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Choice and Competition

Last month, I wrote about the increased attention being paid to oral health care at the federal level.

Last month, I wrote about the increased attention being paid to oral health care at the federal level. The Action for Dental Health Act, signed into law in December, enables more organizations to qualify for federal grants to develop oral health initiatives and programs. It also expands the way that grants can be used to help increase access to oral health care.

Along with the passage of the Action for Dental Health Act, the report, Reforming America’s Healthcare System Through Choice and Competition, was released in early December. It addresses access to care by reducing restrictive supervision requirements on dental hygiene practitioners and calling for all states to authorize dental therapy.1 Co-written by members of the United States Department of Health and Human Services, Department of the Treasury, and Department of Labor, it was a direct response to an executive order issued by President Trump in October 2017. The president charged these departments (to the extent consistent with the law) to “facilitate the development and operation of a health care system that provides high-quality care at affordable prices for the American people by promoting choice and competition.”2


Reforming America’s Healthcare System Through Choice and Competition is a landmark document that outlines how patient choice—and access—can be improved through specific measures. It’s significant because oral health care is recognized as essential and vital, along with health care in general.

The document provides numerous recommendations. Some focus on improving workforce mobility by enhancing license portability and facilitating telemedicine. Suggestions closely related to dental hygiene practice include:

  • “States should consider changes to their scope-of-practice statutes to allow all health care providers to practice to the top of their license, using their full skill set.
  • The federal government and states should consider accompanying legislative and administrative proposals to allow nonphysician and nondentist providers to be paid directly for their services where evidence supports that providers can safely and effectively provide that care.
  • States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (eg, physician assistants, dental hygienists) that are not justified by legitimate health and safety concerns.
  • States should evaluate emerging health care occupations, such as dental therapy, and consider ways in which their licensure and scope of practice can increase access and drive down consumer costs while still ensuring safe, effective care.”1

And there’s more to come. Surgeon General VADM Jerome Adams, MD, MPH, held a planning meeting in October for a new report on oral health that will be released in 2020. It will update the 2000 Oral Health in America: A Report of the Surgeon General and include contemporary concerns that have developed over the past 20 years, such as generational aspects of oral health, disparities in access to care, and dentistry’s role in the opioid crisis.

Let’s embrace this new era!

Jill Rethman, RDH, BA
Editor in Chief
[email protected]


  1. United States Department of Health and Human Services, Department of the Treasury, and Department of Labor. Reforming America’s Healthcare System Through Choice and Competition. Available at: sites/ default/ files/ Reforming-Americas-Healthcare-System-Through-Choice-and-Competition.pdf. Accessed January 15, 2019.
  2. The White House. Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States. Available at: presidential-actions/ presidential-executive-order-promoting-healthcare-choice-competition-across-united-states. Accessed January 15, 2019.


From Dimensions of Dental Hygiene. February 2019;17(2):6.

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