Harborview Medical Center scaled back their general dental services Nov. 1. The primary care center at Harborview provided dental care to uninsured patients prior to this decision.

"Harborview is focusing the resources in its dental clinic to meet the priority needs for the community and mission patients who require complex dental and oral surgery procedures," said Susan Gregg-Hanson, Harborview Medical Center spokesperson, in an e-mail.

The facility will continue to handle care for underserved and uninsured patients, but only if they need oral surgery or other complex procedures.

"I think this is a pretty modest loss and we'll see a gain on the other side where we really need Harborview," said Mark Secord, executive director of the nonprofit Puget Sound Neighborhood Health Centers. "That's where we really need Harborview: oral surgery," he said.

Harborview operates specialty care services and will continue to do so. They serve HIV/AIDS patients, provide healthcare to the homeless and will plan on expanding its oral surgery programs.

"We will be continuing to increase our capacity, if needed, to create access for oral surgery and complex dental care referred to us from the community dental clinics for the underserved," Gregg-Hanson said.

Scaling back the primary care services offered at Harborview affects a relatively small number of patients, but it does highlight the larger issue of access to dental services in the Seattle area.

Access to affordable care remains a problem because offering low rates is essentially a way for a clinic to lose money. This means that clinics like Secord's require financial help to stay in business.

"I am not concerned about Harborview's decision, but I really believe that access to dental services, especially for uninsured adults, is the number one health care problem in King County," Secord said.

Harborview's primary care program was not large to begin with, but Secord's largest clinic serves more than 13,000 people every year and could close its doors if funding is not procured.

"Dentistry is very expensive, and for a low-income person who doesn't have insurance, it's very tough to pay that bill," Secord said.

A substantial minority of the state's uninsured population is composed of students. Adults in their mid-20s who have just finished college are also likely to be uninsured, Secord said.

But he said that the decision on Harborview's part, while restricting some access, is not entirely detrimental to the uninsured population seeking affordable healthcare.

"If you lose any capacity it isn't a good thing, but Harborview continues to see the special populations and they'll be enhancing and expanding their oral surgery program, and that's a very good thing, because they're the only providers of those services to the uninsured," Secord said.

[Reach reporter Andrew Doughman at news@thedaily.washington.edu.]