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PUBLI C POLI CY OPTIONS FOR BETTER DENTAL HEALTH Report of a Study Division of Health Care Services INSTITUTE OF MEDI CINE December 1980 Nat tonal Academy P res s Washington, D. C.

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee con- sisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate profes- sions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 Congressional charter responsibility to be an advisor to the Federal Government, and its own initiative in identifying issues of medical care, research and education. This publication is one of a series, "Issues in Dental Health Policy," sponsored by the W. K. Kellogg Foundation, Battle Creek, MI 49016 2101 Constitution Avenue, N.W., Washington, D.C. 20418 Area (202) 389-6178 Publication TOM 80-06 ii

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COMMITTEE FOR A STUDY OF PUBLIC POLICY OPTIONS FOR BETTER DENTAL CARE Dorothy P. Rice (Chair) Robert M. Ball Lois K. Cohen Melvin A. Glasser Harold Hillenbrand I. Lawrence Kerr C. Arden Miller Alvin L. Morris Owe E. Reinhardt Max H. Schoen Anne A. Scitovsky Jeanne C. Sinkford Director, National Center for Health Statistics Senior Scholar Institute of Medicine Special Assistant to Director National Institute of Dental Research Director, Social Security Department, U.A.W. Detroit, Michigan Executive Director Emeritus American Dental Association Practitioner of Dentistry Endicott, New York Professor and Chairman Department of Maternal and Child Health School of Public Health University of North Carolina Associate Vice President, Health Affairs - Government Relations Professor, Dental Care Systems University of Pennsylvania Professor of Economics and Public Affairs Princeton University Professor and Chairman, Section on Public Health and Preventive Dentistry UCLA School of Dentistry Chief, Health Economics Division Palo Alto Medical Research Foundation Dean, Howard University College of Dentistry . . -

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Study Staff* Linda Demlo INSTITUTE OF MEDICINE Frederick C. Robbins, M.~. President Director, Division of Health Care Services (March 1977 - September 1979) Carleton Evans - Director, Division of Health Care Services (October 1979 - present) Study Director, Harvard University University of North Carolina University of North Carolina University of Washington University of North Carolina University of North Carolina Harvard University Institute of Medicine Secretary, University of North Carolina Secretary, Institute of Medicine Secretary, Harvard University and Assistance California Dental Service Corporation American Fund for Dental Health Fullerton, Jones, and Wolkstein, Inc. Assistant Surgeon General, USPHS Palm Springs Seminars Duke University Bureau of Health Manpower, DHHS American Dental Association George Washington University Chester Douglass Dennis Gillings William Sollecito - Martha Pales Katherine Cole John Day Nancy Benotti Marie Kerr Doris Pollard Naomi Hudson Lauren Cammack Special Consultation Ken Bernardi - Harry Bohannan - William Fullerton - John Greene John Ingle Joseph Lipscomb - Preston Littleton - Kent Nash - Richard Scheffler - *The Institute of Medicine contracted with the University of North Carolina for the staff services of Chester Douglass, Dennis Gillings, William Sollecito, Katherine Cole, John Day, and Doris Pollard. After Dr. Douglass moved to Harvard University midway through the study, Martha Pales (a fellow at Harvard), Nancy Benotti, and Lauren Cammack also assisted ilk the staff work for this study. 1V