Background. Out-of-pocket costs for U.S. dental care in 1996 were $157 per person at the poverty level and $229 for people with higher incomes. This article examines out-of-pocket expenditures for dental care in HIV-infected patients who took part in the HIV Cost and Services Utilization Study (HCSUS), conducted by a consortium of private and government institutions centered at the RAND Corp.
Methods. The HCSUS used a probability sampling design. The authors used a weighted sample of 2,466 HCSUS respondents to estimate the national population of HIV-infected users of medical care. The patients were asked to report how much they had spent on their dental care in the preceding 12 months, including payments made by them, their family or their friends—but not by insurance companies—for their dental care.
Results. In 1996, 135,000 HIV-infected subjects spent $20.5 million on dental care, averaging $152 per user. Whites spent $220, African-Americans $55 and Hispanics $101. People receiving dental care from private dentists spent $232 compared with $7 spent by those who received care in AIDS clinics.
Conclusions. More than one-half of the HIV-infected users of medical care identified private dentists as their source of dental care and spent the vast majority of the $20.5 million. The remaining subjects identified public dental programs as their source of care and had low expenditures. The explanation for these low expenditures is the subsidization of public programs and the likelihood that fewer and less costly services are provided by such programs.
Practice Implications. Dentists should be aware of out-of-pocket funds spent by the HIV-infected population in private practices and public programs. Any policy change reducing public funding may result in higher out-of-pocket costs for disadvantaged groups or in increasing disparities in access to dental services.
