FUTURE OFDENTISTRYusing public funds. While surveys suggest that most
Americans support providing all citizens financial
access to basic health care services, to date, federal
and state legislatures have not allocated funds to
provide the poor the same level of access to dental
care as the non-poor. Without adequate public
funding, the efforts by the dental profession and
others to provide the poor adequate access to dental
care will continue to fall short.
FUTURE FINANCING OF DENTAL CARE
It is expected that total dental expenditures will
increase at an overall growth of 5-7%; but the real
growth rate (i.e., after adjusting for inflation) will be
1-2%, slightly less than the rate of growth of the
real Gross Domestic Product (GDP).
In the short run (5 to10 years), private dental pre-
payment is likely to decline modestly. Annual max-
imums, which have not changed appreciably in the
last 15 to 20 years, should increase with a moderate
increase in premiums of 5% or less. If medical costs
continue to increase as they have during the past
two years (e.g., 8-15% annually), then employers
are likely to either (1) shift costs to employees so
that fewer employees opt for dental prepayment or,
(2) cut back on the dental prepayment coverage they
offer in order to help fund medical insurance. In the
longer run, events and trends in the financing and
organization of medical care may have substantial
impact on dental care financing. The unpredictabil-
ity of medical costs and the response by employers
and government to this situation makes long-term
predictions for dental coverage very uncertain.
The proportion of dental expenditures funded
directly by patients, private prepayment and public
programs will remain essentially the same for the
next five years. Major increases in public funding of
dental care for the poor or medically disabled are
not expected, with the exception of modest increas-
es in programs targeting children (e.g., SCHIP).
Within the structure of dental prepayment, the
percent of the privately insured population with
PPO plans will increase. In turn, there will be a
decline in indemnity and Dental HMO enrollment.
Also, there will be some increase in direct reim-
bursement and there will be more interest in
Medical Saving Accounts as a market-based system
to control medical care costs.
Although many dentists will treat patients with
PPO plans, the overall impact of managed care on
dentists' management of patients and aggregate den-
tal expenditures will be limited.
The concept of a "prepayment/insurance free"
practice may grow as a result of the dentists' per-
ceptions of the difficulties encountered in dealing
with carriers. Dentists are more likely to refuse
assignment of benefits and, therefore, more of the
burden of dealing with the insurance company will
be placed on the patient. In turn, this could put
increasing pressure on insurance companies to sim-
plify their administrative procedures and/or become
more "provider friendly."ACCESS TO DENTAL CARE IN THE FUTUREIn the short run, the demand for care is expected
to continue to increase at about the same rate as it
has for the past five years. Some of the major fac-
tors which are likely to influence demand are: 1)
more affluent, educated and growing population, 2)
new diagnostic and treatment technologies, and 3)
some underserved populations will gain financial
access to care and use services (e.g., SCHIP).
Unless the percent of the population seeking den-
tal care continues to grow, overall demand may
moderate, due to improving oral health among
those who seek services. These trends may become
more pronounced as younger cohorts with less
caries experience replace the so-called baby boom
generation. Nevertheless, a growing economy and
new technologies must be factored into the situation
before any final conclusions can be reached.
In the near term, increasing utilization and expendi-
ture by elderly persons are likely to continue. This
is because the next generation of elderly (the current
55-65 year-olds) is large in number and these
individuals are already high users of dental care.
They will, therefore, be the most affluent elderly
generation thus far and their current dentitions will
require high levels of maintenance. As the elderly
population increases in number and influence, pres-
sure may build to provide them with more dental
coverage either through tax deferred Medical
Savings Accounts or a combination of public subsi-
dies and employer contributions. In the longer
term, as the generation following the baby boomers
begins to retire, demand among the elderly may
decline because these future generations will be
fewer in number and healthier.
While affluent people who live in rural areas have
the means to seek care, low-income families in ruralFinancing of and Access to Dental Services