Economic impact of dental hygienists on solo dental practices

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

Professional charges not reimbursed to dentists in the U.S.: evidence from Medical Expenditure Panel Survey, 1996

OBJECTIVES

This cross-sectional study examined professional charges not paid to dentists.

METHODS

This analysis used logistic regression in SUDAAN examining the 1996 MEPS data from 12,931 adults.

RESULTS

Among people incurring dental care charges, 13.6% had more than $50 of unpaid charge (UC). The percapita UC was $53.30. Total UC was higher for highest income group [45.4% of total] compared to lowest income group [26.0%]. The percapita UC of $76.70 for low income group was significantly greater than for high income group ($47.80, P < 0.01). More Medicaid recipients (52% vs. non-recipients: 12%) incurred at least $50 in UC (P < 0.01). Adjusted odds of incurring UC were greater for those employed (OR = 1.3, 95% CI: 1.0-1.7), and for those with private insurance (OR: 1.5, CI: 1.3-1.9). Number of dental procedure types modified the association between Medicaid recipient and UC (OR = 13.6 for Medicaid recipients undergoing multiple procedure types; OR: 2.3 for Medicaid non-recipients with multiple procedure types; OR: 1.9 for Medicaid recipients receiving single dental procedure.

CONCLUSIONS

Having private insurance, being unemployed and being Medicaid insured undergoing multiple procedure were strongest predictors of UC.

Cost-benefit analysis of a worksite oral-health promotion program

This study was conducted to examine whether oral-health promotion programs provided as an occupational health service for employees were cost-beneficial for employers. The subjects were composed of 357 male workers (20-59 yr of age) who participated in oral-health promotion programs conducted at their workplaces between 1992 and 1997. The design of this study was a quasi-experimental study design in which the three programs (light: 1 visit; medium: 2-4 visits; and heavy: 5-6 visits) were compared through cost-benefit analysis conducted from the viewpoint of the employers. The programs consisted of oral-health checkups by dentists and oral-health education, including that on the proper brushing method, by dental hygienists. The costs of the program included direct costs for the payment of oral-health-care staff and for teaching materials, and indirect costs for the time for employee participation in the program (20 min/employee per visit). The accumulated dental expenses for the seven years were used to calculate benefits, which were determined, based on the differences between 0 visits and each program. The benefit/cost ratios of the three programs were -2.45, 1.46, and 0.73, respectively. These results suggest that a worksite oral-health promotion program of medium frequency is cost-beneficial for employers.

ADEA survey of clinic fees and revenue: 2003-04 academic year

The American Dental Education Association's 2003-04 Survey of Clinic Fees and Revenue obtained data by which to report, by school, clinic revenue information per student. Fifty-one of the fifty-four dental schools that had third- and fourth-year students responded to the survey. The median revenue per third-year student was dollar 9,937. It was dollar 13,602 for fourth-year students. Clinic revenue was also obtained for programs of advanced dental education. General Practice Residency programs generated the highest revenue per student at dollar 66,474, followed by programs of Advanced Education in General Dentistry at dollar 63,860. Other areas of the survey provided information regarding clinic fees by type of program, levels of uncompensated care by type of program, clinic revenue by source of payment, and dental school fees as a percent of usual and customary private practice fees.

Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals

OBJECTIVE

To determine tooth loss, wearing of dentures and associated factors in older individuals from Sri Lanka.

DESIGN

A cross-sectional survey where the data were collected by means of an oral examination and an interviewer administered questionnaire.

SETTING

Negambo within the Gampaha district of Sri Lanka.

SUBJECTS

A total of 630 subjects who were aged 60 years and above.

RESULTS

Only 11 subjects had all 32 teeth and 17% were edentulous. Age, gender and level of income were significantly associated with the number of missing teeth. Of those with missing teeth, 22% wore dentures. Only 16% of the non-denture wearers perceived a need for dentures. Among the non-denture wearers who perceived a need for dentures, a majority had cited 'cost' as the main barrier for obtaining dentures. Logistic regression analysis revealed that age, gender, levels of income and education and missing teeth were significant predictors of wearing of dentures.

CONCLUSIONS

Knowledge of factors that influence tooth loss and wearing of dentures may have implications for oral health care planners in the provision and delivery of oral health services to the older individuals.

The impact of concentration in dental insurance markets on dental reimbursement in Minnesota

The following article has been prepared by the American Dental Association (ADA) at the request of the Minnesota Dental Association (MDA). The article is the culmination of a rigorous national study by the ADA to measure the concentration of dental insurance in major dental marketplaces around the country. Five Metropolitan Statistical Areas (MSA's)from Minnesota were compared to other MSA's around the country. The results of this study are very significant for dentists and dental patients in Minnesota. Minnesota' practicing dental community may find the results of the study to be somewhat disturbing. Nevertheless, the MDA believes that it is important to share the results of this study with MDA members and others in the Minnesota dental community. It is important to consider both the study's short-term ramifications, as well as its long-term implications, as we attempt to better understand Minnesota's dental marketplace. It is also important for MDA members to know that the ADA brought the results of this study as they relate to the Minnesota Dental Marketplace to the appropriate federal agencies. The ADA believed that these agencies might choose to develop it into an anti-trust case. After reviewing the matter and working with the ADA over a long period of time, these agencies decided that they would not proceed with a Minnesota-based anti-trust case; additional information beyond what the ADA was legally able to provide was needed by the federal agencies in order for them to proceed. The MDA will continue to analyze and respond to these dental marketplace developments.

Orthodontic practices in Australasia: practice activity

OBJECTIVE

To collect baseline data on practice types and services provided by orthodontists in Australia and New Zealand.

METHOD

A total of 510 questionnaires was sent and 258 were returned. The response rate was 53 per cent.

RESULTS

The average age of respondents was 50 years (SD: 9.8 years) with female orthodontists being younger (Mean: 42.3 years; SD: 6.5). The ratio of responding female to male orthodontists was 1:8.8. Overall, more orthodontists were in solo private practice than associateships or partnerships. New Zealand orthodontists were more likely to be in associateships. Australian orthodontists had twice the number of practices (Mean: 2.4; SD: 1.4) than their New Zealand counterparts (Mean: 1.1; SD: 0.3). Orthodontists estimated they saw a mean of 21.3 (SD: 11.3) patients per day. Older orthodontists saw few patients in a day and spent fewer hours in any practice activity in a week. The mean waiting time for a consultation appointment in the private sector in New Zealand was nearly twice that in Australia. There was a significant association between male orthodontists and referral of patients by general dental practitioners. More than three quarters of respondents incorporated retention fees into the treatment fee. Overall, orthodontists were satisfied with the workload and did not want more orthodontists in their geographical area.

CONCLUSION

This study provides a sound basis for consideration of challenges in practice and changes over time.

Pediatric dentists' participation in the California Medicaid program

PURPOSE

The purpose of this study was to determine pediatric dentists' participation in the California Medicaid program and investigate barriers to participation.

METHODS

A 24-question mail-in survey with a follow-up was sent to all pediatric dentists in California with questions including demographics, Medicaid participation, and barriers to participation. Data were analyzed using descriptive statistics, chi-square tests, bivariate analysis, and multivariate logistic regression.

RESULTS

Pediatric dentists returned 364 useable mail-in surveys for a response rate of 70%. Forty-five percent participated in the Medicaid program, one third of which would accept all patients and two thirds of which placed some restriction on their participation. Twenty-five percent of respondents had at least 10% Medicaid patients in their practice, and 25% accepted 6 or more new Medicaid patients per month. Dentists in rural areas were significantly more likely than those in urban or suburban areas to accept a new Medicaid patient (P < .05). Eighty-nine percent of all respondents reported low fees and 82% reported broken appointments as important reasons for not participating or limiting participation.

CONCLUSIONS

Participation of California pediatric dentists in Medicaid is low compared to other states that have participation studies. Pediatric dentists in rural areas are most likely to participate. Among the reasons that contribute to California dentists not participating in the Medicaid program, the major ones appear to be low fees, broken appointments, and denial of payment.

Distribution of orthodontic services and fees in an insured population in Washington

Previous attempts to quantify the amount and type of orthodontic therapy provided by nonorthodontists in the United States have relied on survey data. Although there are advantages to surveys, such as control over survey recipients and inclusion of specific questions, they also have limitations, such as low response rates, response bias, and recall bias. This study used insurance claims data from a large dental benefits provider in Washington to assess the distribution of orthodontic services and fees among various dental providers. All orthodontic claims allowed by Washington Dental Service in 2001 were retrieved, along with treatment codes, fees, and demographic information for both patients and providers. A total of 102,984 orthodontic claims were included in the study. General dentists submitted 7.0% of these claims, orthodontists submitted 90.9%, and pedodontists submitted 1.9%. Orthodontists submitted higher average fees for space maintainers, first payments, and records. The percentage of orthodontic treatment preformed by general dentists and pedodontists in this claims-based study was substantially less than what has been previously reported in survey-based studies. Additionally, a smaller percentage of general dentists and pedodontists in this study performed comprehensive treatment, compared with previous studies. This study illustrates the value of insurance claims data to assess the provision of orthodontic care.

Charges for oral health care during a period of economic growth in the US: 1987-96

OBJECTIVES

This study aimed to provide estimates of amounts charged for dental care during 1996 for the US adult population and its major sociodemographic subgroups, and to evaluate whether charges had increased since 1987.

METHODS

We used data from the 1996 Medical Expenditures Panel Survey and report results for 12,931 adults aged 19-64 years. For comparison with previously published charges, we converted 1987 charges to their 1996 "constant dollar" value to control for inflation. Data were analyzed using SUDAAN and the results can be generalized to the US adult population.

RESULTS

In 1996, 43.7 percent (95% CI=42.7%, 44.6%) of the US population incurred dental care charges, which did not differ significantly from the 1987 estimate of 44.5 percent. In 1996, mean per capita charge for dental care was 182 dollars (95% CI=171 dollars, 192 dollars), which did not differ significantly from the inflation-adjusted 1987 estimate of 174 dollars. The average charge per patient who incurred charges in 1996 was 416 dollars (95% CI=394 dollars, 438 dollars), which was only 7 percent greater than the inflation-adjusted 1987 estimate of 389 dollars (P=.08). Sociodemographic variations were observed in per capita charges, but were less apparent in mean charge per patient who incurred charges.

CONCLUSIONS

During a period when economic growth and other market forces were expected to increase delivery of dental services, there was little or no change in percentage of US adults incurring charges or in mean per capita charges. The booming US economy did not raise dental charges significantly and did not increase utilization of dental care services.

Factors influencing choice of dental treatment by private general practitioners

Service rate variations have focused attention on treatment decisions. The aims of this study were to examine factors considered in choosing treatments, to classify dentists in terms of clinical decision making, and to investigate the association of decision making with services provided. From a random sample of dentists (response rate 60.3%) treatment constraints (15.0%), periodontal status (12.1%), tooth status (11.3%), mouth status (10.1%), and patient factors (9.8%) were considered important factors across six alternative treatment pair choice scenarios. Cluster analysis of the treatment choice scenarios produced one cluster that reflected patient preferences, another that reflected treatment constraints such as cost, and a third that reflected oral health factors. Compared with the oral health cluster, dentists in the constraints cluster had higher rates (p < .05) of extractions (rate ratio [RR] = 1.49), bridge work (RR = 1.77), and dentures (RR = 1.32), whereas dentists in the patient cluster had higher restoration rates for two-surface ionomers (RR = 2.45) and resins on three or more surfaces (RR = 1.50) and other preventive services (RR = 1.78) such as oral hygiene instruction. Although a range of factors influenced treatment choice, a limited set accounted for the majority of responses, with cost a major determinant, ahead of oral health status and patient preference. Decision-making style was associated with service provision.

Trends in treatment performed in the Phelophepa Dental Clinic: 1995-2000

Mobile clinics are a cost-effective method of meeting the dental needs of rural communities in South Africa. Phelophepa, the first primary health care train of its kind world-wide, provides eye care, education, medicine, basic health care and since June 1995 dental treatment to rural communities. All services are rendered by students under supervision of qualified staff. The aim of this study was to analyse and report the data for treatment performed in the dental clinic from June 1995 to May 2000. During its first five years of operation, dental services were provided at 183 towns in all provinces except Gauteng. Of the 42,073 patients treated during this time (an average of 229.9 per town), 67.4% were adults. 71.3% of the 103,283 procedures performed were extractions, 15.7% could be classified as preventive with the remaining 13% as restorative procedures. The average value of the service provided to each patient was R218.53. The exposure of dental, dental therapy and oral hygiene students to rural areas of South Africa serves the important purpose of sensitising students to the realities of oral diseases in these communities.

Competition and dental services

Dental services for adults are different from all other Norwegian health services in that they are provided by private producers (dentists) who have full freedom to establish a practice. They have had this freedom since the end of World War II. A further liberalization of the market for dental services occurred in November 1995, when the so-called normal tariff was repealed. The system changed from a fixed fee system to a deregulated fee system. In principle, the market for dental services for adults operates as a free competitive market, in which dentists must compete for a market share. The aim of this study was to study the short-term effects of competition. A comprehensive set of data on fees, practice characteristics, treatment profiles and factors that dentists take into account when determining fees was analysed. The main finding was that competition has a weak effect. No support was found for the theory that the level of fees is the result of monopolistic competition or monopoly. The results also provided some evidence against the inducement hypothesis. At this stage, it is interesting to notice that dentists do not seem to exploit the power they have to control the market. One explanation, which is consistent with the more recent literature, is that physicians' behaviour to a large extent is influenced by professional norms and caring concerns about their patients. Financial incentives are important, but these incentives are constrained by norms other than self-interest. The interpretation of the results should also take into account that the deregulation has operated for a short time and that dentists and patients may not yet have adjusted to changes in the characteristics of the market.

The effects of fee bundling on dental utilization

OBJECTIVE

To examine dental utilization following an adjustment to the provincial fee schedule in which preventive maintenance (recall) services were bundled at lower fees.

DATA SOURCES/STUDY SETTING

Blue Cross dental insurance claims for claimants associated with four major Ontario employers using a common insurance plan over the period 1987-1990.

STUDY DESIGN

This before-and-after design analyzes the dental claims experience over a four-year period for 4,455 individuals 18 years of age and older one year prior to the bundling of services, one year concurrent with the change, and two years after the introduction of bundling. The dependent variable is the annual adjusted payment per user.

DATA COLLECTION/EXTRACTION METHODS

The analysis was based on all claims submitted by adult users for services received at recall visits and who reported at least one visit of this type between 1987 and 1990. In these data, 26,177 services were provided by 1,214 dentists and represent 41 percent of all adult service claims submitted over the four years of observation.

PRINCIPAL FINDINGS

Real per capita payment for adult recall services decreased by 0.3 percent in the year bundling was implemented (1988), but by the end of the study period such payments had increased 4.8 percent relative to pre-bundling levels. Multiple regression analysis assessed the role of patient and provider variables in the upward trend of per capita payments. The following variables were significant in explaining 37 percent of the variation in utilization over the period of observation: subscriber employment location; ever having received periodontal scaling or ever having received restorative services; regular user; dentist's school of graduation; and interactions involving year, service type, and regular user status.

CONCLUSIONS

The volume and intensity of services received by adult patients increased when fee constraints were imposed on dentists. Future efforts to contain dental expenditures through fee schedule design will need to take this into consideration. Issues for future dental services research include provider billing practices, utilization among frequent attenders, and outcomes evaluation particularly with regard to periodontal care and replacement of restorations.

New York State Medicaid dentistry in the 1990s

Medicaid dental expenditure data for the 1990s are reviewed in light of current legal efforts to improve free schedules in New York State.

Oral health systems in Europe. Part II: The dental workforce

OBJECTIVE

To describe and compare the practice of dentistry and the dental workforce in eighteen European countries.

BASIC RESEARCH DESIGN

Semi-structured, in-depth validation interviews were carried out with key-informants from the main national dental associations of EU and associated countries. The interviews were structured around the responses to a previously completed questionnaire, whose topics and terminology had been agreed in advance with the collaborating associations. The resulting descriptions of dental practice and the dental workforce in each country were returned for further validation and correction by the collaborating associations. Ultimate editorial control over the review of each country's oral health system rested with the academic unit from which the associations jointly commissioned the study.

RESULTS AND CONCLUSIONS

With the exception of Austria the primary training and registration of dentists is now more or less standard across Europe. However, wide international variation exists in the official recognition of dental specialists and auxiliaries. The Nordic countries of Sweden, Finland and Iceland recognise the broadest range of specialties. In contrast Spain, Portugal, Luxembourg and Belgium currently do not formally recognise any types of specialist practice. Fee-for-service is the dominant form of remuneration for dentists across Europe, but considerable variation exists in the level of fees, how they are decided and the proportion paid by the patient. When based upon standard questionnaires, semi-structured interviews with key informants are an effective method for capturing both the specifics of how an oral health system works, and the general similarities and differences between countries.

Dental expenditures by selected dentist and practice characteristics

Total estimated dental expenditures in 1995 were approximately $47.6 billion as reported by the Bureau of Economic Analysis, or BEA. According to the Health Care Financing Administration, or HCFA, the total estimated dental expenditures in 1995 were approximately $44.7 billion. Using the reported gross billings from the annual ADA "Survey of Dental Practice," the authors estimated that the total national dental expenditures in 1995 were about $45.5 billion. As this estimate falls between the BEA- and HCFA-estimated total dental expenditures, it is one confirmation of the reliability and validity of ADA's estimates. This estimate also can be used to look at dental expenditures by selected characteristics--such as specialty, office time and number of dentists in the practice.

Dental procedure fees 1975 through 1995: how much have they changed?

A shift toward diagnostic and preventive dentistry in the last two decades is evident from the change in the number of dental procedures performed, as well as the change in the percentage of time spent performing different types of procedures. During the period 1975 through 1995, the average nominal fees for selected dental procedures increased. Once inflation was taken into account, however, the increase in the average real fees charged was more modest.

Levels of restorative care under capitation

OBJECTIVES

1. To compare the prevalences of fissure sealants in similar groups of 14-15-year-old, regularly-attending patients treated under fee-for-service in 1989 and capitation in 1994. 2. To calculate the effect of including sealants in the restorative index on estimates of interventional treatment carried out on 14-15-year-old regularly attending patients treated by general dental practitioners in 1994.

DESIGN

A randomised epidemiological study.

SETTING

Secondary schools in the Wycombe, Doncaster and Hereford/Worcester areas.

METHOD

Random samples of 14-15-year-old, regularly attending patients treated by dentists practising under capitation in three contrasting areas of England were examined in 1994 for the presence of decayed, missing and filled teeth and fissure sealants. Restorative indices were calculated with and without the inclusion of sealants. The latter were compared with restorative indices calculated without the inclusion of sealants on regularly attending patients of the same age group when the dentists in the same three areas were working under fee-for-service in 1989.

RESULTS

The prevalence of fissure sealants increased between 1989 and 1994 from 16% to 30% in Wycombe, from 13% to 50% in Doncaster and from 25% to 47% in Hereford/Worcester. Without fissure sealants the restorative indices fell between 1989 and 1994 from a range of 76.5-94.4 to 63.3-87.1. When sealants were included in the restorative indices for 1994, they ranged from 79.5-92.9.

CONCLUSIONS

There were increases in the prevalences of fissure sealants between 1989-1994. When these sealants were included in the calculation of restorative indices for 1994, the level of restorative care provided by general dental practitioners remained relatively high since the introduction of capitation. Although there has been some increase in the level of untreated disease, if the restorative index is calculated without the inclusion of sealants then there is a risk of underestimating the treatment provided by general dental practitioners to control the carious process. Dentists appear to be redirecting their efforts into newer treatment/preventive items.

Making Medicaid child dental services work: a partnership in Washington state

Eighty-one percent of general dentists and 86 percent of pediatric dentists who are members of the local dental society in Spokane County, Washington, participated in a pilot program to provide dental care in private offices to children up to 5 years of age from low-income families served by the Medicaid program. Outreach staff from the local public health agency recruited and enrolled families in the program. University faculty provided special training in the care of young children to the dentists participating in the program. In the program's first year, 37 percent of the enrolled children had made at least one visit to the dentist, in contrast to 12 percent of children who were not enrolled in the program.

Utilization of dental services by Iowa Medicaid-enrolled children younger than 6 years old

All Medicaid-enrolled children are eligible to receive dental care through the Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT). As part of an evaluation of the effectiveness of the EPSDT program in Iowa, Medicaid enrollment and claims files from fiscal year (FY) 1994 were used to evaluate the utilization of dental services by Medicaid-enrolled children younger than age 6 during FY 1994. During FY 1994, 23% of Medicaid-enrolled children younger than age 6 received at least one dental service while enrolled in the Medicaid program. The total Medicaid-allowed charges for all dental services provided to this population while enrolled in Medicaid during FY 1994 was $1.53 million (the amount Medicaid would pay for the service, prior to calculating any copayments or other insurance charges). Although the EPSDT program in Iowa requires a referral of all Medicaid-enrolled children to a dentist at 1 year of age, fewer than 4% of enrolled children in this age group received any dental services. The percent of enrolled children receiving a dental exam during FY 1994, by age, was as follows: younger than 1 year, 0.2%; age 1, 3%; age 2, 10%; age 3, 27%; age 4, 46%; age 5, 54%. Utilization rates of dental services by Medicaid-enrolled children in Iowa fall far short of federal regulations, which currently require that 80% of enrollees receive EPSDT screenings, referrals, and treatment by age 3.

Comparative cost and time analysis over a two-year period for children whose initial dental experience occurred between ages 4 and 8 years

The dental treatment for 100 children was recorded on both a fee for service and time schedule. One hundred children were divided into one of five groups according to age at the first dental experience. Data were collected for a two-year period. The average cost by Massachusetts welfare standard were calculated. The average expenditure for a patient who presented for the first time at age 4 was $30. This fee increased by mean increments of $34.75 yearly until the average patient who presented initially at age 8 required $169 for two years of dental treatment. Time necessary for treatment likewise increased proportionally. Further data will be presented as they are calculated.

Provision of free and discounted dental services to selected populations: a survey of attitudes and practices of dentists attending the 1996 Dallas Midwinter Meeting

An attitudes and practices survey of dentists attending the Dallas Midwinter Meeting in January 1996 in Dallas was conducted as a collaborative effort between the Dallas County Dental Society and the Baylor College of Dentistry. The survey was developed to help determine participating dentists' attitudes and practices in the area of provision of dental services on a discounted or free basis to disadvantaged patient groups. A total of 225 dentists responded to the survey. Of these surveyed dentists, 213 (94.6%) were in private practice and 199 (88.4%) described themselves as general dentists. A considerable amount of charitable dental services, discounted and free, was reported to be provided by the group of respondent dentists. A total of 152 (67.6%) of the dentists surveyed reported providing discounted or free care to elderly patients with low income, 125 (55.6%) provided such care to low-income patients without age restriction, and 137 (60.9%) cared for patients of record with temporary financial hardship. In other patient categories, 79 (35.1%) of the dentists provided free/discounted services to handicapped persons and 47 (20.9%) provided care to homebound patients. These findings concerning charitable practices by dentists were similar to those found in a comparable survey conducted by the American Dental Association in 1994. Dentists were fairly evenly split as to their preference where to volunteer services. Of the total respondents, 84 (40.6%) preferred providing services in their own office and 91 (44.0%) preferred to do so at a community health clinic that hosted volunteers.

Potential effects of opportunity cost on dental school patients

Predoctoral clinic fees are set below those of private practices to attract patients. Treatment in a predoctoral clinic requires more and longer appointments and patients spend more time waiting to be seen than in a private practice. This time has a value that economists call opportunity cost, the value of the next best alternative (the hourly wage for an employed patient). A model comparing total cost (fee plus opportunity cost) of treatment in dental schools and private practices for insured and uninsured patients is presented. As patient income increases, the total cost of some treatment plans becomes higher in dental schools than in private practices. To insured patients, however, the out-of-pocket cost of a treatment plan depends on copayments rather than fees. This makes predoctoral clinics less competitive. Considering opportunity cost further increases dental schools' lack of competitiveness. For insured patients, more treatment plans will have a lower total cost in private practice. Clinic directors must realize that if opportunity costs are not reduced, the market may dictate that fees be lowered to remain competitive with private practitioners. They are in competition for patients based on total cost, and efficiencies that reduce opportunity cost may increase revenue and attract patients.

A review of dental HMO expenses: where do the dental premium dollars really go?

The savings and profits that managed care programs have realized in medical care have prodded managed care companies to look at dentistry for similar results. In this article, the authors evaluate the impact of various dental managed care plans by examining how they allocate premium dollars. Dentists and purchasers need this information to assure themselves that the plans allocate adequate dollars for the provision of care and that the premium dollars paid are used effectively and efficiently.

A profile of patients in six dental school clinics and implications for the future

Surveys were conducted of patients receiving care at six dental school clinics in the United States during a one-week period in the fall of 1993. Survey data were analyzed to determine who was using services provided by these dental schools, the types of services being provided, and why people chose to receive their care at these dental schools. Eighty-one percent of the patients indicated that low cost was an important reason for seeking care at a dental school; the patients receiving care at these dental schools tended to be low income. Seventy-six percent paid for some or all of their care out of pocket. As dental schools reevaluate their mission regarding patient care issues and assess the impact of their decisions, information about dental school clinics, particularly who seeks care there and why, should be an important consideration.

Survey of clinic fees and clinic revenue--summary report, 1993-94

Figure 4 shows the mean unadjusted revenue-per-student by program type. Advanced Education General Dentistry programs had the highest revenue-per-student this year and in two of the three previous years. Oral and Maxillofacial Surgery programs generated the second highest mean amount of clinic revenue-per-student, followed by General Practice Residencies, Orthodontic programs, and Prosthodontic programs. Pediatric Dentistry, Endodontics, and Periodontics programs also had similar mean revenues-per-student. The smallest revenues-per-student were generated by D.D.S./D.M.D. and dental hygiene programs. These data should be interpreted with care. A review of the information for each program shows that there are significant variations in these data from school to school. These variations could be caused by different accounting procedures as well as differences in program size and location. Consequently, these data are best viewed in general terms.

Survey findings on dental fees. A comparison from 1982-93

The cost of health care services, including dental services, continues to rise at a rate higher than the prices of all goods and services included in the CPI for urban consumers. Increases for physician services, medical care and hospital room rates exceed those for dental care. Dentists generally do not raise their fees across-the-board, but vary increases from procedure to procedure. Increases for certain common dental procedures and services were close to the CPI for consumer goods and services. Fees for such basic preventive and diagnostic procedures--including oral exams, prophylaxes and X-rays--increased at rates well below the overall CPI for dental services.

Changes in utilization of dental services of Alberta's universal dental plan for the elderly

Since 1973, Alberta's dental plan for the elderly has made government-sponsored, premium-free comprehensive care by dentists and denturists available to all residents of the province over age 64. Details on the numbers and types of different services provided were previously unavailable from the annual reports. However, an examination of the plan's six-million records, covering nearly 260,000 different patients from 1978 to 1992, has now made it possible, for the first time, to conduct a detailed analysis of these dental services. Many time-related changes have occurred in the types of services provided. The number of removable prosthodontic services declined from 14 per cent of all services offered by dentists in 1978-79 to five per cent of these services in 1991-1992, but the services provided by denturists increased by a factor of four. The relative number of surgical and restorative dentistry services offered by dentists also declined. Preventive services grew modestly, but periodontal services grew dramatically from three per cent of all services provided by dentists to 22 per cent. These shifts in services from prosthodontics, restorative dentistry and oral surgery to preventive and periodontic services have important implications for the planning and administration of dental plans for the elderly.

A comparative study of costs for dental services and dentists' income in the United States and Norway

The United States and Norway have approximately the same per capita Gross Domestic Product (GDP) and average personal income, but their per capita health spending patterns are quite different. In 1982, the US spent 6.5% of its total health expenditures on dental services while Norway spent 5.4%. A higher percentage of Norwegian adults see a dentist annually as compared to US adults. In 1984, the mean net income of dentists in private practice was $66,940 in the US and $27,125 in Norway; this is respectively 5 and 1 3/4 times the average per capita income in those countries. The American publicly-employed dentist earned approximately two-thirds of what the American private practitioner made, while still earning approximately 50% more than his Norwegian counterpart. Some basic information concerning the ratios of dentists, specialists, and dental hygienists to the population is given. The relative proportion of women dentists in the two countries is contrasted. Finally, data on graduates from the dental schools, enrollment cuts, and estimated dentist to population ratios by the year 2000 are described to compare future manpower that will be available to the two countries. Several dissimilarities in the political and social systems are described and discussed. It is emphasized that caution should be used when interpreting and comparing data about countries with different dental delivery, political, and social systems.

The economics of dental practice in New Zealand, 1974-1993

New Zealand Dental Association survey data were used to explore trends in the principal indicators of dental practice economics over the last two decades. Gross income in the most recent financial year, 1992, was the highest during this period. However, the costs of dental practice have also risen, and now absorb close to 60 percent of revenue compared with around 50 percent in the early 1970s. As a result, real net income has yet to return to the "peak" levels achieved in the mid-1970s. Nevertheless, average real net incomes earned in 1992 (in 1988 dollar terms) of $85,701 is around 8 percent higher than the average real net income between 1974 and 1992 of $79,243. Furthermore, the lower income tax rates applying in the post-1990 period have produced post-1990 after-tax incomes which are higher in real terms than those in the pre-1990 period. The trends in real net dental income earned by dentists between 1982 and 1992 are shown to correspond closely to the trends in the average incomes of higher-income consumers. The rate of increase in the fees charged by dentists between 1978 and 1993 has, for most services, exceeded the rate of increase in consumer prices generally. A notable exception is the fee charged for complete dentures, which displayed much more modest increases. It is possible that this is attributable to the presence of competing suppliers (dental technicians) for this service.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental care in the NHS: reforms with teeth?

Dental services in the UK are currently undergoing a period of major upheaval. This paper examines recent policy initiatives with respect to patient charges, dentists' remuneration, information and patient choice, the supply of dental personnel, and the prevention of dental diseases. It is argued that changes in dentists' remuneration and the greater use of auxiliary personnel are likely to improve efficiency, whereas changes in patient charges are not. Water fluoridation remains the most efficient and equitable means of promoting dental health.