Attempts to control dental health care costs: The U.S. experience

Abstract

This paper presents a review and evaluation of efforts to control dental care costs in the United States. In general, health care costs have become a major concern in the United States; health spending has risen significantly faster than expenditures and prices for other goods and services. The same is not true for dentistry, however. The first section of this paper documents the moderate growth of dental care expenditures and summarizes some of the contributing factors such as increases in health care utilization, productivity, auxiliary utilization and prepayment. For several reasons, including multiple sources of payment and organizational independence of providers, there has been no comprehensive policy of cost containment in the United States. Nevertheless, there are a multitude of separate efforts aimed directly or indirectly at controlling costs. The most important of these are identified and discussed under three general headings : health care organization and delivery, planning and development, and reimbursement. After reviewing a variety of cost containment approaches, it is concluded that, overall, they have been effective but with direction could perhaps be more so. There are certain types of approaches which have proved more effective or promising than others. These are identified and discussed as: (1) programs which encourage increased responsibility on the part of the individual for his or her health; (2) community prevention programs; (3) increased productivity through efficient use of auxiliaries and equipment; (4) certain structural factors illustrated by Health Maintenance Organizations, particularly peer review and methods of reimbursing providers which create incentives for efficient dental practice; and (5) prepayment and review of benefits encouraging early dental care. Last, it is noted that care must be taken in designing and administering cost containment programs to avoid dysfunctional side effects such as reductions in access to services.