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Health Affairs’ December Issue: Oral Health & More

Bethesda, MD - The December issue of Health Affairs explores the state of oral health. Editor-in-Chief Alan Weil writes that “the divide between dental care and medical care is vast, has significant consequences for patients, and is entirely of our own making.”

The December issue is supported by The California Wellness Foundation, the DentaQuest Foundation, the American Dental Education Association, the REACH Healthcare Foundation, the Washington Dental Service Foundation, the Gary and Mary West Foundation, the American Dental Association Health Policy Institute, the Pew Charitable Trusts, and the St. David’s Foundation.

For all age groups, more financial barriers to dental care than other health services.

While the Affordable Care Act (ACA) has brought about a decline in the number of nonelderly adult Americans without health insurance, a much higher share of Americans lack dental insurance. Marko Vujicic of the American Dental Association’s Health Policy Institute and coauthors examined data about financial barriers to care from the 2014 National Health Interview Survey, comparing the responses of nonelderly adults with children and seniors. According to the data, 12.8 percent of nonelderly US adults reported forgoing dental care because of cost, compared to 4.3 percent of children and 7.2 percent of seniors 65 and older. (See exhibit above) For all age groups and all categories of insurance coverage, financial barriers to dental care were more prevalent than other types of health care services. This is largely due to the fact that, within US health policy, dental care is treated differently for children, nonelderly adults, and seniors 65 and older. The authors recommend that policy makers consider reforms at the federal and state level to ease financial barriers to dental care, including rethinking the structure of dental insurance.

Community water fluoridation: a twenty-dollar return on investment.
In 2001 the Centers for Disease Control and Prevention (CDC) released a study of US community water fluoridation program costs and savings, which found that reductions in tooth decay associated with water fluoridation resulted in significant cost savings (that is, savings exceeded costs). Joan O’Connell of the Colorado School of Public Health and coauthors developed a model to update these findings using more recent information on fluoridation costs, the incidence of tooth decay, and treatment costs. According to the CDC, more than 211 million US residents had access to fluoridated water in 2013. The authors estimated the cost to fluoridate the water in that year to be $324 million, with savings due to reductions in tooth decay of $6.469 billion, meaning a twenty-fold return on investment—$20 saved for each dollar spent. As the authors observe, access to fluoridated water is not limited by social and economic circumstances once fluoridation is implemented in a community, unlike many other oral health interventions. Therefore, they recommend that such programs should be given high consideration when assessing options to improve health and reduce health disparities.

A related study in the issue:

Why many young African American adults may now have better oral health.
Healthy tooth development starts early in life—even before birth. Brandy Lipton of the Agency for Healthcare Research and Quality (AHRQ) and coauthors examined the effects of a historic expansion in Medicaid eligibility for infants and pregnant women in the 1980s and 1990s on the adult oral health of those who gained eligibility as infants. Using data from several years of Behavioral Risk Factor Surveillance System (BRFSS) surveys and a sample of adults born between 1979 and 1991, the authors found that the nearly 28-percentage-point increase in Medicaid eligibility among non-Hispanic black pregnant women and infants during this period was linked to better oral health among black young adults, with a significant decrease (about 8–10 percentage points) in the likelihood of the loss of permanent teeth. These results add to the growing literature finding later-life effects of Medicaid and Children’s Health Insurance Program (CHIP) expansions to pregnant women and children, and could merit consideration by state policy makers deciding whether to roll back maintenance of effort in Medicaid and CHIP.

DATAWATCH: The financial burdens of high-deductible plans.
The increasing prevalence of high-deductible employer-sponsored plans raises important policy questions regarding out-of-pocket spending burdens on low-income families. Salam Abdus and coauthors at the Agency for Healthcare Research and Quality (AHRQ) reviewed data from the 2011–13 Medical Expenditure Panel Surveys (MEPS) to determine the financial impact of employer-sponsored insurance by income group and deductible level. The authors noted that regardless of the deductible level, people in the low-income group (with incomes below 250 percent of the federal poverty level) were far more likely to have paid over 20 percent of their after-tax income on premiums and cost sharing, compared to those in higher-income groups. Furthermore, within the low-income group the prevalence of such burdens was greatest among adults with high-deductible plans. According to the authors, more than a quarter of adults in low-income families experienced burdens of over 20 percent when they were enrolled in high-deductible health plans.

Also of interest in the December issue:

NOTE: Check out Health Affairs’ newest web hub: From Obamacare to Trumpcare. Key health policy questions are explored for the Affordable Care Act (ACA), Medicare, Medicaid, and payment reform.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with additional Web First papers and health policy briefs published regularly at You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download monthly Narrative Matters podcasts. Tap into Health Affairs content with the iPad app.