Patient Overload? Maybe Not


Research on dentists shows how doctors could avoid biting off more than they can chew as healthcare act widens insurance coverage.

ANN ARBOR, Mich. – An open question since the Affordable Healthcare Act went into practice is whether primary care providers can cope with the increased demand.

More than 20 million Americans are expected to buy private healthcare insurance on the exchanges in coming years, but coverage doesn’t guarantee access to services. Will clinics be overwhelmed?

New research by Michigan Ross Professors Thomas Buchmueller and Sarah Miller shows how primary care physicians could meet this sudden demand without working unreasonably long hours. But in some states, the solution may also need a policy nudge.

Buchmueller“The concern out there, and what motivated our research, is that we’re going to overwhelm doctors and facilities,” says Buchmueller, the Waldo O. Hildebrand Professor of Risk Management and Insurance Professor of Business Economics and Public Policy. “But for the most part, we didn’t see that in our study.”

Buchmueller served as an economist on the President’s Council of Economic Advisers and worked in implementing the ACA. Buchmueller and Miller analyzed states that added adult dental coverage to their Medicaid plans. It’s a good basis to study a sudden influx of patients, because states often go back and forth on adult Medicaid dental coverage depending on their budgets. And the frequency of dentist visits and primary care visits are similar.

“It’s also the same population, poorer adults, who gain coverage under the ACA, so there are a number of meaningful overlaps,” Miller says.

Dentists met the increased demand by making more efficient use of auxiliary professionals, such as hygienists and technicians. They hired more and, where possible, delegated more work to them.

Wait times increased modestly, as well as hours worked per week by, between 1 and 2 percent.

State regulations dictating what services a hygienist can provide turned out to be a key factor influencing how dental offices were able to respond to the increase in demand. In states that allowed hygienists to perform more work, there was no increase in wait times. States with more restrictive rules on hygienists saw an increase in wait times.

MillerStates have similar varying regulations in place for nurse practitioners and physician assistants, which means a policy prescription may be in order to handle the influx of newly insured patients.

“There are a lot of services that dental hygienists, nurse practitioners, and physician assistants are perfectly qualified to perform, and what’s keeping them from doing it isn’t training or ability, but regulation,” Miller says. “Delegating work to these providers appears to be a way that dentists have accommodated the higher number of insured patients.”

Their working paper, “How Do Providers Respond To Public Health Insurance Expansions? Evidence From Adult Medicaid Dental Benefits,” was co-authored by Marko Vujicic, Chief Economist and Vice President of the Health Policy Institute at the American Dental Association (ADA).


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