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FOREWORD It should be unacceptable in the 1980s for dental health policy to emphasize a patchwork approach to acute care service delivery, when we know full well the major dimensions of the dental care problems with which we must deal and we know that an acute care model is inappropriate. To make the shift to a preventive world view will require significant changes in the scope, organization, patterns of practice, and financing of dental care. Our present knowledge is inadequate to tell precisely how this should be done, but we can be absolutely certain that a strong commitment to preven- tion holds great promise for the future. Dental disease remains the most prevalent of all pathological conditions afflicting Americans. While we have the means at hand to prevent or control the problem, a number of barriers have served to preclude the implementation of appropriate means to meet this goal. Significant among these barriers has been our failure to develop a rational and effective national policy for the prevention of dental disease, and to systematically examine the possibilities for alleviating the financial barriers which prevent millions of Americans from receiving appropriate dental care. Both represent complex policy issues warranting long and careful study. The Kellogg Foundation has been pleased to support efforts by the Institute of Medicine to address these matters and believes that the resulting policy recommendations have the potential for dramatically altering the patterns of dental health and disease within the United States. This work represents an important element in a series of Founda- tion funded projects designed to accumulate and organize more and better information by which the profession and the public could develop rational dental health policies. Among these various approaches, the Foundation wished to encourage expanded efforts in the prepayment of dental care services to include experimentation with different modes of payment and delivery with special attention to cost in relation to the quality and appropriateness of care to be delivered. It is important to recognize that this work was undertaken in 1977 and the conclusions largely drawn near the end of the project in 1980. Within this relatively short interval, far-reaching economic and social factors have emerged which will inevitably impact the public demand for dental care services as well as the private and public resources available to initiate and maintain new services. xi

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Nonetheless, the central and recurring theme in this report urges the implementation and financing of primary prevention programs. The importantance of addressing this consideration at appropriate levels with the view to achieving a national policy commitment cannot be overemphasized. The technology is available, the costs are reasonable and the benefits predictable. This emphasis alone should make this volume a centerpiece in the "Issues in Dental Health Policy" series promoted and sponsored by the Foundation. Ben D. Barker, D.D.S. Program Director W. K. Kellogg Foundation xii