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.”

More Financial Barriers to Dental Care

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.

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Community Water Fluoridation

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 20.0 return on investment — $20 saved for each dollar spent.

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A related study in the issue: School-Based Dental Sealant Programs Prevent Cavities And Are Cost-Effective by Susan Griffin of the Centers for Disease Control and Prevention and coauthors.

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 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.

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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 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.

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Also of interest in the December issue: Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain by Karandeep Singh of the University of Michigan Medical School and coauthors.

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.

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