Reason to smile: The Mid-Peninsula Dental Health Foundation sees to the dental needs of low-income, working poor Reason to smile: The Mid-Peninsula Dental Health Foundation sees to the dental needs of low-income, working poor (October 08, 2003)

By Martin Nobida
Special to the Almanac

With more and more Bay Area residents struggling to make ends meet in an already challenging economy, recent news is offering little reason to be optimistic.

Last week, the U.S. Census Bureau announced that 2.4 million Americans lost their health-insurance benefits in 2002, bringing the total number of the uninsured to 43.6 million.

A day later, the nonpartisan California Budget Project released a study indicating that the cost of living in the Bay Area last year jumped 14 percent over the year before.

But even given such harsh conditions, some of the Peninsula's most economically disadvantaged people are smiling: They've made good use of a unique outreach program offered by the Mid-Peninsula Dental Health Foundation that provides mainstream-quality dental care to low-income families and individuals.

The foundation was established in 1967 as a subsidiary of the Mid Peninsula Dental Society, a Menlo Park-based professional group. Its goal was to provide dental care for children whose families earned incomes just large enough to disqualify them for welfare, but whose jobs didn't provide dental insurance.

"It was a way to serve people caught between the cracks," said dentist Timothy Leary, co-president of the foundation.

As more funds became available, the program expanded to include low-income people of all ages in Menlo Park, East Palo Alto, Palo Alto, Los Altos and Mountain View.

Now, after providing this care for more than three decades, its participants can reflect upon the program's long history of success, while at the same time look ahead, preparing it for the challenges of the future.

What it's about

Applicants wishing to receive foundation services are screened by volunteer community-service organizations, which determine whether an individual qualifies.

The program serves low-income individuals who neither qualify for welfare nor have dental insurance -- the ranks include those from single-parent homes, seniors living entirely on Social Security, immigrants and students.

Applicants who qualify are referred to private dental offices near them. Once there, a participating dentist examines the patient and recommends a course of action, which he or she sends to Dr. Leary to review.

After getting Dr. Leary's approval, the dentist administers the treatment.

Services aren't free (except sometimes for children). Fees are set at 60 percent the "usual, customary, reasonable" fee -- known as the "UCR."

Health-care providers and insurance companies typically use UCR fee calculations to determine reasonable charges for treatment. The charge is considered reasonable if it isn't higher than the amount typically billed by similar providers within the same area for similar services.

Patients are responsible for paying half of the discounted fee, with the foundation responsible for paying the difference.

A different approach

In devising this system, the founders sought to create something that offered the best care at the lowest cost for the most number of people. In the process, they created a program that may be unique in the state, foundation leaders say.

From the outset, the system has avoided the clinic-based approach that most free and low-cost dental providers adopted.

"We rejected the idea of having a special place where poor people would have to go to get care," said retired leader Alvin Janklow, former foundation president and one of its founders.

He and his colleagues instead settled on a decentralized model, where treatment would be administered at participating dentists' own private offices.

With more than 40 such dentists scattered around the community today, decentralization has ensured that a dental facility is close to any given patient. It also has the added benefit of allowing patients to avoid the stigma associated with places that suggest indigence and government bureaucracy.

Moreover, the program is a completely privately funded endeavor. The dentists offer their time, expertise and/or money to keep the foundation going.

Even though the fees are a fraction of the going rate, patients still contribute something. Dr. Janklow noted that he'd seen studies indicating that the appointment-cancellation rates at free clinics can often go higher than 40 percent.

The foundation has had no such problem, he said.

Either way, the program has been a success, Dr. Janklow said. "I'm very proud of what we did," he said. "We didn't quit ... after all these years."

Dr. Janklow retired as the foundation's president 11 years ago. He said he felt as if he were "reactivated" when he was asked to serve as an adviser at the state level. The California Dental Association is considering a foundation approach on a statewide basis, he said.

Something to chew on

The program is made financially feasible in a number of ways.

First, the discounted dentists' fees in effect serve as subsidization of services.

In any given year, the foundation typically donates tens of thousands of dollars worth of treatment, said dentist Richard Durando, co-president of the foundation. The bulk of it comes from the dentist donations themselves and, unlike most charities, which sometimes have administrative costs topping 60 percent, almost all of the money goes directly to pay for services, Dr. Durando said.

The Dental Society has between 200 and 300 members. Of that number, 40 to 50 offer their services to the foundation. Most of them also pay $200 a year to help fund the programs, he said, but some regularly pay in excess of $3,000.

Despite the successes, however, the foundation isn't without its shortcomings. Its problems are twofold, said Dr. Leary: There has generally been insufficient community awareness about its programs, and it has had limited funds to provide all the care it wants to provide. So, many of the people who might best benefit from having access to the services don't even know the foundation exists.

Foundation leaders want to create more awareness, but even that is fraught with challenge. "Historically, when we tried to increase awareness, demand for the services has gone up so much that we've become overloaded," he explained.

So the foundation has been moving forward with growing an endowed fund, looking toward the community for contributions. The hope is to create more community awareness for its programs, expand its offerings, and grow its reserves.

"The initial goal was to have $200,000 in the endowed fund," Dr. Durando said. "But with interest rates where they are now, that amount doesn't return much money."

"Costs have gone up dramatically," he continued. "Now it wouldn't be unbelievable to have $1million for care. There's a tremendous need here."

He admits, however, that raising these funds promises to be a tough job.

"Dentistry is not a sexy charity," he said. "The common perception is that, somehow, dentists should be able to take care of these problems themselves."

Seeking funds

The foundation welcomes contributions from the public. To contribute, or for more information, contact: Mid-Peninsula Dental Health Foundation, 1050 Chestnut St., Menlo Park, CA 94025; (650) 328-2242; http://www.mpds.org/dhf-info.htm.