Utilization and Expenditures for Dental Services Among the Elderly

Utilization and Expenditures for Dental Services Among the Elderly

Larry MeskinJack Brown

Santa Fe Group, June 28, 2007

Total Population281,000,000

Institutionalized4,000,000 (1.4%)

Community Living277,000,000 (98.6%)

(8.7 Severe MedicalCo-morbidities24,500,000 %)

Generally Healthy252,500,000 (89.9%)

EconomicallyDisadvantaged

43,000,000 (15.3%)

Not EconomicallyDisadvantaged

209,500,000 (74.6%)

Remote3,000,000 (1.1%)

Non-remote40,000,000 (14.2%)

Remote10,500,000 (3.7%)

Non-remote199,000,000 (70.8%)

Note: The percentages are of the total population.

Populations with Significant Barriers to Populations with Significant Barriers to Access to Dental Care are in Red BoxesAccess to Dental Care are in Red BoxesPopulations with Significant Barriers to Populations with Significant Barriers to Access to Dental Care are in Red BoxesAccess to Dental Care are in Red Boxes

Size of the Elderly PopulationSize of the Elderly Population

U.S. Elderly by Age, 1900-2030 (in Millions) U.S. Elderly by Age, 1900-2030 (in Millions)

8.4 11.0 12.4 15.6 18.1 18.4 21.3

31.837.9

3.34.6

6.17.7

10.1 12.412.9

15.6

23.9

3.14.2

6.1

7.3

9.6

0

10

20

30

40

50

60

70

80

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030

85+

75-84

65-74

65+ in the United States, 2005, U.S. Depts. of HHS & Commerce

3.1 3.9 4.96.6

9.012.3

16.620.1

25.6

31.235.0

40.2

54.6

71.5

Number (in Millions) & Percent of Total Number (in Millions) & Percent of Total Population By Race/Ethnicity, 2000 & 2030Population By Race/Ethnicity, 2000 & 2030Number (in Millions) & Percent of Total Number (in Millions) & Percent of Total Population By Race/Ethnicity, 2000 & 2030Population By Race/Ethnicity, 2000 & 2030

195.769.3%

33.111.7%

35.612.6%

10.73.8%

7.12.5%

43.912.1%

14.84.1%

22.66.2%

73.120.1%

209.257.5%

White-NH Black-NH All Other Races Asian Hispanic (Any Race)

2000 2030

Number (in Millions) & Percent of Total Number (in Millions) & Percent of Total Elderly By Race/Ethnicity, 2000 & 2030Elderly By Race/Ethnicity, 2000 & 2030Number (in Millions) & Percent of Total Number (in Millions) & Percent of Total Elderly By Race/Ethnicity, 2000 & 2030Elderly By Race/Ethnicity, 2000 & 2030

2.88.0%

0.82.3%

1.85.1% 0.4

1.1%

29.383.5%

6.89.5%

1.42.0%

3.75.2%

7.810.9%

51.772.4%

White-NH Black-NH All Other Races Asian Hispanic (Any Race)

2000 2030

Economic Status of the ElderlyEconomic Status of the Elderly

Percent of Elderly Below Federal Poverty Percent of Elderly Below Federal Poverty Level, Gender and Race/Ethnicity, 2003Level, Gender and Race/Ethnicity, 2003Percent of Elderly Below Federal Poverty Percent of Elderly Below Federal Poverty Level, Gender and Race/Ethnicity, 2003Level, Gender and Race/Ethnicity, 2003

12.3

17.7

5.4

7.3

21.7

16.0

27.4

10.0

12.5

16.6

0 5 10 15 20 25 30

Hispanic (Any Race)

Asian

Black

White-NH

Total Women

Men

U.S. Census Bureau

Net Worth With and Without Home Net Worth With and Without Home Equity, by Age, 2000Equity, by Age, 2000Net Worth With and Without Home Net Worth With and Without Home Equity, by Age, 2000Equity, by Age, 2000

65-69 70-74 75+

Overall Median

Median Net Worth $114,050 $120,000 $100,100

Excluding Home Equity $27,588 $31,400 $19,025

Bottom Quintile

Median Net Worth $32,000 $43,230 $46,266


Top Quintile

Median Net Worth $449,800 $452,992 $569,000


U.S. Census Bureau

General Health and Living Arrangements Among the Elderly

Living Arrangements of the Non-Institutionized Elderly, by Race/Ethnicity and Gender, 2000Living Arrangements of the Non-Institutionized Elderly, by Race/Ethnicity and Gender, 2000

71.2

55.6

68.5

68.7

7.1

6.5

22.5

14.4

18.8

29.5

8.3

12.0

3.0

4.3

0.5

4.7

0% 20% 40% 60% 80% 100%

White-NH

Black

Asian

Hispanic(Any Race)

Men

42.9

25.4

42.6

39.9

13.6

33.5

35.8

36.0

41.8

39.0

19.4

21.9

1.7

2.1

2.2

4.7

0% 20% 40% 60% 80% 100%

White-NH

Black

Asian

Hispanic(Any Race)

Women

Spouse Relatives Non-relatives AloneLiving with

Number and Percent of Elderly Living in Nursing Homes, 1990 & 2000Number and Percent of Elderly Living in Nursing Homes, 1990 & 2000

1990 2000

Number of Elderly 1,772,032 1,720,500

Percent of Elderly 5.7% 4.9%

Percent of U.S. Population 0.71% 0.61%

Percent of Elderly in Nursing Homes, by Percent of Elderly in Nursing Homes, by Age and Gender, 1999Age and Gender, 1999Percent of Elderly in Nursing Homes, by Percent of Elderly in Nursing Homes, by Age and Gender, 1999Age and Gender, 1999

11.7

3.1

1.0

21.1

5.1

1.1

0 5 10 15 20 25

85+

75-84

65-74

Men Women

National Health and Nutrition Examination Survey, 2004

Trends in DMFT Among the Trends in DMFT Among the ElderlyElderly

Change in DMFT by Age and Gender, 1971-74 & 1999-2004Change in DMFT by Age and Gender, 1971-74 & 1999-2004

3.4

5.2

5.9

8.0

10.0

11.8

12.5

14.6

15.4

16.7

18.1

17.9

0.2

17.4

16.5

15.6

15.7

13.7

11.7

9.0

7.3

6.0

4.3

2.8

1.2

10.6

0.31.4

20 15 10 5 0 5 10 15 20

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

Male 99-04 Male 71-74 Female 99-04 Female 71-74

3.8

7.810.5

12.9

14.514.8

15.4

15.4

15.8

16.4

17.5

18.0

18.6

1.0 1.14.3

8.7

11.1

13.7

15.4

16.7

16.516.5

17.1

17.8

17.7

19.5

18.4

Edentulism Among the ElderlyEdentulism Among the Elderly

Percent Edentulous Among Elderly (65+), by Race/Ethnicity, 1999-2004Percent Edentulous Among Elderly (65+), by Race/Ethnicity, 1999-2004

22.125.5

32.9

39.5 41.0

0

5

10

15

20

25

30

35

40

45

Mexican White-NH Black-NH Other Race Other Hisp


Percent Edentulous, by Age and Income, 1999-2004Percent Edentulous, by Age and Income, 1999-2004

27.3

45.3

25.9

36.6

5.48.8

22.0

15.4

05

101520

25303540

4550

55-64 65+

< 100% FPL 100-199% FPL 200-399% FPL 400%+ FPL


Utilization of and Expenditures for Utilization of and Expenditures for Dental Services Among the ElderlyDental Services Among the Elderly

DMFS Versus Fluoridated DMFS Versus Fluoridated Communities*Communities*

2

3

4

5

6

7

8

1967 1971 1975 1979 1983 1987 1991 1995 1999 2003

DMFS

20%

30%

40%

50%

60%

70%

80%

%Fl

Baby Boom Gen X Gen Y

* Decayed, Missing or Filled Surfaces, Children aged 5-17, NIDCR; Percent of population residing in fluoridated communities, ADA

… has been shown to be an effective decay-preventative dentifrice that can be of significant value when used as directed in a conscientiously applied program of oral hygiene and regular professional care.

Council on Scientific AffairsAmerican Dental Association

Dental Patient Visits & Percent of the Population Dental Patient Visits & Percent of the Population Who Visited the Dentist That Year Who Visited the Dentist That Year

0

100

200

300

400

500

600

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Mill

ion

s

0%

10%

20%

30%

40%

50%

60%

70%

80%

Visits % Total Pop % Pop>64

Source: Centers for Disease Control and PreventionSource: Centers for Disease Control and Prevention

Percent with a Visit to a Dentist During the Previous Year, By Age and RacePercent with a Visit to a Dentist During the Previous Year, By Age and Race

66.8

50.0

63.5

41.7

53.057.4

28.4

63.3

48.6

15.3

30.7

61.4

0

10

20

30

40

50

60

70

80

White Black Other

55-64 65-74 75-84 85+

NCHS, Health Interview Survey, 2005

Percent with a Visit to a Dentist During the Previous Year, By HispanicPercent with a Visit to a Dentist During the Previous Year, By Hispanic

66.6

45.4

60.1

49.3

56.6

27.8

46.6

32.3

0

10

20

30

40

50

60

70

Non-Hispanic Hispanic

55-64 65-74 75-84 85+


Percent with a Visit to a Dentist During the Previous Year, By IncomePercent with a Visit to a Dentist During the Previous Year, By Income

37.241.1

56.5

80.6

39.9

60.0

79.2

29.8

42.3

56.4

81.8

37.835.4

48.8

61.8

36.0

0

10

20

30

40

50

60

70

80

90

<FPL 100-199 200-399 400+

55-64 65-74 75-84 85+


Multivariate Analysis of Utilization of Dental Services by the Elderly

Percent with a Visit During the Previous Year, By Selected Factors - Dentists & PhysiciansPercent with a Visit During the Previous Year, By Selected Factors - Dentists & Physicians

Ins No No Yes Yes

Gender M M M M

Age 75-84 75-84 75-84 75-84

Inc High High High High

Educ S Coll S Coll S Coll S Coll

Race B-NH W B-NH W

Dentate Y Y NA NA

83.0 86.5 94.2 94.7

0

20

40

60

80

100

DDS1 DDS2 MD1 MD2

45.852.5

90.9 91.8

0

20

40

60

80

100

DDS1 DDS2 MD1 MD2

No No Yes Yes

M M M M

75-84 75-84 75-84 75-84

Poor Poor Poor Poor

S HS S HS S HS S HS

B-NH W B-NH W

Y Y NA NA


Ins No No Yes Yes

Gender M M M M

Age 75-84 75-84 75-84 75-84

Inc Hi Hi Hi Hi

Educ S Coll S Coll S Coll S Coll

Race W W W W

Dentate N Y NA NA

38.0

89.0 93.8 93.8

0

20

40

60

80

100

DDS1 DDS2 MD1 MD2

9.6

58.0

90.4 90.4

0

20

40

60

80

100

DDS1 DDS2 MD1 MD2

No No Yes Yes

M M M M

75-84 75-84 75-84 75-84

Poor Poor Poor Poor

S HS S HS S HS S HS

W W W W

N Y NA NA


Ins No No Yes Yes

Gender M M M M

Age 75-84 75-84 75-84 75-84

Inc Poor High Poor High

Educ No HS S Coll No HS S Coll

Race B-NH B-NH B-NH B-NH

Dentate N Y NA NA

4.5

83.090.2 94.2

0

20

40

60

80

100

DDS1 DDS2 MD1 MD2

5.9

86.5 91.1 94.7

0

20

40

60

80

100

DDS1 DDS2 MD1 MD2

No No Yes Yes

M M M M

75-84 75-84 75-84 75-84

Poor High Poor High

No HS S Coll No HS S Coll

W-NH W-NH W-NH W-NH

N Y NA NA

Types of Dental Services Received by the Elderly

Distribution of Dental Services: Distribution of Dental Services: All Ages,All Ages, 2005-06 2005-06Distribution of Dental Services: Distribution of Dental Services: All Ages,All Ages, 2005-06 2005-06

31.0%

27.8%

13.4%

5.7%

3.4%

2.7%

2.7%

2.6%

2.3%

1.9%

1.6%

1.3%

3.8%

Oral Evaluation

Prophylaxes

Resins

Amalgams

Crowns

Extractions

Fixed Prosthodontics

Analgesia and Sedation

Periodontics

Other Restorative

Other Services

Removable Prosthodontics

Endodontics

Distribution of Dental Services: Distribution of Dental Services: 65-74 Year-olds,65-74 Year-olds, 2005-06 2005-06Distribution of Dental Services: Distribution of Dental Services: 65-74 Year-olds,65-74 Year-olds, 2005-06 2005-06

28.9%

23.7%

12.0% 5.3%

1.6%

3.0%

2.6%

2.3%

5.2%

1.2%

4.9%

4.4%

4.9%

Oral Evaluation

Prophylaxes

Resins

Amalgams

Crowns

Extractions



Periodontics

Other Restorative

Other Services


Endodontics

Distribution of Dental Services: Distribution of Dental Services: Aged 75+,Aged 75+, 2005-06 2005-06Distribution of Dental Services: Distribution of Dental Services: Aged 75+,Aged 75+, 2005-06 2005-06

29.3%

25.8%

14.5%

5.6%

4.0%

2.6%

2.5%

1.9%

1.7%

2.1%

4.7%

1.8%

3.5%Oral Evaluation

Prophylaxes

Resins

Amalgams

Crowns

Extractions



Periodontics

Other Restorative

Other Services


Endodontics

Percentage of Various Services Received by Elderly, Aged 65+, 2005-2006Percentage of Various Services Received by Elderly, Aged 65+, 2005-2006

14.2%

13.3%

14.7%

14.4%

17.1%

20.2%

11.0%

14.5%

17.6%

47.1%

17.0% 14.0%

20.7%

14.8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Oral E

valuation

Prophylaxes

Resins

Am

algams

Crow

ns

Extractions

FixedP

rosthodontics

Analgesia andS

edation

Periodontics

Other R

estorative

Other S

ervices

Rem

ovableP

rosthodontics

Endodontics

All S

ervices

Percent with a Visit by Type of Procedure By High, Middle, Low Incomes, 65 + Percent with a Visit by Type of Procedure By High, Middle, Low Incomes, 65 +

83.6

81.1

21.7

23.5

9.8

9.5

15.4

86.4

75.1

26.4 16.9

13.0

13.1

11.1

61.9

26.6

13.8

18.4

16.9

15.3

74.8

0

10

20

30

40

50

60

70

80

90

100

Diagnostic Preventive RestorativeCrown/Bridge Denture Oral Surgery Other

High Middle Low

MEPS 2004

Percent with Dental Visit by Type of Procedure, All Ages and ElderlyPercent with Dental Visit by Type of Procedure, All Ages and Elderly

85.8 79.0

22.0

10.7

10.2

17.1

74.4

24.4 19.1 12.9

12.4

14.1

3.6

82.2

0

10

20

30

40

50

60

70

80

90

100

Diagnostic Preventive Restorative Crown/Bridge Denture Oral Surgery Other

All Ages 65+

MEPS 2004

Percent with a Visit by Type of Procedure Black/Hispanic 65 + -- 1996 & 2004Percent with a Visit by Type of Procedure Black/Hispanic 65 + -- 1996 & 2004

73.9

42.8

16.0 11.6

30.0 22.6 15.7

68.4

55.3

17.0 10.5

18.5

19.7 15.2

0

10

20

30

40

50

60

70

80

90

100

Diagnostic Preventive Restorative Crown/Bridge Dentures Oral Surgery Other

1996 2004

MEPS 1996 & 2004

Expenditures & Source of Payment for Expenditures & Source of Payment for Dental Services Among the ElderlyDental Services Among the Elderly

14%

13%

12%

10%

8%

5%

4%

3%

10% 21%Crowns


Resins

Prophylaxis


Oral Evaluation

Endodontics

Amalgams

Other Restorative

Other

Percentage Distribution of Expenditures, By Type of Procedure, 2005-2006 - All AgesPercentage Distribution of Expenditures, By Type of Procedure, 2005-2006 - All Ages

28.8%

23.8%12.1%

5.3%

5.2%

5.0%

4.9%

4.4%2.9%

7.7%


Crowns

Extractions

Implants

Resins


Adjunctive Services

Periodontics

Other Restorative

Other

Percent of Expenditures and Procedures, By Type of Procedure, 2005-2006 – 65+Percent of Expenditures and Procedures, By Type of Procedure, 2005-2006 – 65+

Total Real Charges (2004$) for Dental Services, By Age and Source of Payment, 1996 & 2004Total Real Charges (2004$) for Dental Services, By Age and Source of Payment, 1996 & 2004

$337 $381$469 $425

$227$281 $126

$139

$82

$61$68 $52

$48$17

$23$28

$0

$100

$200

$300

$400

$500

$600

$700

$800

1996 2004 1996 2004

Self Pay Priv Ins Pub Ins Unreimbursed

$669

$760$693 $674

55-64 65+

Medical Expenditure Panel Surveys

Documents

Utilization and Expenditures for Dental Services Among the Elderly