Talk about health care costs often omits dental spending


Adult dental visits are on the decline. Overall spending on dental care has been flat for several years.

Both trends apparently began before the recession hit in 2008 and experts at the American Dental Association’s Health Policy Resources Center are pondering the factors driving them.

Dental care often gets left out of larger discussions about health care. And dental spending represents a small part of American health care spending. The $108 billion spent on dental care in 2011 represented just 4 percent of health care spending overall, down from a peak of 4.5 percent of national health expenditures in 2000, the ADA found.

Still, I am curious about whether the slowdown in the dental economy might get a mention in a July 11 online talk show sponsored by the Institute for Healthcare Improvement (IHI).

The program, “Bending the Cost Curve? Making Sense of the Slowdown in the Growth of U.S. Health Care Spending” will feature experts that include IHI senior fellow and former CMS administrator Donald Berwick, economist David Cutler and Harvard health policy expert Amitabh Chandra. (It’s scheduled for 2-3 p.m. ET; sign up to listen.)

Analysts at the IHI believe that beyond the effects of the recession “pressure from both public and private payers, reinforced by reimbursement reforms rolling out in the Affordable Care Act, may be making a dent in the growth of the country’s health care spending.”

In a research brief on the slowdown in dental spending, ADA analysts did not broach the subject of health care reform. But they cited pressure from public and private payers as factors in the dental economy’s “major transition.”

In recent years, dental financing has shifted away from out-of-pocket payments toward Medicaid and other public programs where dental fees are considerably lower. Private insurors have also reduced their fees, they observed.

And while children, particularly poor children, have been seeing dentists in increasing numbers, adults, who need more expensive care, are getting less of it.

“Among adults, financial barriers to care are growing, particularly among poor adults,” noted the authors of the report.

While millions of additional children are expected to get dental benefits through Medicaid expansion and health insurance exchanges under health care reform, the lack of dental benefits for millions of poor adults is a problem that the Affordable Care Act does not address.

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