Wanchek Tanya N, Rephann Terance J
Public Health Sciences, Department of Public Health, University of Virginia, Charlottesville, VA, USA.
Rural Remote Health. 2013 Apr-Jun;13(2):2366. Epub 2013 May 26.
Southwest Virginia is a rural, low-income region with a relatively small dentist workforce and poor oral health outcomes. The opening of a dental school in the region has been proposed by policy-makers as one approach to improving the size of the dentist workforce and oral health outcomes.
A policy simulation was conducted to assess how a hypothetical dental school in rural Southwest Virginia would affect the availability of dentists and utilization levels of dental services. The simulation focuses on two channels through which the dental school would most likely affect the region. First, the number of graduates who are expected to remain in the region was varied, based on the extensiveness of the education pipeline used to attract local students. Second, the number of patients treated in the dental school clinic under different dental school clinical models, including the traditional model, a patient-centered clinic model and a community-based clinic model, was varied in the simulation to obtain a range of additional dentists and utilization rates under differing dental school models.
Under a set of plausible assumptions, the low yield scenario (ie private school with a traditional clinic) would result in three additional dentists residing in the region and a total of 8090 additional underserved patients receiving care. Under the high yield scenario (ie dental pipeline program with community based clinics) nine new dentists would reside in the region and as many as 18 054 underserved patients would receive care. Even with the high yield scenario and the strong assumption that these patients would not otherwise access care, the utilization rate increases to 68.9% from its current 60.1%.
While the new dental school in Southwest Virginia would increase the dentist workforce and utilization rates, the high cost combined with the continued low rate of dental utilization suggests that there may be more effective alternatives to improving oral health in rural areas. Alternative policies that have shown considerable promise in expanding access to disadvantaged populations include virtual dental homes, enhanced Medicaid reimbursement programs, and school-based dental care systems.
弗吉尼亚州西南部是一个农村低收入地区，牙医劳动力相对较少，口腔健康状况不佳。政策制定者提议在该地区开设一所牙科学院，作为增加牙医劳动力规模和改善口腔健康状况的一种途径。
进行了一项政策模拟，以评估弗吉尼亚州西南部农村地区一所假设的牙科学院将如何影响牙医的可获得性和牙科服务的利用水平。该模拟聚焦于牙科学院最有可能影响该地区的两个渠道。首先，根据用于吸引当地学生的教育渠道的广度，预期留在该地区的毕业生数量有所不同。其次，在模拟中，改变了牙科学院诊所（包括传统模式、以患者为中心的诊所模式和基于社区的诊所模式）在不同临床模式下治疗的患者数量，以获得不同牙科学院模式下额外牙医数量和利用率的范围。
在一组合理假设下，低产出情景（即私立学校和传统诊所）将导致该地区新增三名牙医，共有8090名新增的未得到充分服务的患者获得治疗。在高产出情景（即牙科渠道项目和基于社区的诊所）下，九名新牙医将居住在该地区，多达18054名未得到充分服务的患者将获得治疗。即使在高产出情景以及这些患者在其他情况下无法获得治疗的有力假设下，利用率也仅从目前的60.1%提高到68.9%。
虽然弗吉尼亚州西南部的新牙科学院将增加牙医劳动力和利用率，但高成本加上持续较低的牙科利用率表明，在改善农村地区口腔健康方面可能有更有效的替代方案。在扩大弱势群体获得医疗服务方面已显示出巨大潜力的替代政策包括虚拟牙科之家、强化医疗补助报销计划和基于学校的牙科护理系统。
