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
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
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
Excluding Home Equity $2,900 $2,885 $4,000
Top Quintile
Median Net Worth $449,800 $452,992 $569,000
Excluding Home Equity $237,925 $272,681 $414,369
U.S. Census Bureau
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
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
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
National Health and Nutrition Examination Survey, 2004
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
National Health and Nutrition Examination Survey, 2004
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+
NCHS, Health Interview Survey, 2005
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+
NCHS, Health Interview Survey, 2005
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
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 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
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 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
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
Fixed Prosthodontics
Analgesia and Sedation
Periodontics
Other Restorative
Other Services
Removable Prosthodontics
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
Fixed Prosthodontics
Analgesia and Sedation
Periodontics
Other Restorative
Other Services
Removable Prosthodontics
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
Fixed Prosthodontics
Resins
Prophylaxis
Removable Prosthodontics
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%
Removable Prosthodontics
Crowns
Extractions
Implants
Resins
Fixed Prosthodontics
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