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CONTENTS 1 Conclusions and Recommendations The Rationale for Insuring Dental Services Recommendations Dental Auxiliaries in the Recommended Prevention Programs 1 2 4 10 2 Need for Dental Treatment and Utilization of Services 13 Indicators of Need for Treatment Utilization of Services Summary and Conclusions 3 Epidemiology and Prevention of Dental Diseases Dental Caries Periodontal Diseases Malocclusion Summary and Conclusions 4 The Supply of Dental Services Practitioners Practice Settings Dental Practice Productivity Summary and Conclusions v 13 14 25 27 28 38 43 45 47 47 60 65 71
- Dental Care Expenditures and Insurance Public and Private Insurance of Dental Services Characteristics of Various Financing Systems Utilization Review and Quality Control Summary and Conclusions 6 Benefit Priorities and Their Estimated Costs A Model for Projecting Expenditures Projected Expenditures for Four Dental Plans Expenditure: Demand v. Need-based Projection Summary and Conclusions References Appendix 1. Appendix 2. 73 76 83 87 91 93 95 103 .s 105 107 109 Statistical Notes: Health and Nutrition Examination Survey Individual Comments by Members of the Study Committee vi 1 - 1 2-1
LIST OF TABLES Table . 2 3 4 5 6 7 8 9 10 11 12 13 14 Percent of Persons Needing Dental Treatment, By Type of Treatment and Age, 1971-74 Percent of Persons Needing Repair of Dentures or Bridges, By Age, 1971-74 Percent of Persons in Need of Dental Treatment, By Age and Sex, 1971-74 Percent of Persons with Dental Treatment Needs, By Type of Treatment, Age, and Race, 1971-74 Percent of Persons with Dental Treatment Needs, By Type of Treatment, Age, and Income Level, 1971-74 Indicators of Dental Utilization: Selected Years, 1963-1977 Average Number of Dental Visits Per Person Per Year, By Age and Sex, 1971-74 Percent of Persons with a Dental Visit Within a Year, By Race and Income, 1977 Percent of Persons with Dental Visits, By Time Interval, Income, Educational Levels, and Occupations, 1977 Number of Dental Visits Per Person Per Year, By Selected Occupational Characteristics: United States, 1977 Average Number of Decayed, Missing and Filled Permanent Teeth of Children, By Age and Sex, 1971-74 Average Number of Decayed, Missing, and Filled Permanent Teeth of Adolescents, By Age and Sex, 1971-74 Average Number of Decayed, Missing, and Filled Teeth of Dentulous Adults, By Age and Sex, 1971-74 Estimated Annual Cost-Benefit Ratios of Systemic Fluorides vii Page 15 16 16 7 1. 18 19 19 21 22 23 29 30 30 33
Table Page 15 Recommended Dosages of Dietary Fluoride Supplements, By Age and Level of Fluoride in Water Supply of Locality 34 16 Estimated Cost-Effectiveness of Topical Fluoride Procedures 35 Number of Active Dentists and Dentist-to-Population Ratio~- Selected Years, 1950-79 Dentist/Population Ratio and Selected Practice Character- istics, By Geographic Region 19 20 21 22 23 24 25 26 27 28 29 30 Utilization Rates by Region, 1977 Appointment Delay and Practice Activity, By Size of City, 1975 Total Number of Specialists and Specialists By Type, Selected Years First-Year Enrollment in Dental Auxiliary Programs, 1967-1977 Average Number of Patient Visits Per Week by Dentists in General Practice, With Different Numbers of Auxiliaries, By Age of Dentist, 1977 Selected Characteristics of Three Types of Dental Auxiliaries Patient Visits Per Hour for Dentists Reporting in the Sample By Method of Compensation Number of States and Territories Providing Dental Services, By Type of Service, Fiscal Year 1978 Time Worked and Visits Per Unit of Dentist Time, By Size of Practice Financial Characteristics of Dental Practices Percent of Dentist Time Spent in Rendering Services, By Type of Service and Size of Practice, 1977 Expenditures for All Personal Health Services and For Dentists' Services, Selected Years 1929-1978 viii 49 51 52 52 53 55 56 58 61 63 67 67 70 74
Page 32 33 34 35 36 37 38 39 40 41 42 Table 31 Estimated Expenditures for Dentists' Services, By Type of Service, 1977 National Dental Expenditures, By Age, Fiscal Year 1977 Personal Health Care Expenditures, By Type of Expenditure and Source of Funds, 1978 Number and Percent of Civilian Population Covered Under Private Dental Insurance Plans, 1962-1978 Benefit Expenditures of Private Health Insurance for Dental Care, Selected Years 1970-78 Expenditures for Dentists' Services, By Type of Public Program and Source of Funds, Calendar Year 1978 Pretreatment Review Requirements, By Payer Groups, 1976 Posttreatment Review Procedures Used, By Payer Groups, 1976 Dental Care Services and Projected Unit Costs, By Priority Plan, Fiscal Year 1980 Need-Based Projection of Expenditures for Dentists' Services Under National Health Insurance, Fiscal Years 1980-84 Projected Expenditures for Dentists' Services under Current Dental Care Systems Compared with Expenti- tures Under National Health Insurance, FY 1980 Expenditures for Dentists' Services Based on Need and Demand, Fiscal Year 1980 APPENDIX I Table - I Standard Error for Percentage of Persons Aged 1-74 Years with Need for Dental Treatment by Age and Type of Service II I 11 75 76 77 78 81 82 89 90 98 101 104 106 Standard Errors of Estimates of Aggregates Standard Errors, Expressed in Percentage Points, of Estimates 1X Page 1-3 1-4 1-5
