NIDCR/CDC
Dental, Oral and Craniofacial
Data Resource Center

Oral Health, U.S. 2002 Annual Report

Section 16: DENTAL CARE WORKFORCE/
COST OF DENTAL CARE/
ACCESSIBILITY OF DENTAL CARE

Annual per capita costs for dental services have risen substantially over the past four decades. The annual per capita costs for dental services among the total United States population was $10.50 in 1960, $22.20 in 1970, $57.80 in 1980, and $123.90 in 1990. By 1999, the annual per capita cost had risen to $201.80 (CMS, 2001). In the data presented below, no corrections were made for inflation. Recently, using data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Survey, it was shown that real per patient dental expenses, adjusting for inflation, decreased between 1987 and 1996 (Brown et al., 2002; Wall et al., 2002).

In contrast, the mean annual dental expenses for only those persons with dental expenses have been much higher. These expenses were $137 in 1977, $295 in 1987, and $384 in 1996 (Moeller et al., 1996; Manski et al., 1999; Cohen et al., 2000).

SOURCE OF DATA
Analyses reported here are based on data from several sources. Annual per capita costs of dental services and source of payment were calculated from National Health Accounts (NHA) data produced by the Centers for Medicare and Medicaid Services (CMS) and population figures from the U.S. Census Bureau. Mean annual dental expense data were collected in the Medical Expenditure Panel Survey (MEPS) and its predecessor surveys, the 1977 National Medical Care Expenditure Survey (NMCES) and the 1987 National Medical Expenditure Survey (NMES).

• Annual per capita costs by year and source of payment (Figure 16.2.1)
• Between 1960 and 1980, annual per capita costs for dental services paid out of pocket were substantially higher than costs paid by private insurance. Between 1980 and 1999, private dental insurance coverage increased, making the annual per capita costs for dental services paid out of pocket and by private insurance nearly equal.
• Although annual per capita costs for dental services paid by public funds rose slightly over the past four decades, they remained much lower than the annual per capita costs paid either out of pocket or by private insurance.

• Mean annual dental expense by age and source of payment (Figures 16.2.2)
• Between 1977 and 1996, the mean annual dental care expense was consistently lower for those under 6 and aged 19 to 44 than for other age categories.
• For all age groups, the mean annual dental expense paid through private insurance was much higher in 1996 than in 1977.
• For those aged 19 and older, the mean annual dental expense paid out of pocket was higher in 1996 than in 1977.

• Mean annual dental expense by race/ethnicity and source of payment (Figure 16.2.3)
• For all race/ethnicity groups, the mean annual dental expense paid through private insurance rose substantially between 1977 and 1996.
• The mean annual dental expense paid by Medicaid was higher for non-Hispanic blacks and Hispanics than for the non-Hispanic whites/other group¹ between 1977 and 1996.
• The mean annual dental expense paid out of pocket was higher for the non-Hispanic white/other race/ethnicity group than for non-Hispanic blacks or Hispanics between 1977 and 1996.

• Mean annual dental expense by federal poverty level and source of payment (Figure 16.2.4)
• The mean annual dental expense paid through private insurance generally rose between 1977 and 1996.
• By 1996, the mean annual dental expense paid by Medicaid rose considerably, particularly among those below the federal poverty line.

Bullets reference data that can be found in Tables 16.2.1, 16.2.2, 16.2.3 and 16.2.4.

¹ The 1977 NMCES and the 1987 NMES reported race/ethnicity as white (including all other race/ethnicity groups not shown), black, and Hispanic. The 1996 MEPS reported race/ethnicity as Hispanic, black-not Hispanic, and other (including non-Hispanic whites).

REFERENCES
Brown LJ, Wall TP, Manski RJ. The funding of dental services among U.S. adults aged 18 years and older: recent trends in expenditures and sources of funding. J Am Dent Assoc 2002;133:627–635.

Centers for Medicare and Medicaid Services (CMS), Office of the Actuary: National Health Statistics Group and U.S. Census Bureau, 2001, National Health Accounts.

Cohen JW, Machlin SR, Zuvekas SH, et al. Health Care Expenses in the United States, 1996. Rockville, MD: Agency for Healthcare Research and Quality, 2000; MEPS Research Findings 12. AHRQ Pub. No. 01–0009.

Manski RJ, Moeller JF, Maas WR. Dental services: use, expenditures and sources of payment, 1987. J Am Dent Assoc 1999;130(4):500–508.

Moeller J, Levy H. Dental services: a comparison of use, expenditures, and sources of payment, 1977 and 1987. Rockville, MD: Agency for Healthcare Research and Quality, 1996; AHCPR Pub. No. 96–0005. National Medical Expenditure Survey Research Findings 26.

Wall TP, Brown LJ, Manski RJ. The funding of dental services among U.S. children 2 to 17 years old: recent trends in expenditures and sources of funding. J Am Dent Assoc 2002;133:474–482.

Figure 16.2.1. Trends in annual per capita costs for dental services by year and source of payment, 1960–1999

[D]

Notes: (1) Dental services include services provided in establishments operated by a doctor of dental medicine (D.M.D.) or doctor of dental surgery (D.D.S.) or doctor of dental science (D.D.Sc.). These establishments are classified as NAICS 6213 Offices of Dentists or SIC 802-Offices and clinics of dentists; (2) private insurance includes other private revenues including philanthropy; (3) per capita cost calculations based on total population, including those with and without dental expense.

Data source: Centers for Medicare and Medicaid Services, Office of the Actuary: National Health Statistics Group and U.S. Census Bureau, 2001, National Health Accounts.

Figure 16.2.2. Mean annual dental care expense by age group and source of payment, 1977, 1987, and 1996

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Note: Mean annual dental expense was calculated only among those with dental expenses. For further definitions, see Table 16.2.2–16.2.4 footnotes.

Sources: Moeller J, Levy H. Dental services: a comparison of use, expenditures, and sources of payment, 1977 and 1987. Rockville, MD: Agency for Healthcare Research and Quality, 1996; AHCPR Pub. No. 96-0005. National Medical Expenditure Survey Research Findings 26; Manski RJ, Moeller JC, Maas WR. Dental Services: use, expenditures and sources of payment, 1987. J Am Dent Assoc 1999; 130(4):500–508; Copyright ©1999 American Dental Association. Adapted 2002 with permission of ADA Publishing, a Division of ADA Business Enterprises, Inc.; and Medical Expenditure Panel Survey Household Component, 1996, Agency for Healthcare Research and Quality.

Figure 16.2.3. Mean annual dental care expense by race/ethnicity and source of payment, 1977, 1987, and 1996

[D]

Note: (1) Mean annual dental expenditure was calculated only among those with dental expenses. (2) The 1977 NMCES and the 1987 NMES reported race/ethnicity as white (including all other race/ethnicity groups not shown), black, and Hispanic. The 1996 MEPS reported race/ethnicity as Hispanic, black-not Hispanic, and other (including non-Hispanic whites). (3) For further definitions, see Table 16.2.2–16.2.4 footnotes.

Sources: Moeller J, Levy H. Dental services: a comparison of use, expenditures, and sources of payment, 1977 and 1987. Rockville, MD: Agency for Healthcare Research and Quality, 1996; AHCPR Pub. No. 96-0005. National Medical Expenditure Survey Research Findings 26; Manski RJ, Moeller JC, Maas WR. Dental Services: use, expenditures and sources of payment, 1987. J Am Dent Assoc 1999; 130(4):500-8; Copyright ©1999 American Dental Association. Adapted 2002 with permission of ADA Publishing, a Division of ADA Business Enterprises, Inc.; and Medical Expenditure Panel Survey Household Component, 1996, Agency for Healthcare Research and Quality.

Figure 16.2.4. Mean annual dental care expense by source of payment and federal poverty level, 1977, 1987, 1996

[D]

Notes: (1) Mean annual dental expense was calculated only among those with dental expenses. (2) Federal Poverty level for 1977 and 1987-Poor: incomes below the federal poverty line; near poor: between the federal poverty line and 125% of the federal poverty line; low income: over 125% to 200% of the federal poverty line; middle income: over 200% to 400% of the federal poverty line; and high income: over 400% of the federal poverty line. Poverty levels for 1996-Poor: incomes below the federal poverty line; near-poor: between the federal poverty line and 124% of the federal poverty line; low income: 125% to 199% of the federal poverty line; middle income: 200% to 399% of the federal poverty line; and high income: 400% of the federal poverty line and above. (3) For further definitions, see Table 16.2.2–16.2.4 footnotes.

Sources: Moeller J, Levy H. Dental services: a comparison of use, expenditures, and sources of payment, 1977 and 1987. Rockville, MD: Agency for Healthcare Research and Quality, 1996; AHCPR Pub. No. 96-0005. National Medical Expenditure Survey Research Findings 26; and Medical Expenditure Panel Survey Household Component, 1996, Agency for Healthcare Research and Quality.

Department of Health and Human Services
National Institute of Dental And Craniofacial Research (NIDCR)	CDC Division of Oral Health
National Institutes of Health

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