having volunteer dentists who donate time supervise residents and provide care; offering continuing education for dental school alumni and private practitioners; and participating in research and conducting clinical trials for oral therapies.
  
  

Patient Characteristics

• Dental Reimbursement Program applicants reported serving 28,396 individuals with HIV.
• 13,346 individuals received care from dental schools, while 15,050 received care from postdoctoral programs.
• Of the total of individuals reported receiving care, 17, 566 or over one-half (61.9%) were served by programs in three states (NY, CA, PA).
• 13,421(47.3%), received care in Postdoctoral dental programs located in NY state.
  

Image: Pie Chart showing Gender Distribution of Individuals Served. Males (66.3%), Females (33.3%), Transgenders (.3%), and Unknowns (.1%).

• Overall, 18,831 or 66.3% of the individuals served were males while 9,463 or 33.3% were females and the remaining 102 individuals were identified as transgender (0.2%) or unknown (0.1%).
• Programs in five states (CT,NY, PR, SC, TX) reported serving higher proportions of females, compared to the overall national average.
  
  

Image: Bar Chart showing Age Distribution of Individuals Served. 0-12 yrs. (3.4%), 13 - 19 yrs. (1.9%), 20-24 yrs. (6.1%), 25-44 yrs. (60.3%), 45+ yrs. (28.9%) and Unknown yrs. (.5%)

• Most individuals (60.3%) who received care were in the 25 - 44 yr age group.
• Programs in SC and DC reported serving large proportions of children (57% and 32%, respectively).
• Programs in TX, OR, and MA reported serving higher proportions of individuals over 45 years (47%, 42%, and 40% respectively.
  
  

Image: Bar Chart showing Ethnic Distribution of Individuals Served

Hispanic: 30.40%
Non-Hispanic: 66/10%
Unknown: 3.30%

• In 2001, ethnicity was defined as a separate question from race.
• More than 2/3 of all patients identified themselves as non-Hispanic or Latino/a.
• In geographic areas with historically large populations of Hispanics, close to 70% of patients were Hispanic or Latino/a.
  

Image: Pie Chart showing Race Distribution of Individuals Served.

White: 32.7%
Black or African American: 40%
Multiple Races: 5.8%
Hispanic: 27.38%
Asian: .5%
American Indian/Alaskan Native: .2%
Native Hawaiian/Other P.I.: .02%
Other/Unspecified: 1%
Unknown: 3%

Populations Served

• Over three out of four (77.2)% of the patients were from ethnic or racial minority groups, an increase over previous years.
• 40% of the patients served were African-Americans or Blacks.
• The majority (88%) of the patients served were over 25 years of age.

Image: Pie Chart showing Pregnant HIV+ Individuals Served.

Dental Schools: 37.10%
Postdoctoral Programs: 61.70%

• A total of 175 pregnant women with HIV were served by participating organizations during the service year.
• The majority (61.7%) or 108 of these women were cared for by postdoctoral dental education programs.
• The majority of the pregnant, HIV+ women (66.3%) were served by DRP institutions in NY.

Image: Pie Chart showing Type and Number of Visits for Various
Oral Health Services*.

• DRP applicants provided 173,677 oral health service visits.
• Dental schools provided 54% (93,775) of these service visits and 46% (79,902) were provided by postdoctoral programs.
• Four types of procedures (Diagnostic, Restorative, Oral Surgery, & Prosthodontics account for 58% of the total service visits provided.

*Since patients may receive multiple services in visits , the number of service visits exceeds the HIV+ patient caseload.

2001 Dental Reimbursement Program  TOP

Image: Bar Chart showing Specific Uses of DRP Funds.

Nearly eight in ten (74%) program applicants intending to use the reimbursement funds for direct patients services.

More than one-half (58%) of the DRP applicants plan to use the funds for students and resident education and training.

Image: Area Chart showing Reimbursed vs. Non-ReimbursedOral Health Care.

• Programs received partial reimbursement for over half (58.1%) of the patients they served.
• Some programs reported much higher percentages of non-reimbursed care: For example, GA-97%; IL-92%; 83%.

mage: Area Chart showing Reimbursed Care by Source of Reimbursement.

• About six in ten (54%) patients had some care reimbursed by Medicaid.
• For programs located in TX and PR, all their patients (100%) are covered by private insurance and other insurance respectively.
• Providers located in OR, PA, AL, and VA reported that higher proportions of patients were more likely to have other sources of reimbursement (77%, 75%, 71% and 71% respectively).