Many advocacy groups, the state Department of Health Services (DHS) and state legislators have asked the WDA why dentists do not treat all people in need of dental care and cost-shift the losses on to private-sector patients as is done in medicine. 

The WDA is the voice of the profession in Wisconsin representing approximately 2,900 or some 82 percent of all licensed dentists in Wisconsin.  As such, we are the most appropriate entity to provide an explanation for why dentists don’t cost-shift the burdens of an under-funded state Medicaid program on to private-pay patients.  

1. DENTISTRY IS DEPENDENT ON THE DISCRETIONARY EXPENDITURES OF PATIENTS.

Unless in acute pain, the care being sought by most dental patients is not what patients would consider "urgent" or life-threatening. Many dental patients don't have dental insurance, so their dental care expenditures are truly out-of-pocket. Those who do have dental insurance often pay co-pays or deductibles and are usually very aware of the actual costs of the procedures being performed.

This is not true in the medical model: patients perceive medical care as more urgent and life-threatening in nature and medical patients are often not the payers for the care they receive (their employer or their insurance plan pays).  It is rare for a patient to know the actual medical charges applied to his plan or the costs of the services performed. 

If dentists DID cost-shift the under-funded Medicaid program on to the backs of private-sector patients, the cost of dental care would increase to such a level that private-pay patients would have significant trouble justifying spending their hard-earned discretionary dollars on any but urgent services.

This would lead to:

1. The delay of routine restorative and preventive dental care for the vast majority of private-sector patients.
2. A decrease in the number of private-sector patients to whom the costs for the under-funded Medicaid program could be shifted.

This would result in a negative spiraling effect where more private-pay patients (a high percentage of whom are elderly) would delay dental care to avoid the cost-shifting. Eventually, the system would collapse because it could not successfully sustain itself if dependent only on the payments from private-pay patients in need of emergency dental services and/or private-pay patients with unlimited discretionary incomes. 

The medical model includes the prevalence of health insurance payment/coverage (which disconnects most purchasers from health care costs).

This puts medicine and dentistry in very different situations as viewed by private-pay patients. Private-pay dental patients would notice more quickly and would defer care more frequently if they were faced with the burden of absorbing the cost-shifting necessary to sustain the under-funded dental Medicaid program in Wisconsin. Cost-shifting burdens in the medical model have been getting increased attention and are not viewed positively by most who are involved in the discussions. Expanding cost-shifting into dentistry will worsen, not improve, the current situation. 

 

2. DENTISTRY BASICALLY REMAINS A PROFESSION OF SMALL BUSINESSES, WHICH MAKES IT MORE DIFFICULT FOR THE OWNER TO CALCULATE THE COST-SHIFTING NEEDING TO BE ABSORBED BY THE PRIVATE-SECTOR TO PREVENT GOING UNDER FINANCAILLY. 

There is no comprehensive system of “free care” in Wisconsin - in the medical model, a “hidden tax” is implemented by the hospitals and clinics in their attempt to collect the costs of absorbing enrollees from the state’s under-funded Medicaid program.  This “hidden tax” essentially increases health care insurance costs for the rest of us (including dentists who are largely self-employed and small business owners). This will eventually decrease the pool of private-pay patients below the threshold numbers necessary to sustain the existence of the state’s under-funded programs. Dental Medicaid patients experience a lack of access, because dentists place tighter limits on their participation in the state’s under-funded program or they choose not to participate at all and pick other (less-regulated) ways to provide charity care to patients in need.

3. IN THE LARGER PICTURE, THE GOVERNMENT HAS DECIDED THE PROVISION OF HEALTH CARE (INCLUDING DENTAL) TO THOSE OF LOW-INCOME IS A WORTHY GOAL.

Meanwhile, that same government has chosen to pay care providers substantially less than the costs of services being provided.

Instead of openly paying providers for the costs of these services on an up-front basis, the government depends on providers to either absorb the loss (which continues to become increasingly difficult as rates go lower) or to do the government’s job of taxing individuals to cover the costs by cost-shifting losses to the private-sector patients and/or their dental insurance plans.

The dental community believes the system would operate more fairly and provide better access to those individuals the government has promised care if the government would simply stand by its original promise and properly fund up front the health care programs government policy-makers have established. It should not be the job of health care providers to implement a hidden tax to fulfill promises made by the government or society as a whole. Providing quality care to the state’s enrollees is dentists' responsibility; finding an appropriate mechanism to pay for those services is the government’s/society’s responsibility.