The WDA is the voice of the profession in the state of Wisconsin representing approximately 2,900 or more than 80 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 is).  It is rare for a patient to know the actual 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 the private sector patients, the cost of dental care would increase to such a level that private pay patients would have significant trouble justifying the expenditure of their hard-earned discretionary dollars on services unless the services were of a more urgent nature.

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.

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

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 burdens of absorbing the cost-shifting that would be necessary to sustain the under-funded dental Medicaid program in Wisconsin. The burdens created by cost-shifting in the medical model have been getting increased attention and these burdens are not viewed positively by most who are involved in the discussions. Expanding the 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 THAT COULD BE ABSORBED BY THE PRIVATE SECTOR WITHOUT GOING UNDER. 

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 the 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 that are necessary in order to sustain the existence of the state’s under-funded programs. In the dental model, the 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.

In the meantime, that same government has chosen to pay the providers of that care 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 has depended on providers to either absorb the loss (which continues to become more and more difficult as rates get lower and lower) or to do the government’s job of taxing individuals to cover the costs by cost-shifting the losses to the private sector patients and/or their insurance plans.

The dental community believes the system would operate more fairly and provide better access to those to whom the government has promised care if the government would simply stand by its original promise by properly funding (on the front end) the health care programs that those in government have established. It should not be the job of health care providers to implement a government tax in order to fulfill the promises made by the government or the society as a whole. Providing quality care to the state’s enrollees is the provider’s responsibility; finding an appropriate mechanism to pay for the costs of those services is the government’s/society’s responsibility.