Think Tank: U.S. Dental Access Not So Great

Even well-off U.S. residents report having more trouble getting affordable dental care than low-income residents of Germany and the Netherlands, and low-income U.S. residents say they have a much harder time getting care.

Researchers at the Commonwealth Fund, New York, have included that data in a new system that lets users compare health data from 7 wealthy countries -- Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States.

The researchers created the database using answers to an international survey they conducted in 2007.

Topics include indicators for health care quality and health care access.

One care access indicator is based on responses to a question about whether survey participants had needed dental care in the previous 2 years but had not seen a dentist because of worries about cost.

The United States often comes in last on indicators relating to general medical care access, in part because, in other wealthy countries, the percentage of residents who have some kind of public or private health coverage is much higher.

The other wealthy countries either have universal government-run health plans or, in countries such as the Netherlands, residents have a combination of private health plans and government plans that reach most residents without private coverage.

The situation in dental care access is different, because some countries, such as New Zealand, have universal medical insurance programs but no universal dental insurance programs. In countries with universal dental insurance programs or inexpensive private programs, deductibles, coinsurance amounts and co-payment rates may still affect access levels for low-income residents.

The Commonwealth Fund researchers looked at dental care access responses for survey participants with below-average incomes and participants with above-average incomes.

In Germany, for example, where the government-mandated health insurance plans all provide basic dental coverage, participants with above-

average incomes and below-average incomes still reported different levels of difficulties with getting care.

The difficulty rate was only 5% for German participants with above-average incomes and 11% for participants with below-average incomes.

In the Netherlands, where residents must pay extra for dental insurance for adults, 4% of the higher-income participants and 6% of the lower-income participants reported problems with dental care access.

In the United States, 21% of the higher-income participants and 49% of the lower-income participants said they had trouble with access.

The lower U.S. participants ranked last in terms of access. In New Zealand, the country that ranked sixth in terms of access for lower-income residents, 46% of the lower-income participants reported access problems.

Higher-income U.S. residents were less likely to report access problems than residents of Australia and New Zealand, but, in addition to having more access problems than residents of Germany and the Netherlands, they were also more likely to report access problems than residents of Canada and the United Kingdom.

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