From the U.S. Government Accountability Office, www.gao.gov Transcript for: Dental Services Coverage, Payment, and Fees Description: Audio interview by GAO staff with Katherine Iritani, Director, Health Care Related GAO Work: GAO-13-754 Dental Services: Information on Coverage, Payments, and Fee Variation Released: September 2013 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's September 2013. High rates of dental disease remain prevalent across the nation, especially in vulnerable and underserved populations. A team led by Katherine Iritani, a director in GAO's Health Care team, recently reviewed dental service coverage, access, and fees. GAO's Sarah Kaczmarek sat down with Katherine to talk about what they found. [ Sarah Kaczmarek: ] You looked at trends in dental coverage. Do more Americans have coverage today than they did in the mid '90s? [ Katherine Iritani: ] Unfortunately, Sarah, not much has changed in this arena. Most people know that they need to go to the dentist often. Having dental coverage is strongly associated with the use of dental services. Americans often say that the cost of dental care and the lack of dental coverage are reasons they don't get needed dental care. In fact, in national surveys about 4 in 10 adults reported that they had not seen a dentist even though they had tooth or mouth problems because they didn't have dental coverage or they couldn't afford the out-of-pocket cost. In 1996 it was around 62 percent of Americans reporting they had dental coverage. In 2010 this was around 63 percent. [ Sarah Kaczmarek: ] Well, given that the trends have stayed relatively the same, what are the out-of-pocket costs for dental services, and how have those changed over time? [ Katherine Iritani: ] The out-of-pocket costs for dental services appear to be going up. Of course, this depends on whether or not one has dental insurance. For those who reported having private dental insurance, the average annual out-of-pocket cost was nearly $300 in 2010. This was up from around $240 in 1996 after adjusting for inflation. That's about a 20 percent increase. For those without insurance, inflation-adjusted out-of-pocket costs in 2010 were over $500 compared to not quite 400 in 1996. [ Sarah Kaczmarek: ] Well, given that, how much are dentists charging for their services? [ Katherine Iritani: ] That's a good question. Wouldn't many consumers want to know exactly that? It can be extremely difficult for people to figure out how much dentists in their area charge for basic dental services such as exams or fillings. Fees aren't always transparent. What we learned in looking at insurance claims was that dental fees for common procedures vary widely across the country. For example, teeth cleaning for an adult in Nashville might cost $76--the typical amount charged by local dentists there--whereas a typical fee for the same procedure in New York was $155. Of course, fee variation across the country is to be expected to some extent, given differing input prices, such as the cost of labor in the area. But we also found pretty significant variation even within the same communities for common procedures. In Miami, for example, half of the dentists' fees for an oral exam were $62 or less, but 5 percent of the dentists' fees were $150 or more for the same exam--same type of exam. [ Sarah Kaczmarek: ] If someone can't afford these prices, what options do they have? [ Katherine Iritani: ] Unfortunately, the option that many people choose is to forego preventive dental care and waiting until they have a problem, which can be even more costly when it comes to treatment. Only about 4 in 10 Americans surveyed in national surveys reported that they had seen the dentist in the prior year. So, federally-funded health centers may offer an affordable dental care option. Health centers are required to offer sliding scale discounts, depending on one's income. And the discounts can be substantial--up to 100 percent of the fee for example, in which the case the individual would pay nothing. Most people who receive services from health centers actually receive some sort of discount for what they receive. [ Sarah Kaczmarek: ] Oral healthcare is something that affects everyone, so what's the bottom line here? [ Katherine Iritani: ] The bottom line is that as a nation we aren't where we want to be in ensuring that Americans have access to affordable dental care and have good oral health. The federal government has done a lot in recent years to bring attention to dental access issues, particularly for the low-income children that are served by the Medicaid and children's health insurance program. But more needs to be done. Access barriers are complex, and figuring out how to ensure that Americans have access to affordable dental care is a challenge that's gonna take the concerted efforts of everyone--the federal government, state, insurers, providers, consumers. [ Background Music ] [ Narrator: ] To learn more visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the Congressional Watchdog, the U.S. Government Accountability Office.