Money illusion among health care providers: should we adjust for inflation in analyses of provider behavior?

This analysis questions the appropriateness of inflation adjustment in analyses of provider behavior by comparing results from estimations using adjusted financial variables with those from estimations using unadjusted financial variables. Using Medicaid claims from 1984-1991, we explored the effects of Medicaid reimbursement increases on dentists' participation. Using results from inflation adjusted analyses, we would conclude that a 23% nominal increase in Medicaid reimbursement rates yields no increase in the number of Medicaid children seen by dentists. In contrast, estimations based on unadjusted reimbursement rates suggest that this same 23% nominal increase in reimbursement leads to an expected 16-person (15.4%) increase in the number of Medicaid patients seen per provider per year. These analyses demonstrate that results are sensitive to adjustment for inflation. While adjusting for inflation is a generally accepted practice in health services research, doing so without evidence that providers respond to adjusted reimbursement may be unjustified. More research is needed to determine the appropriateness of inflation adjustment in analyses of provider behavior, and the circumstances under which it should or should not be done.

Student satisfaction with curriculum modifications in a French dental school

Since 1994, important modifications have been implemented in the dental curriculum in France, and an additional year has been included in the dental curriculum. The 1st year has remained unchanged; it is common to both medical and dental schools and leads to a selection procedure of 1 in 10 dental students. In the new curriculum, the dental student is engaged in a 5-year programme in dental school (years 2 to 6), as opposed to 4 years in the former programme (years 2 to 5). Basically, this new curriculum emphasises research initiation, links with medical training and offers broader clinical experience. During the academic year 1998-1999, dental schools had 2 different types of students: the 4th year students belonging to the new programme along with the 5th year students in their final year of the old curriculum. Using a specially devised questionnaire, we investigated the students' perception of their respective training, their motivation and professional plans. At the Faculty of Odontology in Lyon, the new curriculum is perceived as an increased strain by the dental students.

Dental economics: a non-subscription dental journal

The editor of a non-subscription publication for dentists explains the advantages of having a journal whose contents are driven by advertising revenue unrelated to products or services mentioned in the journal and free from political influence as well. The drive on the publication is reader interest rather than author or publisher philosophy, and surveys and other methods are used to stay close to the issues practicing dentists are interested in.

To net or not to net: confessions of a 'tweener

A dentist who sees both the advantages and disadvantage of participation on Internet chat rooms (listservs) reflects on his own participation in this medium. Allowing for individual differences, listservs permit great flexibility and offer alternatives for remaining professionally connected that are between the passivity of reading and the risk of confrontation of face-to-face meetings. Some personal suggestions are offered for good citizenship on the Internet.

Water fluoridation and costs of Medicaid treatment for dental decay--Louisiana, 1995-1996

Treatment costs for dental decay in young children can be substantial, especially if extensive dental procedures and general anesthesia in a hospital operating room (OR) are needed. Because caries in the primary dentition disproportionately affect children from low-income households, the cost for care frequently is reimbursed by state Medicaid programs. To determine whether the average treatment cost for Medicaid-eligible children in Louisiana differed by community fluoridation status, the Louisiana Department of Health and Hospitals (LDHH) and CDC analyzed Medicaid dental reimbursements and Medicaid eligibility records from July 1995 through June 1996 for children aged 1-5 years. Findings suggest that Medicaid-eligible children in communities without fluoridated water were three times more likely than Medicaid-eligible children in communities with fluoridated water to receive dental treatment in a hospital OR, and the cost of dental treatment per eligible child was approximately twice as high.

Dental management service organizations. Lessons from medicine

BACKGROUND

While management service organizations are new to dentistry, they have existed in medicine for many years. The author examined why they developed and what happened to three of them during 1998 to provide dentistry with insights into the future of dental management service organizations, or DMSOs.

METHODS

The author identified and examined the three largest physician practice management firms, or PPMs, as of early 1998. He monitored their stock prices and fiscal changes through 1998. He also tracked all publicly traded DMSOs for growth and evaluated their stock price changes.

RESULTS AND CONCLUSIONS

Economic pressures to control the cost of health care led to the development of organizational structures designed to increase the cost effectiveness of, and to control more variables associated with, health care delivery. The lure of vertical integration of health care delivery with the resultant control of multiple variables-including primary and specialty care, pharmaceuticals and hospitals-promoted the development of many PPMs and DMSOs, although many variables differ for dentistry.

PRACTICE IMPLICATIONS

The realities associated with the loss of control in the corporate model, the lack of sufficient operating margins to support investor expectations and plummeting stock prices call into question the wisdom of universally embracing similar models for dentistry.

Key steps in the strategic analysis of a dental practice

As dentistry is becoming increasingly competitive, dentists must focus more on strategic analysis. This paper lays out seven initial steps that are the foundation of strategic analysis. It introduces and describes the use of service-customer matrices and location-proximity maps as tools in competitive positioning. The paper also contains a brief overview of the role of differentiation and cost-control in determining key success factors for dental practices.

The American Dental Trade Association looks at dental reimbursement: responsible consumption of appropriate dental services. Managed Care Task Force of the American Dental Trade Association

The American Dental Trade Association Managed Care Task Force has provided an extensive study of the effects of reimbursement on the dental profession and the dental trade industry. There is great variety among the needs of patients and in the reimbursement plans available. ADTA is urged to take a leadership position to ensure that programs do not restrict access, value, or quality. The key to this strategy will be communicating a consistent message to dentists, patients, benefit managers, and the research community. The message is: "Responsible consumption of appropriate dental services."

Defensive dental behaviour: illusion or reality?

Defensive medicine or defensive behaviour of physicians is considered a major problem in contemporary health care. It seems reasonable to assume that defensive behaviour also occurs in dental practice, although so far very little has been published in the dental literature on this subject. The main objective of this study was to investigate whether defensive behaviour occurs in dentistry. As a survey study 38 dentists were interviewed: 30 men and 8 women, mainly general dental practitioners with an average of 20.9 years in practice. The results of this pilot-study indicate that it is very likely that defensive behaviour occurs in dental practice, despite the fact that there is hardly any evidence of fear for malpractice claims and lawsuits among the respondents. The majority of the dentists interviewed stated that they carried out some treatments at their patient's request although they did not believe the treatment to be necessary from a professional point of view. A motive for deliberately refraining from treatment is lack of dental motivation by the patient and poor oral hygiene. According to some respondents patients are sometimes referred unnecessarily to specialists. Also 'difficult' patients run the risk of unwarranted referral to specialists, and, moreover referrals because of insurance reasons are mentioned. The financial situation of the patient and the defensive behaviour of dental practitioners seem to be closely connected.

[Supplementary insurance: yes or no? An investigation into the motives of patients]

Of the group of dentate adults taking part in the Public Health insurance scheme, 78% has opted for a supplementary insurance for dental care after the dental health care reform on January 1, 1995. For edentulous people this figure is 33%. Both for people who choose for a supplementary insurance and for those who did not, financial motives were most important. For the dentates visiting a dentist regularly, the time period between two check-ups has grown from 6.0 months to 6.9 months. The extent to which check-ups are postponed is not different for people with or without a supplementary insurance for dental care.

The business of dentistry. Financial experts look at the future of the dental industry

A financial conference, held in February, took a look at where the dental industry is heading. Given the consolidations already apparent in the manufacturing and laboratory aspects of the profession and the growth of managed care companies, what does the future hold for the profession?

The patient and the shifting health-care paradigm

The public's image of the relationship between the health care provider and his or her patients has shifted. This relationship was once seen by the public as being based on trust, compassion, and good will and now is viewed as much more subject to negotiation. The public's perception of dentists and physicians is that they have been seduced by technology, money, and specialization and that they have little time for patients' concerns, wants, and needs. Moreover, there has been a dramatic expansion of patient choice including treatment alternatives and providers. Never before have patients had access to so much information (and misinformation) about treatment, options, materials, and alternatives. All of these factors contribute to a growing discontentment among patients and practitioners. Practice management courses are full of recommendations for shifting the unflattering perception of dentists and physicians to one of more "patient-centeredness." On the other hand, many dentists and physicians are frustrated because for them the patient has always been the center of the caregiving. For many caregivers and patients, it has become far too easy to alternately blame each other, other health care providers, the insurance industry, etc. for being the villain. This paper focuses on what patients want from their dentists. Patients have always assumed that the dentist is competent, reliable, and sincere. What patients also want today is to be involved and educated about their treatment options. Further, they want the dentist to listen, pay attention to their concerns, and to treat them as individuals.

Economic issues in the development and use of practice guidelines: an application to resource allocation in dentistry

In this paper, the extent to which practice guidelines using cost-effectiveness data can be used to inform programme decisions is analysed. In particular it is shown that guidelines aimed at informing individual patient-provider decisions are unable to reflect the economic concepts that are required to inform public decisions concerned with making best (i.e., most productive) use of the resources available to serve defined populations. The research on which practice guidelines are based represents an important but incomplete source of information for taking decisions about which clients to serve, with which services, and when in the disease process, in the context of provision of services to groups or populations. Moreover, the inappropriate use of 'individually focused' guidelines to inform 'collectively-focused' decisions can lead to more harm than good. An alternative approach for dealing with the difficult choices faced by decision makers involved in public programmes is identified. An illustration of the proposed approach is presented concerning the provision of pit and fissure sealants to children served by a public health clinic.

The vocational training scheme: decision-making in relation to general dental practitioners participating as scheme trainers

In recent years, well-documented changes have occurred in the patterns of oral disease and, as a result, the scope and complexity of dental treatments has widened considerably. In response to this the Department of Health has introduced a compulsory one-year postgraduate vocational training scheme [VTS]. In this scheme, new graduates spend time in approved general dental practices, trained by selected general dental practitioners [GDPs] who are seen as having 'best practice' standards. For the VTS to succeed it will require the continued support of these 'best quality' GDPs who at the moment are competing for places as trainers. Such competition has not always existed and this paper describes a decision-making model for trainers which was developed because future external influences could reverse this competitive scenario, with a major effect on the postgraduate training programme.

The dental curriculum: what should be new in the 21st century?

Dental education is at a critical juncture. The success of water fluoridation has reduced the caries burden of Americans and, consequently, has raised questions about the disproportionate technical emphasis on treating the sequelae of caries in US dental schools. Additionally, several powerful external factors-such as changing demographics, advances in biological science, fundamental changes in our health care delivery system, and a modest US economy-are forcing dental educators to question the appropriateness of retaining the current dental curriculum into the 21st century. The author considers these factors, suggests what type of dentist will be needed by society in approximately 20 years, and concludes that today's dental educational system is inadequate to produce such a dentist. Several elements, in addition to technical excellence, are required for the dental curriculum, including major changes in pedagogy, relevant science training, practical fluency in medicine, an increased mix of stomatologic skills, and broader contact with other health care providers.

Dental practice in New York State counties. 10-year economic analysis

Results from a series of Federal reports indicate a continuing up-turn in dental economics in New York State through the early 1990s. A review of dental practices at the state and county level document these developments.

[Analysis of the variability of primary care costs]

OBJECTIVE

To find the costs of Primary Care services and centres and identify the variables which enable the possible differences between them to be explained.

DESIGN

Cost analysis study.

SETTING

Primary Care Centres.

PARTICIPANTS

15 Primary Care Centres managed by the Catalan Health Institute.

MEASUREMENTS AND MAIN RESULTS

Costs of chapters 1 (staff), 11 (running costs) and 1V (medicines) of the accounts for the 1993 exercise and possible cost variability between services and Health Centres were analysed. The cost per inhabitant of services was, in order of importance: general medicine (18,873 pesetas per inhabitant), Paediatrics (16,204), Odontology (638) and Social Work (255). The mean cost of Primary Care Centres was 19,137 pesetas per inhabitant. The variables which seemed to explain variability of operating costs were: for general medicine, the inhabitant to doctor ratio (r2 0.31, p < 0.02); for Paediatrics, the number of attendances (r2 0.35, p < 0.01); and for health centres, the inhabitant to doctor ratio, teaching and number of attendances (r2 0.75, p < 0.001).

CONCLUSIONS

The analysis of costs of services and centres enables us to identify and compare results between different suppliers, which can be useful when we need parameters to measure efficiency.

[Current trends in antibiotic therapy in dentistry]

The place and role of surgical, dental physio- and pharmacotherapy in oral and head and neck diseases has been debated for decades. In addition the price and reimbursement system had been changed lately in our country that also underlines the relevance of this issue. The overconsumption (1.7 packages per inhabitant per year) of antibiotics is also proven in Hungary. Beside surgical and dental interventions the treatment of dental inflammations caused by pathogenics requires the administration of different kinds of antibiotics. The first choice antibiotic is determined on the base of clinical features and general resistance of oral flora in the given period. When the first choice antibiotic proves to be ineffective, treatment has to be followed by antibiotics determined on individual resistance. In stomatology antibiotics are administered for prevention or treatment of dental inflammations. The length of therapy has a great importance which is usually 4 days in prevention and 5 days in treatment of dental inflammations. The modern antibiotics have to comply with the following requirements: efficacy, safety and cost-effectiveness. The typical mistakes in the administration of antibiotics can be avoided by the application of therapeutical schedules. The macrolide and cephalosporin derivates have become more and more popular. The mixed bacterium flora has been changing in time and also influenced by geographical factors depending on the habit of prescriptions. Therefore the experiences obtained in other countries are not applicable.

The spatial distribution and geographic analysis of endodontic office locations at the national scale

The major purpose of this article was to quantify and describe the spatial distribution of endodontic office locations at the national scale. This study consisted of 2858 US American Association of Endodontists member endodontists as subjects. Three research questions were developed and explored. The location quotient technique, the spatial autocorrelation approach, and the multiple-regression procedure were the major analytical methods. Major results were as follows: the highest concentration (2.09 to 2.62) of endodontic offices per 100,000 US population was located in just two states, Massachusetts and Connecticut; the spatial distribution of endodontic office locations did exhibit significant (p < or = 0.05, two-tailed test) spatial autocorrelation. Therefore, the spatial distribution of endodontic office locations was nonrandom. Individually, the most significant predictor of endodontic office locations was the location of general practice dentists (its beta coefficient was 0.960606, significant at p < or = 0.0001).

Medicine one of many professions battered by latest recession

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The orthodontic practice ownership transition

Any orthodontist contemplating a transfer of ownership interests would be well served ensuring that the decision-making process is handled objectively and analytically and that appropriate advice is acquired before entering into an arrangement. Boiler plate agreements and rules of thumb do not work any more effectively than developing a single diagnosis and treatment plan for all patients.

Cost-conservative dentistry: appropriate dentistry at lower cost

Dental practitioners in both private and public dentistry are faced with patients who for reasons of public or private finance are not able to be treated with the most sophisticated available dentistry. A concept of appropriate dentistry is provided whereby, with reference to available literature, it is shown that cost-conservative treatment can be provided that is likely to be satisfactory to both the client and the practitioner.

Profit prophet

Immense resources have been channelled by the business world into the analysis of future trends, control of processes and costs, and the application of the behavioural sciences. Dentistry, still deeply into cottage industry methods and performance, can transform itself through these discoveries by opening up to new ways of seeing its problems and solving them.