Financing and reimbursement of elders' oral health care: lessons from the present, opportunities for the future.
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This article describes current financing and reimbursement for elders' oral health care and presents innovative options and opportunities for the future. Current health and dental care financing data from the Centers for Medicare and Medicaid Services and Agency for Health Care Research and Quality are reviewed. Existing and potential reimbursement options for the future are presented. Options for future financing and reimbursement include extending dental insurance into retirement, inclusion of oral health care into existing comprehensive health care plans, developing retiree plans for selected, well-defined (by the sponsor) groups of retirees, pre-paying dental care during employment, development of an Elders Health Insurance Program for the poor and near poor, and developing optional "Part D (for Dental)" plans within the Medicare program. Given the absence of universal oral health insurance, a mix of financing options and reimbursement schema will be required to cover the costs of oral health care and eliminate disparities in oral health access and outcomes for the growing elderly population. (+info)
Prepaid dental annuity for retirement.
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A number of different groups exist within those ages sixty-five and up. They have varying dental needs and resources with which to treat those needs. This program is targeted at those individuals who are moving toward age sixty-five, currently have dental insurance through their employer, and desire to prepay their dental insurance premiums for the remainder of their lives while preserving any unused portion of their prepaid amount for their heirs. It does so by creating a "dental annuity" instrument with minimal administrative burden. (+info)
Expansion of dental benefits under the Medicare Advantage program.
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Uninsured older adults are twice as likely to not receive needed dental care as their insured counterparts. Yet, nearly one-third of older adults have untreated dental caries, and older adults are more likely to have complete tooth loss, periodontal disease, and oral cancer. Moreover, persons sixty-five and older had the lowest percentage of individuals with dental insurance and the highest average out-of-pocket expenses of all persons with a dental visit in 2000. Given that retiree health benefits for large companies have declined from 66 percent in 1988 to 38 percent in 2003, it is unlikely that the private sector will increase funding for dental benefits for the elderly. However, some Medicare managed care plans already cover either preventive or comprehensive dental benefits. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created incentives for Medicare managed care plans to offer beneficiaries additional benefits, including dental. The First Seniority Dental Plan, described in this article, demonstrates that it is possible to create a dental plan that is affordable for the HMO, reimburses providers at reasonable rates, provides a reduction in costs to Medicare beneficiaries, and may present a method to expand dental benefits for elders of the future. (+info)
Access to oral health care for elders: mere words or action?
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For many years, the health care community has used a silo approach to oral health, with little exception, treating the oral cavity as the sole province of the dentist, with no interaction with the medical profession. However, as research shows links between periodontal disease and diabetes, stroke, heart disease, and peripheral arterial disease, it seems clear that the silo approach to oral health should be replaced with a new paradigm-that of including dental care in comprehensive medical benefits. Retirees who have limited or no access to traditional employer-based dental benefits should be among the early beneficiaries of this paradigm shift. The federal government should consider social insurance mechanisms to ensure that retirees have access to oral health care. (+info)
Use of dental services by immigrant Canadians.
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Although the health status and health behaviour of foreign-born residents of Canada have been well documented, little is known about their use of dental services. The authors, hypothesizing that foreign-born people would have lower utilization of dental care services than native-born Canadians, undertook this study to identify the factors associated with dental visits by Canadians aged 12 years and older and to compare the use of dental services by foreign-born and native-born populations. According to data derived from Statistics Canada"s 1996-97 National Population Health Survey, foreign-born people were somewhat more likely than native-born Canadians to have visited a dentist within the previous year. Higher levels of education, greater income adequacy, and the presence of dental insurance were associated with greater use of dental services, whereas increasing age was associated with lower use. Although immigrants reported greater use of dental services than native-born Canadians, a variety of barriers to care may be present in this population. (+info)
Why do we need an oral health care policy in Canada?
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Although health care is a right of citizenship, severe inequities in oral health and access to care persist. This paper provides information on the financing, organization and delivery of oral health services in Canada. It concludes that dental care has largely fallen out of consideration as health care. The increasing costs of dental insurance and disparities in oral health and access to care threaten the system"s sustainability. The legislation that allows the insured to receive tax-free care and requires all taxpayers to subsidize that expenditure is socially unjust. Unless an alternative direction is taken, dentistry will lose its relevance as a profession working for the public good and this will be followed by further erosion of public support for dental education and research. However, never before have we had the opportunity presented by high levels of oral health, the extensive resources already allocated to oral health care, plus the support of other organizations to allow us to consider what else we might do. One of the first steps would be to establish new models for the delivery of preventive measures and care that reach out to those who do not now enjoy access. (+info)
Oral health care in Canada--a view from the trenches.
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PURPOSE: Concern is increasing over the effect of lack of access to oral health care on the oral health, and hence general health, of disadvantaged groups. In preparation for a national symposium on this issue, key informants across Canada were canvassed for their perceptions of oral health services and their recommendations for improving oral health care delivery. This paper reports the results of that survey. METHOD: A questionnaire was constructed to address problems facing agencies with responsibility for meeting the oral health care needs of people receiving government assistance, the underhoused and the working poor. The survey was sent to 200 agencies, government and professional organizations. Data from the returned questionnaires were entered into a Statistical Package for the Social Sciences database and analyzed. Responses from Ontario were compared with those from the rest of Canada, those from government organizations were compared with others and results were examined by cultural nature of clients and by type of organization. RESULTS: In assessing the positive aspects of oral health care, 84% of respondents agreed that public programs were useful and 81% felt that dentists offer good care. However, 77% disagreed that preventive care is accessible and that access to dentists and dental specialists is easy. More Ontarians than others thought that there are few alternative settings for care delivery (95% vs. 83%) and that the poor feel unwelcome in dental offices (83% vs. 70%). The issues most commonly identified were the need for alternative delivery sites, such as community health centres where service delivery could be affordable, accountable and sustainable; the need for oral health to be recognized as part of general health; regulatory issues (e.g., expanding practice opportunities for non-dentist oral health care providers and removing restrictions on other dental health professionals in providing basic care to the financially challenged); and training. DISCUSSION: The survey helped to identify access and care issues across the country. There was considerable agreement that lack of access to dental care services is an important detriment to the oral and general health of many Canadians. Respondents believe that dental health is isolated from general health. (+info)
An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population.
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BACKGROUND: Chronic medical conditions have been associated with periodontal disease. This study examined if periodontal treatment can contribute to changes in overall risk and medical expenditures for three chronic conditions [Diabetes Mellitus (DM), Coronary Artery Disease (CAD), and Cerebrovascular Disease (CVD)]. METHODS: 116,306 enrollees participating in a preferred provider organization (PPO) insurance plan with continuous dental and medical coverage between January 1, 2001 and December 30, 2002, exhibiting one of three chronic conditions (DM, CAD, or CVD) were examined. This study was a population-based retrospective cohort study. Aggregate costs for medical services were used as a proxy for overall disease burden. The cost for medical care was measured in Per Member Per Month (PMPM) dollars by aggregating all medical expenditures by diagnoses that corresponded to the International Classification of Diseases, 9th Edition, (ICD-9) codebook. To control for differences in the overall disease burden of each group, a previously calculated retrospective risk score utilizing Symmetry Health Data Systems, Inc. Episode Risk Groups (ERGs) were utilized for DM, CAD or CVD diagnosis groups within distinct dental services groups including; periodontal treatment (periodontitis or gingivitis), dental maintenance services (DMS), other dental services, or to a no dental services group. The differences between group means were tested for statistical significance using log-transformed values of the individual total paid amounts. RESULTS: The DM, CAD and CVD condition groups who received periodontitis treatment incurred significantly higher PMPM medical costs than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). DM, CAD, and CVD condition groups who received periodontitis treatment had significantly lower retrospective risk scores (ERGs) than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). CONCLUSION: This two-year retrospective examination of a large insurance company database revealed a possible association between periodontal treatment and PMPM medical costs. The findings suggest that periodontitis treatment (a proxy for the presence of periodontitis) has an impact on the PMPM medical costs for the three chronic conditions (DM, CAD, and CVD). Additional studies are indicated to examine if this relationship is maintained after adjusting for confounding factors such as smoking and SES. (+info)