Oral Health, U.S. 2002 Annual Report
Section 16: DENTAL CARE WORKFORCE/
COST OF DENTAL CARE/
ACCESSIBILITY OF DENTAL CARE
| 16.3 |
Trends in the proportion of dental care paid for by public
programs, private insurance, and out of pocket |
Trends in payment for dental care services over the past four decades show a
dramatic shift from almost exclusive out of pocket payment in 1960 to a nearly
even balance between out of pocket payments and private health insurance in
1999. Annual out-of-pocket payments for dental services steadily decreased from
97.2% in 1960 to 45.8% in 1999, while the proportion of annual costs for dental
services paid by private insurance steadily increased from only 1.9% in 1960 to
almost 50% in 1999 (CMS, 2001).
These trends are confirmed by corresponding data from other sources. Between
1977 and 1996, the proportion of total annual dental expense paid out of pocket
decreased from 72% in 1977 to 55.6% in 1987 to 51.5% in 1996. The proportion
reimbursed by private insurers increased from 18.1% in 1977 to 34.4 % in 1987
to 42.5% in 1996. Public sources of payment for annual dental expenses,
including Medicare, Medicaid, or other public funds, represent approximately
10% in both 1977 and 1987 and less than 4% in 1996 (Moeller et al., 1996;
Manski et al., 1999; Cohen et al., 2000. Based on data from 1977 National
Medical Care Expenditure Survey, 1987 National Medical Expenditure Survey, and
the 1996 Medical Expenditure Panel Survey).
SOURCE OF DATA
Analyses reported here were based on data from the National Health Accounts,
produced by the Centers for Medicare and Medicaid Services (CMS) and from the
series of medical expenditure surveys conducted by the Agency for Healthcare
Research and Quality: the 1977 National Medical Care Expenditure Survey
(NMCES), the 1987 National Medical Expenditure Survey (NMES), and the 1996
Medical Expenditure Panel Survey (MEPS).
-
Annual costs for dental services by source of payment (Figure 16.3.1)
-
The percentage of annual cost for dental services paid out of pocket steadily
decreased from 1960 to 1999, while the proportion of dental services paid by
private insurance steadily increased.
-
Less than 5% of the annual costs for dental services have been covered by
public funds, with the majority of these services covered under Medicaid (CMS,
2001). Medicaid covers mainly children below state-specific poverty thresholds.
Older age groups may not be eligible or may need to meet more rigid eligibility
criteria depending on the state.
-
Source of payment for annual dental expenses by age (Figure 16.3.2)
-
Between 1977 and 1996, those age 65 and older paid proportionately more of
their annual dental expenses out of pocket and less was paid for by private
insurance than for any other age group.
-
Medicaid paid a higher percentage of annual dental expenses for those under age
6 than for any other age group.
-
Differences by race/ethnicity (Figure 16.3.3)
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Medicaid paid a higher percentage of annual dental care expenses for blacks and
Hispanics than for the white/other race/ethnicity group.2
-
Between 1977 and 1996, a higher percentage of annual dental care expenses was
paid out of pocket among the white/other race/ethnicity group than by blacks or
Hispanics.
-
Differences by federal poverty level (Figure 16.3.4)
-
Between 1977 and 1996, the proportion of annual dental expenses paid out of
pocket decreased for all income groups.
-
The proportion of annual dental care expenses covered by Medicaid for those at
or below the federal poverty level (poor) doubled between 1987 and 1996
Bullets reference data that can be found in Tables
16.3.1, 16.3.2,
16.3.3 and 16.3.4.
2 The 1977 NMCES and the 1987 NMES reported
race/ethnicity as white (including all other race/ethnicity groups not shown
separately), black, and Hispanic. The 1996 MEPS reported race/ethnicity as
Hispanic, black-not Hispanic, and other (including non-Hispanic whites).
REFERENCES
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.
Centers for Medicare and Medicaid Services (CMS), Office of the Actuary:
National Health Statistics Group, 2001, National Health Accounts.
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.
Figure 16.3.1. Trends in annual payment 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.
Source: Centers for Medicare and Medicaid Services, Office of the Actuary:
National Health Statistics Group National Health Accounts.
Figure 16.3.2. Trends in annual payment for dental services by age
and source of payment, 1977, 1987, and 1996
 [D]
Notes: Expenses from any type of dental care provider are included.
Private insurance includes CHAMPUS and CHAMPVA (Armed Forces related coverage)
in 1996.
Sources: Moeller J, Levy H. Dental services: 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 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.
Figure 16.3.3. Trends in annual payment for dental services by
race/ethnicity and source of payment, 1977, 1987, and 1996
 [D]
Notes: (1) Expenses from any type of dental care provider are
included. (2) Private insurance includes CHAMPUS and CHAMPVA (Armed Forces
related coverage) in 1996. (3) 1977 NMCES and 1987 NMES reported race/ethnicity
as whites (including all other race/ethnicty groups not shown separately),
black, and Hispanic. 1996 MEPS reported race/ethnicity as Hispanic, black-not
Hispanic, and other (including non-Hispanic whites).
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 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.
Figure 16.3.4. Trends in annual payment for dental services by
federal poverty level and source of payment, 1977, 1987, and 1996
 [D]
Notes: (1) Expenses from any type of dental care provider are
included. Private insurance includes CHAMPUS and CHAMPVA (Armed Forces related
coverage) in 1996. (2) For 1977 and 1987, poor refers to 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. For 1996, poor refers to incomes
at or below the federal poverty line; near-poor, over the federal poverty line
through 125% of the federal poverty line; low income, over 125% through 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.
Sources: Moeller J, Levy H. Dental services: a comparison of use, expenditures,
and sources of payment, 1977 and 1987. Rockville, Maryland: Agency for
Healthcare Research and Quality, 1996;
AHCPR Pub. No. 96–0005. National Medical
Expenditure Survey Research Findings 26; and 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.
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