The Big Picture

Economics

Background

Expenditures for dental services showed a greater than 50-fold increase between 1960 and 2012, mostly driven by a higher proportion of the population seeking care and increased dental service costs. However, between 2007 and 2012, dental expenditures grew only at a rate of 2.8% annually. The US Centers for Medicare and Medicaid Services estimates that dental expenditures will rise by an addition 53% by 2020, with annual increases averaging 6.7%. This view is regarded as overly optimistic,

Sources of Expenditures

Although government sources for dental service payments were nearly nonexistent 50 years ago, they have grown slowly and now account for 9.6% of all expenditures. In contrast, 55.4% of all physician and clinical services are covered by government sources. Other sources for dental expenditures are private insurance and out-of-pocket expenses, which account for 48.1% and 42.3%, respectively.

For the future, the US Centers for Medicare and Medicaid Services estimates that insurance payments will

Inflation

Inflation increased by about 114% between 1984 and 2014, which translates to a doubling of the cost of dental goods and services over this period (Fig 3). Durable goods costs have risen just 76% over this time period, reflecting the ability to import goods at relatively low prices.

Dental service costs have risen by 279% since 1985, whereas medical service costs have risen just 212%. Reasons for these cost increases include increased requirements for infection control protocols and increased

Dental Income

General dentists’ real income has increased by about 50% since 1981, but most of the increase was up to 2005 (Fig 4). Since that time, real income increases have not kept pace with inflation, falling 16.2% for general dentists. Dental specialists’ real income increased 89.1% between 1981 and 2007, but between 2007 and 2013 it fell 21.0%. Dental incomes are likely to have no increase if expenditures for dental services don’t grow and the number of practicing dentists increases.