Would any of us, given the chance, trade a few pennies of healthcare costs for a dollar of future healthcare savings and better health outcomes? The answer is so obvious that the question hardly needs to be asked.
For far too long, oral health has not received the attention it deserves. In part, this reflects an educational system in which dental training is separate from medical training, which has perpetuated the notion that somehow the mouth is not a part of the body. The separate provision of medical and dental care also reflects economic dynamics, especially in the United States.
But we have reason to believe the tide is about to turn. New research – driven more by economics than medicine – strongly suggests that money spent on oral care more than pays for itself by lowering the total cost of care for those suffering from chronic disease. What’s more, the chronically ill who do receive oral care also enjoy better health outcomes, according to recent research by the American Journal of Preventive Medicine (AJPM).
The team behind the study sought to “estimate the effects of periodontal therapy on medical costs and hospitalizations” among individuals with various diagnosed health conditions. These included type 2 diabetes, coronary artery disease, cerebral vascular disease, rheumatoid arthritis and pregnancy. The researchers analysed insurance-claims data from 338,891 individuals in the US who had both medical and dental insurance coverage between 2011 and 2013.
The results are eye-opening – we might even say jaw-dropping. According to the study, “statistically significant reductions” in both the total allowed medical costs and the number of hospitalizations during the period of 2005 through 2009 were found for type 2 diabetes, coronary artery disease, cerebral vascular disease and pregnancy, for which costs were lower by 40.2%, 40.9%, 10.7%, and 73.7%, respectively. The numbers for the drop in hospital admissions were comparable. (The study found no effect relative to rheumatoid arthritis.)
The researchers conclude that “these cost-based results provide new, independent and potentially valuable evidence that simple, non-invasive periodontal therapy may improve health outcomes in pregnancy and other systemic conditions”.
The reasons for this should surprise no one. As the study notes, periodontal disease is a “chronic inflammatory disease” that, left untreated, can lead to a host of other issues, such as infections that complicate the condition of those with chronic disease. With respect to economics, the study also notes that “simple periodontal treatment, as examined here, comes at modest cost and minimal risk”.
This brings us back to where we started: the cost-benefit trade-off of increased oral care. Here at the World Economic Forum we are attuned to this issue, especially when it comes to the enormous burden placed on society by chronic disease. Each year, the Forum carries out a survey of its members and releases the results in its Global Risks report. Chronic disease routinely crops up among the risks. As the Forum noted in its 2014 report, an “increasing burden of illness and long-term costs of treatment threaten recent societal gains in life expectancy and quality while overburdening strained economies”.
The Forum has even gone so far as to put a number on it – $47 trillion. That is the potential global economic impact of the five leading non-communicable diseases (NCDs) – cardiovascular disease, chronic respiratory disease, cancer, diabetes and mental ill-health – over the next 20 years, according to a 2011 study released by the Forum in conjunction with the Harvard School of Public Health.
The AJPM study suggests that increased frequency of periodontal treatment – which is safe, simple and relatively inexpensive – more than pays for itself in reducing total healthcare costs and could, over time, significantly reduce the crushing cost burden of ill-health and its related medical complications.
So how do we persuade policy-makers, and people, to embrace this opportunity?
The Harvard School of Dental Medicine is planning to host a symposium in October 2014, titled Put Your Money Where Your Mouth Is: The Economic Imperative of Oral Health. It will bring together thinkers from across Harvard, insurance company executives and the researchers behind the AJPM study to argue the economic case for oral health, as never before. (In the interests of full disclosure, I will be among the participants.) We will hear from business leaders, insurers, healthcare providers, economists and public health experts about the new analyses suggesting that the humble toothbrush might be among the most overlooked and underappreciated tools we can deploy to bend the cost curve of chronic disease.
If we had to choose, wouldn’t we rather spend dimes at the dentist instead of dollars at the hospital? The question answers itself.
Author: Stanley M. Bergman is chairman of the board and chief executive officer at Henry Schein, Inc., and governor of Global Health and Healthcare at the World Economic Forum.
Image: Toothbrushes at the Vesnova institution, near Minsk, June 6, 2013. REUTERS/Vasily Fedosenko