The Health Divide: Medi-Cal progress in kids’ dental care stalled during pandemic

In 2016, the Little Hoover Commission looked into California’s Medi-Cal Dental program because of “a worsening epidemic of tooth decay among the state’s children,” according to the state watchdog organization. That investigation found a broken dental care system for people with Medi-Cal’s low or no-cost plans, which made it difficult to find and access care.

Earlier this month, a follow-up report found the state still has a long way to go in improving its Medi-Cal dental program. For example, the Commission’s updated report found that fewer than half of children with Medi-Cal saw their dentist at least once a year in 2022, though the 2022 percentage had risen slightly to 47.6%, compared with 44.5% in 2016.

“While some of our recommendations have been implemented, we need to do more than the easy stuff,” said Commission Chair Pedro Nava in a release on the recent findings. “It’s clear we haven’t done enough to help California’s kids.”

Department of Health Care Services officials dispute that sentiment, saying that they have fully implemented all of the recommendations from the 2016 report, journalist Jenny Gold wrote in a recent Los Angeles Times article.

More kids with Medi-Cal saw a dentist in 2019, but the pandemic interrupted progress, according to the state’s response statement. Among the steps taken to improve utilization was expanding teledentistry, increasing provider networks and creating an outreach campaign for both patients and providers, the statement explained.  

While the commission acknowledged some noteworthy reform efforts, it pointed out that California still ranks among the worst states nationwide for pediatric dental disease. A 2021 report from the California Department of Public Health identified “profound” disparities by race/ethnicity, as well as socioeconomic disadvantage, for both tooth decay and untreated decay. 

Among the possible threads for reporters to follow in the September report: a county-specific graphic highlighting the 21 counties that have five or fewer dental providers enrolled to treat Medi-Cal patients.  

Separating Asian subgroups key for identifying heart health disparities

Figures from the Centers for Disease Control and Prevention show that Non-Hispanic Asian/Pacific Islanders have the lowest heart disease death rates in the United States. But cardiovascular health can vary widely among different subgroups of Asian Americans, underscoring the need to separate data by subgroup, the American Heart Association said in a scientific statement published this month in Circulation, the AHA journal. Using the category of “Asian American” for all Asian subgroups can mask important differences in  heart health and disease outcomes, the group said. 

That’s because some ethnic groups within that broader category may experience a higher burden of adverse social conditions and poorer heart health. Understanding these nuances is essential, especially given that Asian Americans are the fastest-growing major racial or ethnic group in the country, according to a Pew Research Center analysis of census data. The vast majority of that group (85%) is composed of six subgroups: Chinese, Indian, Filipino, Vietnamese, Korean and Japanese. 

Despite the diversity within the broader category, researchers often use a single “Asian American” category. Other times, “Native Hawaiian/Pacific Islanders” are grouped with Asian Americans or excluded altogether, given their small sample size. The AHA statement described how different historic experiences may shape a group’s heart health. For example, many Bhutanese, Burmese, Cambodians, Hmong, Laotians and Vietnamese arrived in the United States as refugees and may have experienced trauma and stress that can influence health outcomes, authors wrote. 

More broadly, the report offers useful data and charts to show how factors ranging from household income to health insurance coverage can vary widely among Asian origin groups and impact their heart health. 

Dobbs affects OB/GYN training 

A Perspective article in the September 21 edition of the New England Journal of Medicine describes how the U.S. Supreme Court’s decision in the Dobbs case is impacting OB/GYN medical residents training in states with restricted abortion laws or bans. For example, providers in Wisconsin stopped offering the procedure in 2022 following the high court’s decision, leading to more than a year of virtually no legal abortions, NPR reported.  

The changed landscape posed training challenges for Wisconsin’s OB/GYN residents who require these procedural skills “to confidently and expertly care for patients who needed uterine evacuation, whether the procedure is done as part of induced-abortion care or miscarriage management,” authors explained. In an increasingly restrictive environment in other states, too, residency program administrators must either seek opportunities for hands-on training out of state, or forego it, Dr. Abigail Cutler, the lead author, said in a videotaped interview accompanying the article. For instance, the residency program of the University of Wisconsin School of Medicine and Public Health, which she co-directs, created a partnership with Illinois abortion providers to give OB-GYN residents four weeks of experience. 

The changes are impacting both current and future OB/GYNs, “to say nothing of our patients, many of whom reside in maternity care deserts at a time when the United States has the highest maternal mortality among all high-income countries,” the authors wrote. The publication comes just weeks after the March of Dimes published a report on maternity deserts in the United States, highlighting the obstacles facing patients who live in counties without maternity services.  

Widespread gaps in Paxlovid awareness among disadvantaged groups

The oral antiviral pill Paxlovid is highly effective at preventing hospitalization and death from COVID-19, but the medication is underused in the United States – even among patient populations most at risk from the illness. That could be because people are unaware of the drug and the potential benefits, explain authors of a study published in Health Affairs this month.

A nationwide survey of Paxlovid awareness showed substantial gaps in people’s knowledge of the drug, which is used to reduce COVID-19 symptoms. About 85% of respondents had no or low awareness of Paxlovid, while 31% of respondents hadn’t heard of the drug at all. Those awareness gaps were more prevalent among medically vulnerable and disadvantaged populations who might benefit the most, such as “adults unvaccinated against COVID-19, those with lower levels of education, and Black and Hispanic or Latino adults.” While authors did not know the precise reasons for the knowledge gaps, they point to a lack of effective public communication as a contributor.  

Study: Interplay of telehealth and language could widen disparities

The uptick in telehealth services during the Covid-19 pandemic poses an important question: What happens to the millions of individuals with limited English? A team of researchers set off to understand the impact of someone’s primary language in telehealth use and outcomes, with their findings published in September in Cancer Medicine.

The link between telehealth use and clinical outcomes is complex. Even so, the observations of nearly 8,000 patients identified differences in the ways people with different primary languages used the service. For one, non-English speaking cancer patients used telehealth options less throughout the pandemic. The study also found that Spanish-speaking patients who used telehealth had higher rates of re-admissions when compared with English speakers.

“These differences suggest that the interplay of telehealth and language could contribute to widening of disparities in clinical outcomes in these populations,” authors wrote. “The study underscores the need to optimize telehealth usage and minimize its limitations to enhance the quality of cancer care in a telehealth-driven era.”

Previous studies, such as this 2022 report published in Oncologist, have also identified lower telemedicine use during the pandemic among historically disadvantaged populations. A recent article in npj Digital Medicine examined persistent telehealth inequities, noting that “while telehealth has generally reduced missed appointments, it has not fully overcome the longstanding access barriers faced by individuals of lower socioeconomic status.” 

What we’re reading

• First Day of a ‘New Life’ for a Boy With Sickle Cell - The New York Times (nytimes.com)
• Rural towns are building new hospitals with federal funding (usatoday.com)
• Deadly High Blood Pressure During Pregnancy Is on the Rise - KFF Health News
• Study in Africa aims to improve ovarian cancer treatment - The Washington Informer
• The human cost of ghost networks : Shots - Health News: NPR

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Child Welfare Symposium and Impact Reporting Fund | USC Center for Health Journalism