Public dental expenditures and dental visits among children in the U.S., 1996-2004

Abstract

Objectives: Congress created the State Children's Health Insurance Program (SCHIP) in 1997 as an expansion of the Medicaid program to provide health insurance to children whose family income is above the Medicaid eligibility standards-generally up to 200% of the federal poverty level (FPL). This article examines changes in the utilization of dental services during a period of increasing public funding of dental services.

Methods: Public dental expenditure estimates came from the Centers for Medicare & Medicaid Services (CMS), and a breakdown of these expenditures by patient age and income level was based on the Medical Expenditure Panel Survey (MEPS).

Results: According to CMS, funding for dental SCHIP and dental SCHIP expansion grew from $0 prior to 1998 to $517 million in 2004. According to the MEPS, between 1996 and 2004 there was an increase in the number and percent of children 2 to 20 years of age who reported a dental visit during the past year. These increases were most notable among children in the 100% to 200% FPL category. Approximately 900,000 more children in this income group visited a dentist in 2003-2004 than in 1996-1997. Children in this income group reported an increase in the amount of mean dental charges paid for by Medicaid and a real increase in mean dental charges per patient from $217 to $310.

Conclusions: Recent increases in the public funding of dental services targeted to children in the 100% to 200% FPL category were related to increased utilization of dental services among these children from 1996 to 2004.

Figure 1

Trends in the public funding of dental services, 1996 2005^{a a}In 2004 U.S. dollars SCHIP = State Children's Health Insurance Program

Figure 2

Total public funding (nominal) of dental services: CMS vs. MEPS CMS = Centers for Medicare & Medicaid Services MEPS = Medical Expenditure Panel Survey

Figure 3

Medicaid funding of dental services (nominal) for children vs. adults, 1996–2004 MEPS^{a a}2000 data not included. MEPS = Medical Expenditure Panel Survey

Figure 4

Real^a Medicaid dental expenditures for children aged 0 to 20 years by family income level, 1996–2004 MEPS^{b a}In 2004 U.S. dollars ^b2000 data not included. FPL = federal poverty level MEPS = Medical Expenditure Panel Survey

Figure 5

Per-patient mean real^a annual dental expenditure by sources of funding for children aged 2 to 20 years, by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS (orthodontic services removed) ^aIn 2004 U.S. dollars MEPS = Medical Expenditure Panel Survey FPL = federal poverty level

Figure 6

Change in real^a mean annual dental charges per patient for children aged 2 to 20 years, by family income level, 1996–1997 MEPS vs. 2003–2004 MEPS (orthodontic services removed)^{b a}In 2004 U.S. dollars ^bExpenditures represent the fully established charges for care and do not reflect actual payments for services. MEPS = Medical Expenditure Panel Survey FPL = federal poverty level