By CHRISTINE NATHE, RDH, MS
Oral health issues continue to be the impetus to many legislative and policy discussions on both the state and federal levels. Oral health disparities have been reported, and those populations with low incomes have the most dental diseases and difficulty accessing care. For these reasons, focus has been placed on solutions which increase the labor force who are able to provide dental procedures to this population. Although funding dental care for the underserved, low-income populations is suggested as a solution, it is rarely initiated. In fact, funding of dental care continues to be influenced by the private sector market.
Almost 92% of dental expenditures were paid for by private funds, whether by the patient out-of-pocket (49.7%) or by private insurance (41.8%).1 Approximately 54% of the population had private dental coverage, 12% had public coverage, and 35% had no dental coverage.2 Historically, financing of dental care started in the private sector model, with the patient directly paying or bartering for dental services from a dental provider. As reflected in these aforementioned data, this private sector paradigm seems to continue to this day.
One of the major changes that has influenced the financing of dental care is the adoption of dental insurance by employers. Many employers offer dental insurance as a benefit or part of a salary package to employees. Although employees pay a premium for such an amenity, most routine, preventive dental services are exclusively covered by dental insurance. This has been a tremendous triumph for dental hygiene, since it is proof that the practice of prevention is necessary and logical in health-care delivery.
An unintended consequence that may have resulted from covering preventive care is the association Americans have regarding dental care and payment for such care. Many times, if individuals change jobs and lose dental insurance benefits, they assume that they are no longer able to access dental care since they do not have insurance. Although people may be paying part of their dental insurance, this is done via their company payroll mechanisms, so the “value” for paying out of pocket may not be realized.
Other times people may lose jobs and not be able to afford dental care. In other words, sometimes individuals do not access care because they do not value paying for preventive care. Other times they cannot afford preventive care, and most of the time there is a combination of reasons people do not obtain preventive care.
Preventive dental care, in both the private and public sectors, is a logical way to decrease overall dental-related expenditures. One recent study showed that Medicare beneficiaries who used preventive dental care had more dental visits, but had fewer visits for expensive, nonpreventive procedures, and lower dental expenses than individuals who saw the dentist only for treatment of oral problems. This led the researchers to conclude that adding dental coverage for preventive care to Medicare could pay off in terms of both improving the oral health of the elderly population and limiting the costs of expensive nonpreventive dental care for the dentate beneficiary population.3
Most dental care in the U.S. remains a private sector entity. Dental insurance plans have made preventive dental care affordable for many individuals and have focused on prevention as a means to decrease restorative dentistry costs. In order to become a consumer advocate, dental hygienists must understand dental funding in both private and public organizations, and when solutions are developed to address oral health disparities, funding for preventive dental care should be paramount. RDH
References
1. Rohde F. Dental expenditures in the 10 largest states, 2008. Statistical Brief #353. December 2011. Agency for Healthcare Research and Quality, Rockville, Md.
2. Manski RJ, Brown E. Dental use, expenses, private dental coverage and changes, 1996-2004. Rockville, MD: Agency for Healthcare Research and Quality; 2007. MEPS Chartbook N.
3. Moeller JF, Chen H, Manski RJ. Investing in preventive dental care for the Medicare population: a preliminary analysis. Am J Public Health. 2010 Nov;100(11):2262-9. Epub 2010 Sep 23.
CHRISTINE NATHE, RDH, MS, is a professor and graduate program director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of “Dental Public Health Research” (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at [email protected] or (505) 272-8147..
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