Apart from lacking insurance coverage to pay for health care costs, a related concern is that although some patients may be able meet such expenses, they reside in locations marked by serious health personnel shortages. Along with mental health services, dentistry represents that deficiency all too well. An inability to obtain dental care can lead to serious health problems that will result in more expensive interventions at a later time. According to the Health Resources and Services Administration (HRSA), 70 million individuals live in areas with a shortage of dental providers. Access especially is limited for those who receive their dental coverage through Medicaid, because it is estimated by the American Dental Association that approximately only 38% or about 75,000 of the 200,000 licensed dentists in the U.S. accepted that form of insurance.
A challenge for dentistry is to expand the size of its health care team. A positive development is the inclusion of dental therapists, a group of licensed providers that work under the supervision of dentists to provide routine care involving dental exams and fillings. A problem is that they are authorized to work in only 13 states, but current efforts to expand their numbers in other states will make it possible to treat larger numbers of patients in different settings that include private practices and nursing homes. Higher education institutions have an important role to play in producing greater numbers of these essential practitioners.
National Health Spending
A decline in federal government spending led to more modest growth in health care expenditures in 2021, according to figures released in December 2022 by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). The 2021 National Health Expenditures (NHE) Report found that U.S. health care spending grew 2.7% to reach $4.3 trillion in 2021, slower than the increase of 10.3% in 2020. The slowdown was driven by a 3.5% decline in federal government expenditures for health care that followed strong growth in 2020 due to the COVID-19 pandemic response. This decline more than offset the impact of greater use of health care goods and services and increased insurance coverage in 2021. In 2021, the federal government and households accounted for the largest shares of national health spending (34% and 27%, respectively), followed by private businesses (17%), state and local governments (15%), and other private revenues (7%).
Health spending by major funds sources was as follows: Private Health Insurance (28% share) spending increased by 5.8% in 2021 to $1.2 trillion. Medicare (21% share) spending increased 8.4% to reach $900.8 billion in 2021, Medicaid (17% share) spending increased 9.2% to $734.0 billion in 2021, Out-of-Pocket (10% share) spending increased by 10.4% to $433.2 billion in 2021. Health care spending in 2021 for the largest three services—hospital care, physician and clinical services, and retail prescription drugs—was: Hospital Care (31% share) spending increased 4.4% in 2021 to reach $1.3 trillion, Physician and Clinical Services (20% share) spending increased 5.6% to $864.6 billion, Retail Prescription Drugs (9% share) spending increased 7.8% to $378.0 billion in 2021, a faster rate than in 2020 when spending increased by 3.7%. The acceleration in growth was due to an increase in the use of prescription drugs in 2021.
New Medicare-Funded Residency Slots For Hospitals In Underserved Communities
The Centers for Medicare & Medicaid Services (CMS) on January 9, 2023 took a critical step to advance health equity and access to care, awarding the first 200 of 1,000 Medicare-funded physician residency slots to enhance the health care workforce and fund additional positions in hospitals serving underserved communities. Approximately three-quarters of the new positions will be for primary care and mental health specialties. The Fiscal Year 2022 Inpatient Prospective Payment System (IPPS) final rule established policies to implement new Medicare-funded physician residency slots to qualifying hospitals authorized by the Consolidated Appropriations Act, 2021, phasing in 200 slots per year over five years. In allocating these new residency slots, CMS prioritized hospitals with training programs in geographic areas demonstrating the greatest need for additional providers, as determined by Health Professional Shortage Areas. The first round of 200 residency positions awarded are for 100 teaching hospitals across 30 states, the District of Columbia, and Puerto Rico. They become effective on July 1 of this year.