Preventive vs. Curative Treatment – Why are Vision and Dental Coverage (often) Separate?


    One aspect of American healthcare (and healthcare in general) is the exclusion of dental and vision services from primary offered services. Medicaid will cover dental services for all children; however, each state will determine which dental benefits adults are eligible for. Most states provide emergency dental services for adults, but a minority provide comprehensive dental care. Since there are no minimum requirements for adult dental coverage, even emergency dental services are not guaranteed depending on which state you're in. In Michigan, routine exams and cleanings are covered under the Healthy Michigan Plan. However, in Florida (my home state) Medicaid coverage for dental exams and x-rays is very limited, and services must be considered "medically necessary" to be covered for those 21 years old and older. Similarly, Medicaid vision coverage differs from state to state, with children being generally covered and no federal minimum requirements for adults.

    This is not something that is isolated to the United States. The NHS also does not guarantee free dental treatment in the UK, but rather it employs a tiered payment system depending on the type of work is being done. Additionally, the NHS only offers free sight tests to children, diabetics, those with a history of glaucoma, and those 70 years and older. Despite this, the NHS also recommends that most people (regardless of age/disease state) get their eyes checked every 2 years. 

    Clearly there is a precedent of separating dental and vision services from all other medical care. This could be because these services are typically seen as preventive care as opposed to curative care, but non-emergency curative dental procedures are also often not covered by basic health insurance plans. Additionally, dentistry has a history of being considered a different practice from medicine; even today we see separate dental and medical schools. Perhaps this separation has led to a widespread acceptance that dental and vision problems are not as medically important. I have also heard the perspective that not everyone needs glasses, so why would everyone need vision insurance. I would argue that regular eye check-ups are something that even those with perfect vision could benefit from. Near- or far-sightedness are not the only conditions that are screened for at eye exams. 

    Obviously, cost plays a huge role in why these services are not typically covered. However, there has also been a lot of debate over whether preventive care saves money in the long run compared to curative care. Arguably, most (though not all) of the services that would be offered under a dental or vision insurance plan would be preventive. Some studies that have compared preventive and curative healthcare costs have shown that the cost versus clinical benefit really depends on the disease state. Regardless of cost, I would argue that being able to prevent life-changing health issues on a broad scale would have more of a societal benefit compared to the money saved. 


References

1. Cohen JT, Neumann PJ, Weinstein MC. Does Preventive Care Save Money? Health Economics and the Presidential Candidates. N Engl J Med. 2008;358(7):661-663. doi:10.1056/NEJMp0708558

2. How much will I pay for NHS dental treatment? nhs.uk. Published November 9, 2020. Accessed February 22, 2023. https://www.nhs.uk/nhs-services/dentists/dental-costs/how-much-will-i-pay-for-nhs-dental-treatment/

3. How often can I have a free NHS sight test? nhs.uk. Published November 9, 2020. Accessed February 22, 2023. https://www.nhs.uk/nhs-services/opticians/how-often-can-i-have-a-free-nhs-eye-test/

4. Kampen IG van, Engelfriest PM, Baal PHM van. Disease Prevention: Saving Lives or Reducing Health Care Costs? PLOS ONE. 2014;9(8):e104469. doi:10.1371/journal.pone.0104469

5. Medicaid Adult Dental Benefits: An Overview. Center for Health Care Strategies. Accessed February 22, 2023. https://www.chcs.org/resource/medicaid-adult-dental-benefits-overview/

6. Teutsch SM, McCoy MA, Woodbury RB, et al. Making Eye Health a Population Health Imperative. The National Academies Press (US); 2016. Accessed February 22, 2023. https://www.ncbi.nlm.nih.gov/books/NBK402364/ 

















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