ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

Medicaid programs which themselves have had
limited impact, the overall impact of SCHIP
on access to dental care may be limited (Bailit,
1999).

Bureau of Primary Health Care, Health Resources and
Services Administration
Another source of financial support for dental
services is the Bureau of Primary Health Care,
Health Resources and Services Administration. The
Bureau gives grants to private non-profit Migrant
and Community Health Centers to provide compre-
hensive health care, including dental services, to the
poor and migrants. Approximately 56% of the 671
Migrant and Community Health Centers offer den-
tal services, and in 1997 they provided dental care
to 1.13 million people (Bailit, 1999).

The Indian Health Services
Several federal agencies provide direct services to
specific, often disadvantaged, populations and to
military personnel. The Department of Health and
Human Services' Indian Health Service (IHS) pro-
vides oral health services to Native Americans and
Alaska natives in dental facilities located in pre-
dominantly Native American communities and
reservations. The IHS also purchases care from pri-
vately practicing dentists located near Native
American communities (Bailit, 1999).

The United States Department of Veterans
Affairs (VA)
The Department of Veterans Affairs (VA) provides
the largest network of hospital based dental pro-
grams in the United States. VA Dental Services meet
the oral health needs of eligible veterans. VA den-
tists have training and expertise in caring for med-
ically compromised patients, many of who are
homeless or reside in nursing homes or long term
care facilities. A large part of VA practice provides
oral health care to patients with complex medical
problems such as substance abuse, psychiatric and
psychomotor disorders, oral cancer and HIV (Bailit,
1999).

Dental Schools
Dental schools are an important source of care for
the poor and individuals with disabilities. In part,
this is because most schools are part of academic
health centers that are located in older urban areas.
A large percentage of patients treated at these cen-

ters come from the local neighborhood and have

low incomes, making dental schools their primary

source of dental care (Bailit, 1999). In addition, the

majority of dental schools are public institutions

that receive some state support. As such, the gener-

al public and state legislatures expect schools to

function as safety net providers.

Some schools have dental clinics that provide care

to low-income children who are covered by the

Medicaid program or have no insurance coverage.

These clinics are usually partially subsidized by

state, county and municipal funds even though they

bill Medicaid where possible. There are no compre-

hensive national data available on school-based

dental clinics.

UTILIZATION OF DENTAL SERVICES

Whether, and how often, individual Americans

obtain dental care are frequently studied as meas-

ures of access. Several reports have focused on the

extent, determinants and likelihood of dental visits

(National Center for Health Statistics [NCHS],

1972). Measured as the number of visits per year or

the number of individuals with at least one visit dur-

ing the previous year, these studies have provided

useful information about dental services use.

The second measure of utilization is expenditures

for dental services. Expenditures are a dollar meas-

ure of the extent of utilization of resources once

entry into the dental delivery system occurs.

Expenditures are influenced by a combination of

several factors including, but not limited to, profes-

sionally determined need for care, ability to pay,

perceived value of oral health and local supply and

availability of providers.

Visits and Expenditures

VISITS

Americans seek dental care in considerable num-

bers. In 1996, Americans visited dentists about 294

million times (Manski et al, 2001).

The available data on use of dental care is char-

acterized by variability from one source to another

(Brown and Lazar, 1999). One survey suggests that

75% of the adult population have an annual dental

visit (ADA, 1997), while another source puts the fig-

ure at 42% (Manski, 1987). Some of the differences

between these and other estimates are likely to be

due to differences in survey methods. All sources

Financing of and Access to Dental Services