FUTURE OFDENTISTRY
(United States General Accounting Office, 2000).
The 1997 State Child Health Insurance Program
(SCHIP) extends public funds to approximately 10
million near-poor children. Enrollment in this pro-
gram has only reached 25% of the target population
(HCFA, 2000).
A few states (e.g., Indiana and Michigan) have sub-
stantially increased dental Medicaid fees and expen-
ditures and improved program administration. These
changes have led to significant growth in dentist par-
ticipation, patient utilization, and total expenditures
(Drs. Stephen Eklund and Mark Mallat, Personal
Communication, September 1, 2000).
Medicare covers dental services only when asso-
ciated with the treatment of medical conditions,
although some medical managed care plans offer
limited dental benefits to attract elderly enrollees.
In 1998, the Medicare program provided $200 mil-
lion for dental care (HCFA).
Approximately 110 million Americans have private
dental prepayment (Wassenaar, 2000). From the late
1980s until the present the percentage of employees
with dental prepayment declined modestly (Blostin
and Pfunter, 1998), but the trend has reversed in the
past several years of strong economic growth (Long
and Marquis, 1999). Although less than half of the
population has private dental prepayment, these
patients account for 60-65% of patients in the average
dental office (ADA, 1998). Dental expenditures and
sources of financing information also are available
from the 1996 Medical Expenditure Panel Survey
(MEPS) (Cohen, 1997) and the 1987 National
Medical Expenditure Survey (NMES) (Edwards and
Berlin, 1989). These data allow for breakdowns of
dental expenditures by major demographic variables
such as age and income, which are not available from
HCFA.^2
The 1987 NMES survey indicates that $1.6 billion,
5.0% of total expenditures, was provided without
charge to the patient by providers (Manski et al,
1999). This estimate includes charitable care, profes-
sional courtesy, and bad debt. When this estimate is
adjusted to 1998 dollars, it amounts to $2.9 billion or
$19,936 per dentist. This compares favorably to the
estimated $2.0 billion (1998 dollars), 3.7% of total
expenditures, from public sources for 1987.
Another estimate of the size of the charitable com-
ponent of free care is available from the ADA's
1997 Survey of Current Issues in Dentistry(ADA,
1998). This survey indicates that 73.5% of private
practitioners provided some charitable care in 1996.
The total estimated value of this care is $1.3 billion
(1998 dollars). The average amount of charitable
care per dentist (based on all private practice
dentists in the United States) was $8,637 (1998 dol-
lars). The total value of charitable care is equivalent
to about two-thirds of total expenditures from
public sources reported above using the 1987
NMES data.
In addition, dentist volunteers have been provid-
ing care to needy patients through Donated Dental
Services programs sponsored by state dental soci-
eties (Fox, 2000). According to the National
Foundation of Dentistry for the Handicapped,
Donated Dental Services programs are active in 26
states, include about 8,000 volunteer dentists, and
have provided free care to about 30,000 persons at
an approximate value of $34 million.Types of Dental Care Payment Arrangements
EMPLOYER-BASED PAYMENT PROGRAMSFigure 4.4 presents estimates of the number of
people enrolled in three types of private, group den-
tal prepayment plans for the past six years: indem-
nity, PPO, and Dental HMO (National Association
of Dental Plans, 2000).INDEMNITY INSURANCE PLANSIn the past, indemnity plans have been the domi-
nant form of employer-based prepayment. Under
the provisions of indemnity style coverage, the third
party payer provides payment of a specified dollar
amount for defined services, regardless of the actual
charges made by the provider.
As recently as 1994, 75-80% of employer-based
prepayment enrollments were estimated to be
with indemnity plans. Dental HMO and PPO plans
together represented only about 20% of enrollment.
By 1999, about half of all people with group private
dental prepayment were enrolled in indemnity
plans. In absolute terms, the decline in the number
of people covered by indemnity plans has been more
modest, from about 80 million in 1994 to about 66
million in 1999.Financing of and Access to Dental Services(^2) Dental expenditures in the 1987 NMES are based on charges. In the 1996 MEPS dental expenditures are based on the sum of payments for
care received. Fortunately the 1996 MEPS also includes a measure of charges. In order to maintain consistency in terms of what is being
compared over time, the results presented in this section are based on the total charges for dental services.