According to estimates from CMS, public funding for dental services in the U.S., measured in terms of current dollars (nominal), increased from $2 billion in 1996 to $5 billion in 2004, or from 4.5% of total dental expenditures to 6.0%. As part of total public funding, funding for dental SCHIP and dental SCHIP expansion grew from $0 prior to 1998 to $517 million in 2004. shows these expenditures measured in constant 2004 dollars (adjusted for inflation). Real public dental expenditures grew from $3.16 billion in 1996 to $5.2 billion in 2004, an increase of 64.6%.
Trends in the public funding of dental services, 1996 2005a
A comparison of CMS and MEPS nominal estimates of public dental expenditures is shown in . For all years except 2000, the MEPS estimate is lower than the CMS estimate. There is an explanation for why the MEPS estimate should be lower.12
CMS estimates are intended to represent the resident U.S. population. The MEPS estimates, on the other hand, are constructed for individuals in the civilian, non-institutionalized population. The MEPS does not include people in the military, prisons, long-term care facilities, assisted living facilities, group homes, juvenile facilities, residential treatment centers, and other types of group quarters.
Total public funding (nominal) of dental services: CMS vs. MEPS
Because the MEPS dental expenditure estimates for 2000 were not consistent with the estimates for other years, MEPS data for the year 2000 are not included in and . Also, the MEPS estimate of total public dental expenditures includes some categories of expenditures that are not targeted to the economically indigent, such as Medicare, Veterans Affairs, and TRICARE. In and , expenditures in these categories were removed to focus on MEPS estimates of Medicaid dental expenditures, which includes SCHIP expenditures.
Medicaid funding of dental services (nominal) for children vs. adults, 1996–2004 MEPSa
Reala Medicaid dental expenditures for children aged 0 to 20 years by family income level, 1996–2004 MEPSb
The MEPS allows for a breakdown of Medicaid dental expenditures by patients' age. shows nominal Medicaid dental expenditures based on MEPS divided into two parts: (1) those <21 years of age and (2) those ≥21 years of age. The amount of public funding of dental services going to adults (nominal) increased from $572.2 million in 1996 to $1.3 billion in 2004. The real increase in constant 2004 dollars was from $811.1 million to $1.3 billion (data not shown). Medicaid funding for adult dental services was 46.7% of the total in 1996. In 2004, it was 43.8% of the total.
As shown in , Medicaid dental expenditures reported for children 0 to 20 years of age grew in real terms from $925 million in 1996 to $1.7 billion in 2004. also shows these expenditures broken down by family income level. Beginning in 1997, there was a steady real increase in the amount of Medicaid expenditures reported for children in the 100% to <200% FPL group, from $168.7 million in 1996 to $551.8 million in 2004. In 1996 (prior to SCHIP), Medicaid accounted for 7.5% of dental expenditures among children at the 100% to <200% FPL group. In 2004, the percentage was 25.8% (data not shown). There was also a real increase in Medicaid dental expenditures reported for children in the 200% to <400% FPL group, from $87.0 million in 1996 to $372.8 million in 2004.
In 1996, children in the lowest income group accounted for 70.9% of Medicaid expenditures for this age group (0 to 20 years of age). In 2004, children in the lowest income group accounted for 43.7% of Medicaid expenditures for this age group.
The MEPS also collects information concerning the utilization of dental services. shows the percentage of children aged 2 to 20 years with a dental visit during the past year by family income level. Among children in the <100% FPL group, the percentage of children with a visit during the past year increased from 30.3% in 1996–1997 to 33.5% in 2003–2004. Among children in the 100% to <200% FPL group, the percentage with a visit increased from 32.4% in 1996–1997 to 37.0% in 2003–2004. Among children in the highest income group, the percentage with a visit increased from 63.5% in 1996–1997 to 67.1% in 2003–2004.
Percentage of children aged 2 to 20 years with a dental visit during the past year, by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS
As shown in , according to the MEPS data, the number of children aged 2 to 20 years increased from 74.8 million in 1996–1997 to 77.9 million in 2003–2004. The number with a dental visit increased from 34.2 million to 38.7 million and the number without a visit dropped from 40.6 million to 39.2 million. The number of children <100% FPL fell from 14.8 million to 13.5 million. The number with a visit increased from 4.49 million to 4.52 million, and the number without a visit fell from 10.3 million in 1996–1997 to 9 million in 2003–2004.
Number of children aged 2 to 20 years with a dental visit during the past year and those with no dental visit, by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS
Although the number of children in the 100% to <200% FPL group grew by just 350,000 (from 16.08 million to 16.43 million), 880,000 more children in this poverty category reported a visit in 2003–2004 than in 1996–1997. The number of children in the highest income group (≥400% FPL) rose from 18.7 million to 22.4 million. The number with a visit increased from 11.9 million to 15.0 million. However, the number with no visit also increased from 6.8 million to 7.4 million. According to the MEPS data, 45.7% of children reported a dental visit in 1996–1997. In 2003–2004, almost half (49.6%) reported a visit.
While seldom reported in the literature, the MEPS data can be used to demonstrate the relationship between dental expenditures and the utilization of dental services. Based on the 2004 MEPS, the correlation between expenditures and utilization (number of dental visits reported during 2004) was 0.53 (p<0.0001) among those with at least one visit. Among all children surveyed—with a dental visit or not—the correlation was 0.61 (p<0.0001).
shows changes in four sources of funding for dental expenditures from 1996–1997 to 2003–2004 for children aged 2 to 20 years by family income level. The estimates were adjusted for inflation, and expenditures for orthodontic services were removed because they comprise a large portion of overall dental expenditures for adolescents and are more likely to be reported for children in higher income categories. The estimates are per patient; that is, these are mean annual expenditures reported for children in each income group who visited a dentist.
Per-patient mean reala annual dental expenditure by sources of funding for children aged 2 to 20 years, by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS (orthodontic services removed)
Annual mean out-of-pocket dental expenditures declined for children in all income groups from 1996–1997 to 2003–2004. In 2003–2004, mean out-of-pocket expenditures were $37 for children in the lowest income group, $58 for children 100% to <200% FPL, $92 for children 200% to <400% FPL, and $101 for children in the highest income group. Mean per-patient Medicaid dental expenditures in 2003–2004 were $147 for children in the lowest income group—down somewhat from $154 in 1996–1997; $82 for children 100% to <200% FPL—up from $23 in 1996; and $24 for children 200% to <400% FPL—up from $6 in 1996–1997. Private dental insurance as a source of expenditures rose from a mean of $157 to $181 for children in the highest income group, but remained constant for children in other income groups.
shows changes in real mean charges per patient for dental services for children aged 2 to 20 years by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS. Charges in MEPS represent the sum of all fully established charges for care received and usually do not reflect actual payments made for services, which can be substantially lower due to factors such as negotiated discounts, bad debt, and free care. However, charges can be considered as a measure of the amount of dental services received. A large real increase was reported for children in the 100% to <200% FPL group (>$93).
Change in reala mean annual dental charges per patient for children aged 2 to 20 years, by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS (orthodontic services removed)b