ADEA Policy Statement on Health Care Reform: Oral Health Care: Essential to Health Care Reform
(As approved by the 2009 ADEA House of Delegates)
As the voice of dental education, the American Dental Education
Association (ADEA),1 whose members serve as providers of
care for thousands of uninsured, underserved low-income
patients,believes that dental and allied dental educators have an
ethical obligation to promote access to oral health care. To that
end, ADEA believes that any comprehensive reform of the U.S.
healthcare system should provide universal coverage to all
Americans and access to high-quality, cost-effective oral health
care services. Health care reform must also include investments
in dental public health that improve our nation's capacity to meet
the health care needs of patients, communities, and other
Ensuring oral health is a shared responsibility of
individuals and families, the private sector, and federal, state,
and local governments. The United States spends over two trillion
dollars annually on health care,2 more than any other
nation in the world.3 Nevertheless, access to health care
is still beyond the reach of more than 47 million
Millions Lack Dental Insurance
In 2003, the U.S. surgeon general reported that the number
of Americans without dental insurance was more than 2.5 times
the number lacking medical insurance.5 Approximately 130
million adults and children are without dental coverage.6
Many individuals,particularly those who are uninsured, often delay
dental treatment until serious or acute dental emergencies occur.
The cost of caring for Americans without health insurance in
emergency rooms adds approximately $922 to the average cost of
annual premiums for employer-sponsored family coverage.7
And the cost of providing preventive dental treatment is estimated
to be ten times less than the cost of managing symptoms of dental
disease in a hospital emergency room.8
Grave Oral Health Disparities Exist
According to the U.S. surgeon general,9 dental
disease is disproportionately found among individuals with special
health care needs, with low incomes, from underrepresented
minorities, and among those who live in underserved rural, urban,
and frontier communities. Special care patients have more dental
disease, missing teeth,and difficulty in obtaining dental care than
the rest of the population. These inequities challenge us to make
adequate investments in a strong dental public health infrastructure
that extends beyond the traditional, economically driven model of
care. The current model may well serve a majority of U.S. citizens,
but it is not achieving universal coverage and equitable access to
oral health for everyone.
Enhancing Productivity and Preserving Employer-Sponsored
Dental disease significantly impacts the nation's
domestic productivity and global competitiveness. More than 51
million school hours and 164 million hours of work are lost each
year due to dental-related absences.5 More generally,
uncompensated care adversely affects American businesses as costs
are shifted to private payers. Health care costs added $1,525 to the
price of every car produced by the Big Three auto makers in
2007.10 Most workers and families receive health
insurance through employer-sponsored coverage. Changes to the health
care system should bolster rather than erode businesses' capacity to
purchase health and dental coverage for their employees. Any
proposal to reform the U.S. health care system should ensure that
the economic viability of American businesses is maintained and that
they are able to compete in the global marketplace.
Principles for Health Care Reform
Academic dental institutions are vital public trusts and
national resources. They educate the future dental workforce,
conduct dental research, inform communities of the importance and
value of good oral health, and provide oral health care services
and serve as dental homes to thousands of patients. It is within the
broad range of oral health expertise and the interests
represented by our membership that the American Dental Education
Association offers the following principles for providing access to
and coverage of affordable oral health care services in health
- The availability of
healthcare, including oral
healthcare,fulfills a fundamental
human need and is necessary for the attainment of
general health. Every American should
have access to affordable diagnostic, preventive, restorative, and
primary oral healthcare services so as to eliminate pain,
suffering, and infection. Coverage must ensure that individuals are
able to obtain needed oral health care and must provide them with
protection during a catastrophic health crisis. Oral health care
services are proven to be effective in preventing and controlling
tooth decay,11 gum infections, and pain, and can
ameliorate the outcomes of trauma. Oral health services should have
parity with other medical services within a reformed U.S. health
care system. The equitable provision of oral health care services
demands a commitment to the promotion of dental public health,
prevention,public advocacy, and the exploration and implementation
of new models of oral health care that provide care within an
integrated health care system.
- The needs of vulnerable populations have a unique
priority. Health professionals, including those
providing oral healthcare services, must individually and
collectively work to improve access to care by reducing barriers that
low-income families,minorities, remote rural populations, medically
compromised individuals, and persons with special health care needs
experience when trying to obtain needed services. New integrated
models of care that expand roles for allied dental professionals
as well as other health professionals (including family
physicians,pediatricians, geriatricians, and other primary care
providers)as team members12 may be needed to address the
complex needs of some patients. Statutory language may be needed to
clarify and expand coverage of "medically necessary" dental care
provided under Medicare to beneficiaries with serious medical
conditions in order to prevent complications and death associated
with their health condition and treatment.
- Prevention is the foundation for
ensuring general and oral
health. Prevention and wellness hold the
promise of stemming escalating costs and treating diseases at early
stages before expensive emergencies occur. Most dental diseases are
preventable, and early dental treatment is cost-effective. Preventing
and controlling dental diseases include adequate financing of
organized activities to promote and ensure dental public health
through education,applied dental research, and the administration of
programs such as water fluoridation and dental sealants. Improving
oral health by multiple preventive approaches (including
periodontal disease management) has saved more than $4 billion per
year in treatment costs.13 Prevention of dental diseases
ranks above HIV screening and influenza immunization in cost
savings.14 Children who receive preventive dental
care early in life have lifetime dental costs that are 40
percent lower than children who do not receive care.15
Oral cancer treatment costs in the earliest stages of the disease are
estimated to be 60 percent lower than those at an advanced stage of
disease.16 Every dollar invested in community water
fluoridation yields approximately $38 in savings on dental treatment
- The financial burden of ensuring coverage
including oral healthcare
coverage, should be equitably shared by all stakeholders.
Access to affordable health care services requires a strong
financial commitment that is a responsibility shared by all major
stakeholders, including individuals and families,as well as
providers, employers, private insurers, and federal,state, and
local governments. To ensure health, oral healthcare services must
be an integral component of financing and delivery systems
regardless of whether the care is provided by a public or private
insurance program or in a community or an individual setting. The
burden of uncompensated care and the cost shifting that occurs
adversely impact U.S. businesses,limit governments' capacity to
address other pressing economic and social concerns, and strain the
health care safety net to the breaking point.
- A diverse and culturally
competent workforce is necessary to meet the general
and oral health needs of our
demographically changing nation. Racial and ethnic
diversity of health professionals contributes to improved access to
care,greater patient choice and satisfaction, and enriched
educational experiences for students.18 Proposals to
reform the U.S. healthcare system should include adequate funding
for programs that are designed to increase the number of
underrepresented minorities in the health professions.This would
ensure a workforce that is prepared to meet the needs of a diverse
population that continues to expand. Academic dental institutions,
which educate and train oral health care professionals, have a
distinct responsibility to educate dental and allied dental health
professionals who are competent to care for the changing needs of
society. This responsibility includes preparing oral health care
providers to care for a racially and ethnically diverse population,
an aging population, and individuals with special needs.
- Reducing administrative costs and realigning spending
can increase quality, improve health, and create
savings for additional
reforms. Approximately$700 billion (about
a third) of U.S. health care spending is used for administrative and
operating costs or to benefit third-party payers and does not
directly impact health outcomes.19 Reducing these
administrative burdens in the delivery of health care and creating
new payment incentives that reward providers for delivering quality
care will improve health care. It also has the potential to enhance
provider participation and lower healthcare costs over time. More
dollars would then be available for reforms such as strengthening
primary care and chronic care management, increasing the supply and
availability of primary care practitioners, and reinvesting in the
training of a twenty-first-century health care workforce. Targeted
tax changes might also be used to improve efficiencies, ensure
the even distribution of healthcare, and promote efficient use of
consumers' health care dollars.
- The American Dental Education Association (ADEA)
represents all fifty-seven dental schools in the United States in
addition to 714 dental residency training programs and 577 allied
dental programs, as well as more than 12,000 faculty members who
educate and train the nearly 50,000 students and residents
attending these institutions. It is at these academic dental
institutions that future practitioners and researchers gain their
knowledge, where the majority of dental research is conducted, and
where significant dental care is provided.
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03-5303. Rockville, MD: U.S. Department of Health and Human
Services, Public Health Service, National Institutes of Health,
National Institute of Dental and Craniofacial Research, 2003.
- National Association of Dental Plans/Delta Dental
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Oakbrook, IL: National Association of Dental Plans/Delta Dental
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Babaeva L. Paying a premium: the added cost of care for the
uninsured. Washington, DC: Families U.S.A., 2005.
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Medicaid reimbursement for non-definitive pediatric dental
treatment in the emergency room versus periodic preventive care.
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Services, National Institutes of Health, National Institute of
Dental and Craniofacial Research, 2000:74""8.
- Dalmia S. Health care costs imperil big three: the
UAW's health care dreams. Wall Street Journal, July 27, 2007.
- Diagnosis and management of dental caries throughout
life. NIH Consensus Development Program, Conference Statement.
Rockville, MD: U.S. Department of Health and Human Services,
National Institutes of Health, 2001.
- Haden NK, Catalanotto FA, Alexander CJ, Bailit H,
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