Public Policy Options for Better Dental Health Report of a Study (1980) / Chapter Skim
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Dental Care Expenditures and Insurance
Dental Care Expenditures and Insurance
Pages 73-92
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From page 73... ...
Expenditures for professional dental services in the United States rank fifth among expenditures for all personal health care services -- after hospital care, physicians° services, drugs, and nursing home care. Dental care expenditures have been increasing slightly more rapidly recently than expenditures for other personal health care services, amounting to $3.7 billion in 1968 and $13.3 billion ten years later.
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From page 74... ...
The resulting estimates of expenditures by type of dental service are shown in Table 31 339/. Expenditures for professionally administered preventive dental services (which include prophylaxis and the application of topical fluorides and teeth sealants)
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From page 75... ...
To date, no longitudinal studies have been performed to evaluate this substantial shift toward fixed prosthetic services. Dental Expenditures by Age Dental services for the adult population (ages 19 through 64)
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From page 76... ...
* In Millions Source: Gibson and Fisher 347-348 / Public and Private Insurance of Dental Services Public expenditures for dental services as a percentage of total health expenditures are small and diminish with age.
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From page 78... ...
Indeed, many states have cut back on Medicaid dental care coverage in recent years. Thus, those dental services which are or will be covered by any third-party plans are more likely to be covered by private insurance plans.
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From page 79... ...
The first dental service organization was the Washington Dental Service, which evolved from 1954 labor-management negotiations 355/. Three years later the American Dental Association formally endorsed the concept of dental service corporations, and in 1965 the ADA established a national agency to coordinate the activities of state dental service organizations, which in 1969 became known as the Delta Dental Plans Association.
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From page 80... ...
In summary, private dental health insurance has grown rapidly, and if it continues to grow, 54.3 percent of all Americans would have some type of private dental insurance by 1990 360/. Publicly Funded Dental Care Of the $13.3 billion spent for dental services in 1978, only about a half-billion dollars (or 4 percent)
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From page 81... ...
Source: Private Health Insurance; Selected Issues, Social Security Bulletin; Social Security Administration; U
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From page 82... ...
Source: Gibson 364/ Public expenditures for dental services is mostly in federal and state Medicaid programs, which are required under federal statute to provide dental services to eligible children as part of the EPSDT program (early and periodic screening, diagnosis, and treatment)
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From page 83... ...
, and such cost containment strategies as utilization services and quality control. Most private dental health insurance plans contain provisions requiring the patient to pay some part of the cost of the services covered.
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From page 84... ...
Reimbursement Methods Providers of dental services are reimbursed most commonly on a fee-for-service basis. Salaries are frequently used to reimburse providers.
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From page 85... ...
It also provides an incentive for dentists to practice and encourage preventive dental care, because it is less expensive over time for a dental organization to provide preventive services than restorative and other more costly procedures. A study of two samples of patients receiving care from the same dentists on either capitation or fee-for-service arrangement found that patients received significantly more preventive services, fewer fillings, and experienced a more favorable modification in their DMF Index under the capitation arrangement 371/.
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From page 86... ...
* These disadvantages may also occur when dental health insurance pays for benefits on a fee-for-service basis.
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From page 87... ...
Although these committees may have beneficial effects for individual patients who ask for assistance, they are not routine monitors of the quality and appropriateness of dental services. Many dental prepayment programs have instituted routine reviews of utilization and costs of the dental care for which they provide payment.
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From page 88... ...
The ADA has recently issued a joint report of the Councils on Dental Care Programs, Hospitals and Institutional Dental Services, and the Bureau of Economic Research and Statistics, which describes 230 various systems employing a quality assurance program. It covers the categories of inpatient hospital review, ambulatory review, and third party carrier review, and assesses their data bases and associated strengths and limitations.
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From page 89... ...
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From page 90... ...
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From page 91... ...
Preventive dental services are estimated to represent only 7 percent of the total outlays for dental services. Reconstructive crown and bridge services have become the largest single expenditures for dental care, representing almost one-third of all dental care expenses.
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From page 92... ...
The committee concluded that sound mechanisms of quality and utilization review for ambulatory dental care be included in a national health insurance program. The committee also recognized that the successful implementation of quality and utilization review mechanisms as well as the administration of national health insurance require the development of a sound management information system and therefore recommended that an information system be instituted as an initial component of a national health insurance program.
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