Cost of Care
School-based dental care programs around the world are usually administered by a public health service and supported with public funds. The cost of care per child can be calculated on the basis of the number of children enrolled in the program and the total costs (direct and indirect) of operating the program.
In 2011, the cost to the New Zealand government for the school dental service was US $99 per child for comprehensive preventive and restorative care. By contrast, the cost of an initial diagnostic appointment, with no treatment, by a New Zealand dentist in the private sector was US $102.
Australian studies documented that the savings from treating children in the school dental service compared with private practice ranged from 14% to 20%. In 1996, the savings in 1 state was much greater: A$265.00 (US $276.00) per child treated in private practice versus A$52.49 (US $54.62) per child treated by the school dental service. In Western Australia, the cost of care per child in 2001 was A$65.70 (US $68.36).
The estimated cost of care per child per year in Hong Kong was US $78 in 2011–2012, based on the fee charged to foreign nationals to enroll a child in the school dental service (E. C. M. Lo, personal communication, August 2012).
In 2011, the Canadian Center for Policy Alternatives analyzed the financing of the Saskatchewan school-based program of the 1980s. The report concluded that if the program existed throughout Canada today, the inflation-adjusted cost for comprehensive preventive and restorative care would be Can$176.25 (US $172.88) per child in contrast to a general dentist's fee in the private sector of more than Can$225 (US $220.70) for 1 pulpotomy and stainless steel crown. The estimated cost for such a public, school-based program using dental therapists to treat all of Canada's children aged 5 to 14 would have been Can$560 million (US $549 million), which the report indicated would be a dramatic savings over current expenditures in dental care for children.
The United States Agency for Health Care Research and Quality reported in the Medical Expenditure Panel Survey that dental expenditures in 2010 for children younger than 5 years were $223; for children aged 5 to 17 years, $308. The $308 represented a decline from the 2004 data of $310 ($365 in 2011 dollars). In 2010, Beil and Rozier reported on the average dental expenditures per child using 2004 data, based on whether or not the child had been advised to visit the dentist by their primary health care provider. The costs for children aged 2 to 5 years who had been advised to seek care was $187; for those not advised, $204. For elementary school children aged 6 to 11 years who were advised to seek care, the costs were $504 per child, compared with $397 for those not advised to do so. For comparison to the previously cited international elementary school programs, in 2011 dollars these costs were $593 and $466, respectively.