FUTURE OFDENTISTRY
u Endodontic procedures decreased for individuals
through age 64. Due to the increase in retention
of teeth in older adults, endodontic procedures
increased by 56% for people over 65 years of age.
u The absolute number of edentulous patients in-
creased despite the decrease in the percentage of the
population that was completely edentulous.
Market Forces Affecting Demand
THIRD PARTY COVERAGE
Private Coverage
Dentistry is an approximately $60 billion indus-
try. Individuals pay about 48% ($28 billion) of den-
tal expenditures out of their pockets directly to den-
tists. Another 48% of dental expenditures is reim-
bursed by employer-sponsored insurance (Health
Care Financing Administration [HCFA]). Together
these two sources of payment account for approxi-
mately 96% of all dental expenditures. About 160
million Americans do not have private dental insur-
ance. (Also see Chapter 4, Financing of and Access
to Dental Services.)
With dental expenditures increasing at a more
rapid rate than expenditures for most other goods and
services, employers are seeking ways to hold down the
increasing dental premiums. This may result in more
cost sharing by enrollees, reduction in dental benefits,
and more negotiated discounts on services.
There is a relatively strong demand for dental
services. Capitated managed care plans are not like-
ly to become a significant factor in the dental mar-
ketplace. Given the relative tightness of supply, den-
tists are more likely to maintain busy patient sched-
ules without participating in capitated managed
care plans (Bailit, 1999).
As an inflation-adjusted benefit, there has been
a steady decrease in the constant dollar value of
dental insurance. A strong economy contributes
significantly to the demand for dental services.
This discussion assumes that the economy will
continue to be strong. Should the economy weaken, the
demand for dental services is likely to also weaken.
Evidence that dental disease is linked to mor-
bidity and even mortality could recast the signifi-
cance of dental insurance from a discretionary to a
required benefit. Additionally, pressure to expand
dental benefits under Medicare may come from the
"baby boomer" generation as it moves into retirement
(Niessen, 1984). Members of this group have had
access to dental services throughout their lifetime.Publicly Funded Third Party Payment Programs
Government funding of dental care for low-
income populations is decreasing. Medicaid, the
primary funding vehicle for low-income, medically
compromised, physically challenged, and nursing
home populations, is under-funded. Less than
1% of Medicaid funds are spent on dental ser-
vices compared to approximately 5% of the total
United States health care dollar spent on dental
services (HCFA). State coverage of Medicaid
dental services for adults is discretionary, with
many states providing coverage for emergency
services only.
Given the high administrative overhead involved
in treating Medicaid recipients, low levels of patient
compliance, and the reimbursement rates that are
often less than half of market value, many dentists
do not participate in Medicaid.COMMUNITY-BASED ORAL DISEASE
PREVENTION PROGRAMSDental professionals traditionally have played a
leadership role in the implementation of communi-
ty-based preventive programs. Community-based
prevention programs, such as community water
fluoridation, sealant programs, or oral cancer screen-
ing will continue to play an important role in improv-
ing the public's oral health. Fluoridation, for example,
benefits more than 150,000,000 Americans, and is the
most cost-effective means to prevent dental caries.
The dental profession will continue to support
community-based preventive programs, such
as water fluoridation. This support will be need-
ed to strengthen local, state and federal public
health capacity to track disease patterns, develop
policy, and assure that people are linked with
appropriate education, preventive, and clinical
services.
Future research and technology may result
in new community-based preventive programs
that help prevent caries, periodontal diseases
and other oral diseases and conditions. (See Chapter
7, Dental and Craniofacial Research.) Implementing
these programs will require efforts by dental profes-
sionals, perhaps working with other health profes-
sionals, such as school nurses to prevent sports
injuries and child care workers to prevent early
childhood caries.Clinical Dental Practice and Management