[FROM THE PRUSSIAN FEE REGULATION TO THE FEDERAL FEE REGULATION].
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The aim of this study was to analyze the association between dental anxiety, dental attendance, health status and social factors. Our previous studies have shown that dental anxiety declines with age and is associated with poor oral health. In addition, correlations between dental anxiety, dental utilization and dental status have been revealed. However, the association of these factors with general health and social factors has not been analyzed in our previous studies. In a study of women's health in Göteborg, Sweden in 1992, 1.017 urban women aged 38 to 84 years took part in a series of investigations including clinical examinations, interviews and questionnaires. In addition to descriptive and simple inference statistics, a two-part multiple logistic regression model was utilized to investigate dental anxiety and dental utilization. Dental fear was less prevalent among older women, dentate or not, although 10% of females 62 years of age and older still reported high dental anxiety (DAS > or = 12). 94% of the younger (< or = 62 yr) and 76% of the older (> or = 70 yr) women reported regular dental attendance. When separating all women into dentate and edentulous groups, 94% of the dentate and 11% of the edentulous respondents reported regular dental care. Due to the large difference in dental attendance between dentate and edentulous women, these groups were analyzed separately. Multiple logistic regression analyses showed that the following factors were associated with irregular dental utilization among dentate women: high dental anxiety, fewer teeth and restorations, more caries, poorer chewing ability and dissatisfaction with dental esthetics. In the multiple regression for dental anxiety, high fear was shown to be associated with irregular dental care, age (younger), fewer teeth, dissatisfaction with dental esthetics and lower scores on the SF-36 mental health scale. A separate analysis showed that individuals with high fear and regular, as opposed to irregular, dental attendance had more teeth at a statistically significant level, which were less often decayed and more often restored. In spite of the group with high fear and irregular attendance having fewer teeth, their level of decay was seven times higher. Overall, the results indicate a strong association between dental fear and dental attendance. Weak associations were found among socio-economic, dental health and general health factors.
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Results from a series of federal reports indicate general improvement in dental economics in California since the mid 1980s. A review of dental establishments at the state and local levels documents this improvement.
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The relationship between socio-economic factors and dental health in an Obstetric Nigerian population was studied. The mean gestational age (+/-standard deviation) was 30.16 + 5.45 weeks (range 16-40 weeks). Acquisition of dental education was found to be unrelated to level of education. When the prevalence of dental caries and periodontal disease were considered, the difference between the high, middle and low socio-economic groups were found to be significant (p < 0.05).
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Reports by the ADA, U.S. Dept. of Commerce, and the HCFA all confirm the improving economics of dental practice, a reflection of increasing use of dental services by children of all ages. Unfortunately, the continued activity of questionable proprietary economic surveys results in a jaded group of practitioners continuously asked to respond. It is inexcusable that we just don't know very much about the income of the profession.
This paper examines the idea that medical professions in the United Kingdom have, as a result of restrictive practices of various kinds, managed to obtain rates of return to their education and training well above those achieved in other professions. It concludes that after making various adjustments, in particular allowing for differences in hours worked, the returns obtained are in most cases not very different from those for other professions. With the exception of dentists there is therefore no clear-cut evidence from earnings data alone of restrictive practices in the medical professions.
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The literature currently available indicate that there have been substantial improvements in at least four areas of dental diseases: dental caries, root surface caries, edentulousness, and periodontal disease. Oral cancer appears to have remained stable. The literature on craniofacial anomalies, malocclusions, and traumatic injuries is such that similar statements cannot be made. Although decreases have been observed in caries, root surface caries, edentulousness, and periodontal disease, the improvements have occurred largely within the white population. Caries, for example, has been significantly reduced because of water fluoridation, fluoride dentifrices, and perhaps some changes in dietary patterns. Nevertheless, the disease continues to increase with age, although the cumulative effect of fluorides lowers the overall magnitude. The sheer numbers will still be substantial. For a variety of reasons, dental disease still remains substantially high in the nonwhite population, and will require concerted intervention if it is to be reduced.
This paper discusses some basic economic principles and concepts and how they relate to the analysis of dental care delivery. The fundamental theories of consumer behavior, profit maximization, information and transaction costs, and agency are considered. It is asserted that the information gap existing between patients and providers gives rise to a principal-agent problem, the operative element of this paper. The authors conclude that while under managed fee-for-service (MFFS) delivery systems, third-party administrators use financial, administrative, and utilization management tools to guide consumer and provider behavior, to reduce the size of the information gap, and achieve a more efficient allocation of resources, this does not occur under direct reimbursement (DR).
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