Academic journal article Journal of Economics and Economic Education Research

Cost-Effectiveness Analysis: Extending Dental Care Coverage to Medicare Beneficiaries

Academic journal article Journal of Economics and Economic Education Research

Cost-Effectiveness Analysis: Extending Dental Care Coverage to Medicare Beneficiaries

Article excerpt


In 2014, U.S. healthcare spending reached $3.0 trillion with projected increases to 20 percent of the GDP by the year 2020 (Centers for Medicare & Medicaid Services, 2015). With Medicare accounting for 20 percent of the total current healthcare expenditure and nearly ten thousand Americans attaining Medicare eligibility daily, the Congressional Budget Office sounded the alarm that 60 percent of the growth in healthcare spending over the next several decades will be attributable to the aging population (Congressional Budget Office, 2014). Furthermore, health policy researchers report that waste on activities that produce little if any value account for as much as one third of health care expenditures. The continual escalation of healthcare spending combined with the aging population and waste of scarce resources poses a serious threat to the sustainability of the nation's healthcare.

The government responded to both the cost and waste challenges through the enactment of the Patient Protection and Affordable Care Act (ACA). This reform is a major attempt at increasing access to healthcare services and expending preventive health programs primarily for the non-Medicare eligible population. The ACA also includes provisions to address gaps in Medicare prevention and prescription drug benefits, to test new Medicare payment and healthcare delivery models, and to control waste, fraud, and abuse in the Medicare system. Since the enactment of Medicare in 1965, numerous amendments, including the ACA, attempted to expand benefits and/or control costs. Despite the many payment, quality, and delivery system reforms throughout the years and the important role Medicare plays in providing health and economic security for beneficiaries, policy makers have never formally considered cost-effectiveness analysis (CEA) to address these challenges (Gold, Shoshanna & Siegelberg, 2007; Neumann, Rosen, & Weinstein, 2005; Pearson & Bach, 2010).

CEA informs health care decision making by assessing the gains in health relative to the costs of different health interventions. The goal is to identify ways to redirect scarce resources to achieve greater value. Despite the clear link between oral health and systemic health, Medicare has never covered preventive and restorative dental services; Essential care for older adults who face greater age-related oral health risks due to physiological changes, underlying chronic diseases, and increasing use of medications. Therefore, this paper contends that CEA should be utilized to inform ongoing and future policy discussions related to coverage decisions, cost control costs, and allocation of resources, specifically as it relates to dental coverage under Medicare to reduce health costs and improve the long-term health for older Americans.


In 2000, the U.S. Surgeon General issued a landmark report entitled "Oral Health in America: A Report of the Surgeon General," which alerted the American public to the relationship between oral health and systemic health. The report highlights that poor oral health impacts an individual's psychological and social wellbeing, leads to nutritional deficiencies, chronic pain, microbial infections, the inappropriate use of emergency rooms, and the development of chronic diseases such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes (U.S. Department of Health and Human Services, 2000). Sixteen years after the release of this report, oral health still does not receive the same importance in the establishment of health policy as systemic health and the gap in access to dental care remains. While the enactment of the ACA expands access to insurance coverage for millions of American adults under age 65, addresses gaps in Medicare preventive and prescription drug benefits, and initiates testing of new Medicare payment models, oral health is all but ignored.

Left untreated, oral diseases will not resolve itself, will profoundly impact quality of life, and will increase the risk of adverse health outcomes (Griffin, Jones, Brunson, Griffin, & Bailey, 2012). …

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