FUTURE OFDENTISTRYof data agree that there are important differences
in the use of dental care among subgroups of the
population even though the true rate of annual
dental visits in the United States is currently
uncertain.
According to data from the National Health
Iterview Survey (NHIS), annual utilization of dental
care in the United Stated has increased gradually
over the past several decades. In 1983, 55.0% of
the population 2 years and older reported a dental
visit in the prior year, while in 1998 the annual rate
was reported to be 65.5% (Jack and Bloom, 1988;
Bloom et al, 1992; NCHS, 2000a; and NCHS,
2000b). Figure 4.6, which is based on data from
NHIS, shows this gradual increase.EXPENDITURESAccording to the Health Care Financing
Administration (HCFA) estimates, in 1998, $53.8
billion was spent for dental services, representing
4.6% of total health expenditures. For the past
seven years the annual rate of increase in dentalexpenditures ranged from 5-11%. This is more
than twice the rate of general inflation. Between
1993 and 1998, dental care expenditures were rising
faster than hospital and physician services expendi-
tures. This represents a historic shift in the compara-
tive rates of growth between the two sectors. Many
observers believe this is the result of the much larger
penetration of managed care into the medical sector. It
may also reflect the changing mix of dental services
sought by the public with significant increases in cos-
metic dental services.
In real dollars (base=1998), the increase in expendi-
tures has been smaller, increasing from about $43 bil-
lion in 1982 to $53.8 billion in 1998, an average annu-
al increase of 1.4%. This is only slightly greater than
the rate of increase in the United States population,
which is 1.1%. Factoring out pop-
ulation changes, real per capita
expenditures (including both those
with a visit and those without)
have been almost level from the
early 1980s through 1998, ranging
from approximately $185 to $192
in 1998 dollars. As mentioned
previously, the percent of the pop-
ulation who visited a dentist with-
in a year increased during this
same period (see Figure 4.6).
These trends imply that real den-
tal expenditures among those with
a dental visit have declined. To
verify this implication, dental
expenditure information from the
1996 Medical Expenditure Panel
Survey (MEPS) and the 1987
National Medical Expenditure
Survey (NMES) is helpful.^3 Based
on large national probability sam-
ples, MEPS and the NMES allow
for examination of dental expenditures by major
demographic variables.^4
Average nominal dental expenditures (based on
those with a visit) increased from $295.55 in 1987 to
$435.80 in 1996. However, when these expenditures
are expressed in 1998 dollars (i.e., adjusted for infla-
tion), the NMES and MEPS data show a decrease inFinancing of and Access to Dental ServicesPercentage Distribution of Persons 2 Years of Age and
Older who Visited the Dentist within the Past YearSource: National Center for Health Statistics, National Health Interview Surveys.
68
66
64
62
60
58
56
54
52
50(^48) NHIS 1983
55. 0
NHIS 1986
57. 1
F I GURE 4. 6
NHIS 1989
57. 2
NHIS 1997
64. 3
NHIS 1998
65. 5
SURVEY YEAR
P
ER
C
EN
T
(^3) 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.
(^4) Estimates of total national dental expenditures derived from the 1996 MEPS and the 1987 NMES are in line with national estimates from
HCFA. For example, in 1996, HCFA estimated national dental expenditures at $47.5 billion while the MEPS estimate for 1996 was $50.3
billion. Although these numbers vary slightly, the two sources are in basic agreement.