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PubMed1988

Capitation and fee-for-service dental benefit plans: economic incentives, utilization, and service-mix.

Insurance carriers, corporations, and labor groups are actively developing and marketing dental capitation benefit plans. Incentives to both dentists and patients in these plans differ from those in the traditional fee-for-service system used with conventional benefit plans. This paper describes the likely effects of these incentive differences on utilization and service-mix patterns in both systems. Data for a large (approximately 10,000), homogenous group of subscribers are presented and discussed. Faced with a dual option, at no cost to the employee, 60% of the subscribers chose the fee-for-service plan, and 40% chose the capitation plan. Observed differences in the utilization and mix of services between the two plans cannot be explained solely in terms of dentists' responses. Employee response to altered economic incentives appears to be strong.

Capitation Fee↗
PubMed1979

[Extended fissure sealing--a review for the dental practitioner].

There is scientific proof that destructive processes of the oral cavity can be avoided through a combination of general prophylaxis with individual preventive care. In children with few or no carious lesions in the deciduous dentition a complete eradication of caries of the permanent teeth should definitely be attempted. Pits and fissures of premolars and molars should therefore be individually sealed within six months after tooth eruption. In cases of incipient occlusal caries preventive resin restorations allow the repair with a minimum of tooth removal, i.e. therapeutic preventive dentistry. The use of the somewhat destructive conventional restorative techniques including prophylactic odontotomy, fissure eradication and extension for prevention that are unfortunately favored by the common dental fee policy should be strictly limited to cases where better alternatives are as yet unpracticable.

Child↗
PubMed1991

[Institutionalized elderly in Reykjavik in 1984. Their opinions of dental visits, need for dental service and possible changes in dental service and third party payments].

In 1984 an investigation was done among a random sample of 400 old-age pensioners, 67 yrs, and older, who were either inmates of old people's residential or nursing homes or long-term patients in geriatric departments at the hospitals in Reykjavík. A dentist asked all participants standardised questions, among which were: questions concerning dental visiting habits; opinion on the dental public health system; subjective estimation on own need for dental services; opinion on the services rendered by the dental profession; and refunds of dental fees by the public health system. During the last twelve month period only 16.6% had visited a dentist and 34% had not gone to a dentist for more than 20 years. Of those who had made use of dental services during the last 5-10 years, 79.6% said they were satisfied. Barely 75% considered themselves in need of dental services, and 67.6% claimed that they would not seek dental services more frequently if they were made available in the institution, or if free transportation were available to the dentist's office. Only 35.9% said that they would make use of free dental checkups, while 82.2% however were in favour of free health services for old age pensioners. For statistical analysis chi-square at 5% level was used, comparing the answers by sex, age, and institution. There was no statistically significant difference with the exception of difference between institutions with regard to a question of free dental services (0.005 less than p less than 0.01). This question however did not give a significant difference between the sexes or the two different age groups.

Aged↗
PubMed1982

Optimizing the dental delivery system.

This paper examines the application of information and principles derived from social science research to increasing the effectiveness and efficiency of the dental care delivery system. Four major delivery system attributes are considered: the availability, accessibility, appropriateness and acceptability of care. The dentist to population ratio is a major determinant of the availability of dental care and many factors have to be considered in deciding on the appropriate number of dentists needed in a population. Optimum size of dental practices is another aspect of availability. The evidence suggests that practices with 2 or 3 dentists are more efficient than solo practices. However, large group practices appear only to be of equal or even less efficiency than small group practices. The accessibility of dental care is influenced by the geographical location of practices, the convenience of obtaining care during non-working hours, the reduction and dissemination of information on dental fees and, most importantly, the beliefs of people concerning their oral health status. The appropriateness of care concerns the impact of different services on improving oral health. Relatively little clinical research has been published on the costs and benefits of different dental services. The acceptability of dental care concerns both patients who visit the dentist and the larger society. Studies show that patients who visit the dentist are generally satisfied with the care they receive. Societal attitudes about the dental care system have not received much attention. Although social science research on the dental care delivery system is at an early stage of development, some data exist which are relevant to optimizing the practice of dentistry.

Consumer Behavior↗
PubMed1983

The Minnesota dental practice analysis system.

The Minnesota Dental Practice Analysis System (DPAS) is a three-year project sponsored cooperatively by the University of Minnesota's School of Dentistry, Health Services Research Center, and the Minnesota Dental Association. The primary intent of the DPAS is to generate timely, reliable information on dental practice conditions for dental work force planning efforts. The system semiannually collects data from a representative sample of Minnesota dentists to monitor trends in such important areas as practice productivity, auxiliary utilization, types of procedures performed, payment mechanisms, and dental fees. Preliminary results of the project indicate that, in comparison with 1980 indicators, overall practice conditions among established Minnesota dentists have declined.

Adult↗
PubMed2001

Tobacco-use cessation programs and policies at the University of Manitoba's faculty of dentistry.

The deleterious effects of tobacco use on general health and oral health are well documented. While one-third of Manitobans are current smokers, up to 79% report they want to quit. Counselling by health care professionals can help achieve quit rates of 15-20%. Yet many health professionals do not provide tobacco-use cessation counselling because they feel they are not trained to do so. In 1998, the faculty of dentistry of the University of Manitoba implemented a number of tobacco-use cessation interventions in its undergraduate curricula and general teaching clinic. The faculty has also successfully obtained the inclusion of a dental fee code for tobacco-use cessation services in the provincial fee guide and has received approval to allow dentists who have completed an approved course in tobacco-use cessation training to prescribe bupropion HCl (Zyban), in consultation with a patient's physician, to aid smoking cessation.

Bupropion↗
PubMed1989

[Use of a dental health education center].

In the year 1986 1910 persons made use of the services of a dental health education center in Amsterdam. One day a week a dentist could be consulted. The rest of the week other members of the team were available for answering questions. Almost 30% of the questions concerned dental treatment, diagnosis of treatment plan, 20% dental fees and other financial aspects of treatment and questions for folders, posters et cetera accounted for another 20%. Only 5% of the questions referred to preventive matters. A quarter of the dentist's interventions consisted of giving a second opinion. More women than men, and more privately insured than sick fund insured contacted the center.

Adult↗
PubMed2001

Use of an interactive tool to assess patients' willingness-to-pay.

Assessment of willingness to pay (WTP) has become an important issue in health care technology assessment and in providing insight into the risks and benefits of treatment options. We have accordingly explored the use of an interactive method for assessment of WTP. To illustrate our methodology, we describe the development and testing of an interactive tool to administer a WTP survey in a dental setting. The tool was developed to measure patient preference and strength of preference for three dental anesthetic options in a research setting. It delivered written and verbal formats simultaneously, including information about the risks and benefits of treatment options, insurance, and user-based WTP scenarios and questions on previous dental experience. Clinical information was presented using a modified decision aid. Subjects could request additional clinical information and review this information throughout the survey. Information and question algorithms were individualized, depending on the subject's reported clinical status and previous responses. Initial pretesting resulted in substantial modifications to the initial tool: shortening the clinical information (by making more of it optional reading) and personalizing the text to more fully engage the user. In terms of results 196 general population subjects were recruited using random-digit dialing in southwestern Ontario, Canada. Comprehension was tested to ensure the instrument clearly conveyed the clinical information; the average score was 97%. Subjects rated the instrument as easy/very easy to use (99%), interesting/very interesting (91%), and neither long nor short (72.4%). Most subjects were comfortable/very comfortable with a computer (84%). Indirect evaluation revealed most subjects completed the survey in the expected time (30 min). Additional information was requested by 50% of subjects, an average of 2.9 times each. Most subjects wanted this type of information available in the provider's office for use in clinical decision making (92%). Despite extensive pretesting, three "bugs" remained undiscovered until live use. We have demonstrated that the detailed information, complex algorithms, and cognitively challenging questions involved in a WTP survey can be successfully administered using a tailor-made, patient-based, interactive computer tool. Key lessons regarding the use of such tools include allowing the user to set the pace of information flow and tailor the content, engaging the user by personalizing the textual information, inclusion of tests of comprehension and offering opportunities for correction, and pretesting by fully mimicking the live environment.

Adult↗