Research issues related to oral health expenditures and financing oral health care for the aging veteran.

This article was intended to stimulate research on the financing and cost of oral health care provided to older veterans. Such research is needed as increasing costs and gaps in health care coverage have awakened federal interests in developing national health insurance plans. Although the status of oral health care benefits under such plans remains unclear, plans approaching universal coverage will likely lead The Department of Veterans Affairs (VA) to compete with private providers for patients. Oral health care may be financed as a benefit under a VA-sponsored health plan or financed directly as an appropriation to VA medical centers. This article suggests that research is needed 1) to examine different methods of payment, or rate schedules, that may be used to reimburse providers for the cost of oral health care, 2) to calculate reimbursement rates, and 3) to determine profitability by comparing reimbursement rates with estimates of production costs. The need for such research is underscored by wide variations in operating costs of dental services at different VA medical centers. The cost of oral health care services may include not only the cost of providing dental services but also possible medical care cost "offsets," because patients with better oral health may also experience better overall health status requiring fewer medical services. Finally, the literature suggests that time costs play an important role in rationing care among patients with dental insurance. Studies should be conducted in VA to determine how waiting time, cost of travel, and appointment scheduling affect the use of outpatient dental care services.