Nadereh Pourat

A recent journal article in Health Affairs by Nadereh Pourat, the Center’s director of research, garnered attention for its headline that one-quarter of Californian children have never seen a dentist. Beneath that statistic, however, are equally disturbing data about dental health inequities. Pourat and her co-author found that even with publically-funded insurance, low-income minority children were less likely to get regular dental care. Here Pourat discusses some of the reasons why, how health care reform may affect the situation, as well as what to do about the shortage of dentists in low-income communities.

Q: Publically-insured kids go longer between dental visits. Why?

Public programs have made great strides in getting kids to see the dentist, but not as frequently as private insurance. The lower frequency may be because fewer dentists participate in public programs and these programs pay lower fees than private insurance. Parents may also not fully understand the importance of regular visits or have difficulties taking time-off from work to take their children for visits.

Q: One of the main reasons for the difference in the frequency of visits to dentists between publicly- and privately- insured kids may be because not enough dentists accept Medicaid. Is this likely to change anytime soon?

Many believe that with the recent cuts in adult dental benefits, the numbers of dentists who accept public insurance will drop. This may be specially impacting private practice dentists who did not take many of these patients and find the required paperwork too cumbersome. Health care reform may increase the number of children in public insurance and increase the number of alternative dental providers in the long run. The future is uncertain at this point.

Q: What should be done to increase the pool of Latino and African-American dentists and dentists willing to work in low-income communities?

There are some efforts underway to train more Latino and African-American dentists and to train dental students in low-income communities with the hope being that they would continue their practice in such communities. There are also school loan repayment programs that bring dentists to areas with shortages of these professionals. Another way to provide care to children in low-income communities is by bringing dentists and hygienists directly to school clinics. An added benefit to this is that it makes it easy for busy parents to ensure their children are getting dental care.

Nadereh Pourat is director of the Center's Health Economics and Evaluation Research (HEER) Program and lead author of an evaluation of L.A. County's Parks After Dark (PAD) program. In this brief interview, Pourat discusses the origin and evolution of the after-dark program, what makes it different, and whether it improved community-police interaction.

Q: The Parks After Dark program started in 2010 as an intervention to keep at-risk teens busy and out of trouble. Has its evolution over the past seven years made it more effective?

​The program has been effective in advancing a number of its goals, such as addressing needs of a broader community by providing safe spaces for sports and recreation, and increasing perceptions of safety at parks. The spread of the program in many new parks speaks to the importance of this type of publicly funded programming in many areas of Los Angeles County. The success of the program is in part attributable to the County's recognition of the importance of such programming and dedicating funding and resources to the program.

Q: "Let's go to the park" is a retro idea in an age where most people interact through electronic devices. What makes the program work?

​That is exactly the point. The lack of safety in public spaces, such as parks, contributes to kids and adults staying at home with their electronics instead of venturing out. Low-resource communities find it harder to join a gym or take the kids to the movies or to fun, paid activities. What has made the program successful is the opportunity to get out, exercise, and have fun with your family.

Q: Did the L.A. County Sheriff's Department see a difference in how they were viewed by the communities with PAD program, and vice versa?

​In interviews with Sheriff's Deputies, they were acutely aware of the opportunity they had to interact with community members and building trust-based relationships. They were interested in showing kids and young adults what they do on a daily basis by bringing their mobile command centers to some parks and giving children tours. The PAD participants were particularly interested in seeing the deputies getting out of their cars and walking and interacting with people as a way of changing the perceptions of law enforcement.

​Nadereh Pourat is the Center's director of research and author of the new policy brief that summarizes the evaluation of a pilot program that aimed to improve health care delivery at a group of California's safety-net hospitals. In this brief interview, Pourat discusses what prompted the program, how the evaluation of hospitals was conducted, and how the hospital systems achieved success through the program.

Q: DSRIP was born out of a frustration with the rate of innovation and reform in public hospitals. What were the reasons for this? 

​In California, the majority of public hospitals are owned and operated by counties. They frequently face resource limitations and high demand from uninsured patients who cannot pay for their care and disabled and elderly Medicaid patients with poor health. Most of the resources go to providing care for the patients and there are limitations on how much effort can go towards innovations, improving quality of care, or improving patient experiences. Overtime these organizations have lagged behind many private hospitals with more resources. The improvements taken on by hospitals under DSRIP are essential for the ability of these organizations to keep up and remain competitive.

Q: Participating California public hospitals met 97 percent of their milestones. That seems almost too good to be true. How was the program so successful over so many categories?

​The hospitals had five years to plan, implement and improve their outcomes. They had time to achieve their goals. The goals ranged from more easy to achieve to more complex and this variation was also helpful. Most importantly, the hospitals had a mix of optional and required milestones. When possible, they chose projects that were consistent with their prior goals, which were not previously implemented due to lack of resources.

Q: DSRIP was a $3.3 billion program involving 17 public hospitals serving millions of patients. How did you evaluate such a large, complex project with so many different kinds of interventions?

​These evaluations require significant effort and an army of analysts. Some components were evaluated primarily using multiple hospital reports, in-depth surveys, and lengthy interviews. Others further involved analyses of large, confidential, and statewide datasets. We leveraged available data from another Medicaid Waiver evaluation ― the Low Income Health Program ― for one set of analyses, and we analyzed California hospital discharge data for another set of analyzes. We engaged experts in questionnaire design, quality of care assessment, and HIV care. We consulted with various other experts and worked closely with DHCS and CMS to complete the evaluation.