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Biomedical subjects

M H Schoen

Publications and source records attributed to M H Schoen.

At least 19 recordsLinked to original sources
PubMed1992

Measurement of dollar value of services in a capitated dental plan.

A number of attempts have been made to develop measures of the cost of resources expended to produce specific services that are more equitable than fees. Two conceptually different relative value methods (RVU and RTCU) and UCR fee-for-service were used to measure the dollar value of care produced in three consecutive years under a network-type capitation dental plan. While each yielded a different total, the values were relatively close in the first year. However, they diverged in the second and third years even when an inflation factor was kept constant for all three. In addition, the dollar value of specific services varied markedly over the three methods. The relative merits of the different systems are discussed, as well as possible reasons for the divergence. It is concluded that the RTCU system is preferable, but that great care must be taken to keep any system current, regardless of specific derivation.

Capitation Fee↗
PubMed1992

Dentistry and national health insurance.

Access to dental care is not equitable in the United States. The dental health of the population varies widely by socioeconomic status. Private dental insurance coverage has peaked at about 40% of the population, and benefits are variable. Dentistry is not included in Medicare and is optional for adults under Medicaid. Inflation is greater than for all goods and services. There is considerable administrative waste, and quality is variable. In this author's opinion, only a national system with universal coverage, one set of benefits, a single payer, a cap on expenditures, and no participation by insurance companies that is increasingly based on salaried consumer-or community-owned group practices with dentist input into decision making can hope to solve the existing problems.

Dental Care↗
PubMed1991

National health care and the public's oral health.

This article presents an outline of a proposal for a national health program, together with a discussion of the necessity of inclusion of dentistry for optimum benefit to the public. A thorough restructuring of current principles of coverage, benefits, methods of payment, administration, and methods of protection of the public is proposed. Disease prevention and the role and responsibility of public health dentistry would be enhanced in such a scheme. Current total dental care expenditures should be sufficient to cover most of the costs. It is the author's belief that further tinkering with the existing health care system and the application of more bandaids can only exacerbate existing problems.

Dental Health Services↗
PubMed1991

Quality of dental care.

Studies on the quality of dental care have included several models that view the subject broadly, far beyond technical quality. However, most studies are based on some variation of the structure, process, outcome approach. In addition, there has been presentation of data on the quality and distribution of services, as well as information tied more directly to evaluation of clinical performance. The wide variations found within the reports raise cause for concern about the adequacy of care. The development of quality assurance activities in dental schools has been discussed. However, as yet there has been little application of quality assessment and assurance measures to the vast majority of dental practices.

Curriculum↗
PubMed1991

Capitation in dentistry: original concepts and current reality.

Modern dental capitation was conceived as being based on staff model group practice, receiving regular periodic payments to provide comprehensive care with few exclusions, limitations and copayments, to a given population. High utilization, completion and recall rates were expected. Examples are presented. The dominant form of capitation has become a network of solo and small group practices, usually with a for-profit intermediary. Premiums are low and administrative costs are high. There are many exclusions and limitations. Low utilization and under-treatment are endemic. Specific examples are presented. The reasons for this development include competition among dentists concerned about busyness, and predominance of cost control concerns over quality concerns on the part of purchasers.

Capitation Fee↗
PubMed1990

A proposed new system for valuing dental procedures. The relative time-cost unit.

The relative time cost unit (RTCU) is a proposed new system for valuing dental procedures that provides an alternative to traditional relative value units in fee-setting and reimbursement allowances. It incorporates personnel costs, task mixes, and task times into relative weights for dental procedures. The frequently performed procedure, "2-surface amalgam restoration," is used to illustrate how the RTCU values are derived from hospital task analysis data. The RTCU, as a data-based construct, holds appeal for restructuring fee schedules and has been used for almost a decade by insurance companies to value dental services, construct fee schedules, and evaluate reimbursement to providers.

California↗
PubMed1990

A comparison of quality in a dual-choice dental plan: capitation versus fee-for-service.

The quality of dental care provided under a dual-choice dental plan was evaluated. Eleven practices, six capitation and five fee-for-service, were examined. The methodology was based primarily on examination of elements of structure and process of care. Samples of patient dental records were drawn from each practice for a total of 495 patient records. The results showed that none of the five fee-for-service dental practices and only two of the capitation practices were found to meet all the criteria for acceptable dental practice. Universally poor documentation made it extremely difficult to evaluate process measures of care. Fee-for-service patients received more visits and services than capitation patients. Overtreatment occurred in fee-for-service practices and undertreatment occurred in capitation practices. The distribution of services also differed, with capitation practices providing a less expensive type of service. Annual utilization of one or more services for capitation practices varied substantially by the practice. In this plan, both capitation and fee-for-service practices demonstrated a need for strong quality assurance mechanisms to protect the interests of patients.

Adolescent↗
PubMed1989

A quality assessment system: the search for validity.

Quality assessment and assurance should involve all of dentistry, not just third party payment plans. One evaluation system is described and a draft outline of guidelines for criteria and standards is presented. An important, and usually neglected, aspect of the use of the system is illustrated by the presentation of some quantitative data from the review of a dental care program. Concerns about the validity of various elements are discussed, together with the difficulty of establishing such validity. Nevertheless, there are indications that the system is able to distinguish among different levels of quality using a dichotomous scale. More research in the field is urged.

Dental Care↗
PubMed1987

An evaluation of the Robert Wood Johnson Foundation's Hospital-Sponsored Ambulatory Dental Services Program.

This article summarizes the results of an evaluation of the Hospital-Sponsored Ambulatory Dental Services Program funded by the Robert Wood Johnson Foundation. Goals of the program were to increase service to the underserved both in the volume of persons treated and in continuity of care, while supporting expanded dental general-practice residency training and aiding financial viability of the dental departments. The principal findings were that, while the volume of new patients increased, the number of disadvantaged persons did not. Continuity of care may have worsened. Policy implications are that hospital dental departments should improve their efficiency and narrow their goals to the special populations best treated in their environment. Innovative financial mechanisms should be explored, including combining with medical care hospital-based HMOs. However, the goals cannot be reached without expanded and continuing governmental subsidy.

Continuity of Patient Care↗
PubMed1986

Estimating treatment and treatment times for special and nonspecial patients in hospital ambulatory dental clinics.

Increased time to treat the special patient is often cited as a barrier to dental care. The purpose of this study was to analyze the separate and combined effects of differences in dental services planned, services actually performed, and differences in treatment time requirements between special and nonspecial patients in a hospital ambulatory clinical setting. Data for this study were obtained from the UCLA evaluators of the RWJ-funded Hospital-Sponsored Ambulatory Dental Services Program (HSADSP). The results show that special patients require more dental treatment than nonspecial patients for advanced dental disease (i.e., periodontics, surgery, and removable prosthetics) and that they receive more of such services. The study also found that special patients should not be viewed as a homogeneous group when evaluating dental needs and required time resources for treatment. Three subgroups of special patients were identified: developmentally disabled, severely compromised, and moderately compromised. The developmentally disabled as compared to the nonspecial patients required significantly more (20 percent) provider time in completing a "representative" treatment plan.

Adult↗
PubMed1985

Does dentistry as we know it have a future?

The American Dental Association's Strategic Plan for the Future of Dentistry is primarily a self-serving document in that it attempts to protect the dentist regardless of the changing oral health needs of the population. Marketing, even if initially successful, will not increase the absolute demand for dental services, because persons on maintenance care require less care per year than sporadic users. Higher use will be balanced by less need. Excess supply creates incentive to overtreat. Today's dentist, as the dominant provider, does not have major motivation toward prevention, either by training or economic self-interest. The paper proposes that a modified hygienist, with more diagnostic training, should become the primary dental provider, with a better trained dentist as a secondary provider, combining problem solving and "surgical" skills. These changes would function best under a system combining group practice with a national health service.

American Dental Association↗
PubMed1985

Social, economic, and political forces in quality assurance.

Licensure and accreditation, established primarily to protect the existing profession, have been incorrectly assumed to be effective agents for quality assurance. Although dentistry, being less institutionalized than medicine, has had less pressure for quality assurance, both increasing third party payment for care and sophistication of population have led to the development of assessment and assurance mechanisms. At present, these are used more for cost containment than quality assurance, but considerations for the protection of the oral health of the public are growing.

Accreditation↗