influences that these expenditures have on access to oral health care among vulnerable and underserved populations.

OVERVIEW OF EXPENDITURES

Health care costs and spending have been rapidly increasing in the United States in recent years. In 2009, overall health expenditures were $2.5 trillion, including the cost of hospital care, physician and dental services, home health care, nursing home services, prescription drugs, medical equipment and supplies, and public health direct services (CMS, 2010b). This translates to more than $8,000 per person and accounted for 17.6 percent of the national gross domestic product (CMS, 2010b). Growth in national health expenditures is expected to increase by 6.1 percent between 2009 and 2019 (CMS, 2010c). In contrast, expenditures for dental services in the United States in 2009 were $102.2 billion, approximately 5 percent of total spending on health care (CMS, 2010b). While medical and dental spending both have been rising, the growth in medical expenditures has far outpaced the growth in dental expenditures.

The reported national expenditure levels undercount the total spent on improving oral health. Estimates represent only the costs associated with direct services delivered by dentists in traditional practice settings. Spending on public health initiatives (e.g., water fluoridation and public education campaigns) and oral health services delivered in medical care settings are not included in estimates of overall expenditures. For example, there are approximately 3.6 million craniofacial cases (e.g., diabetes-related conditions, oral cancers, and injuries) treated in medical care settings each year, and the total costs for these treatments exceed several billion dollars (Snowden et al., 2003).

Average Annual Dental Expenses

In 2007, the average annual expense for individuals who had any dental expenses was $643 (Rohde, 2010). Individual expenses varied by age, income, race and ethnicity, and insurance status (see Figure 5-1). Annual dental expenses also varied by source of insurance. The average annual dental expense for individuals with private dental insurance was $662. Among individuals with public dental insurance (e.g., Medicaid or CHIP), the average annual dental expense was $370 (AHRQ, 2009). Individuals with higher incomes had higher annual dental expenses. The average annual dental expense for “high-income” individuals (<400 percent of the federal poverty level [FPL]) was $710. Among “poor” individuals (≤100 percent FPL), the average annual dental expense was $428 (AHRQ, 2009). This difference in expenses may reflect the ability of individuals with higher



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