Initial incremental dental care for the Leeds Primary School

Economic specification of cost estimates in dental programs

This paper compares two approaches to the estimation of costs in dental care programs: a conventional approach and an approach based on theoretical expectations. The conventional approach typically uses a linear extrapolation of an average figure - e.g., cost per visit - over various program sizes and thus predicts constant costs. Constant costs are, however, theoretically implausible, and it should be anticipated that their use in program planning or analysis would generate biased estimates. This hypothesis is examined using annual costs and visits from a group of uniform clinics over a five-year period. Results show that costs calculated by the conventional method are underestimated at low volumes and increasingly over-estimated at higher volumes. The findings, which illustrate how in-efficiency can inadvertently be incorporated into program design, have implications for cost-effectiveness of dental care delivery in the public sector.

The estimation of need for dental care

This paper presents a background discussion of the estimation of normative need for dental care. Definitions are given which differentiate normative need for dental care from perceived need, demand, or utilization. Four different approaches to obtaining estimates of normative need for dental care are outlined. They are the translation of data from surveys of dental status, surveys of need for dental care, analyses of service or treatment records, and best judgment of dental practitioners. Present limitations within the four aproaches to estimating need to include factors such as objectivity, directness, completeness, precision, and extent of population coverage. Applications of estimates of need for dental care are identified in the areas of evaluation, setting of priorities, and planning of dental health programs. Current developments in the area of health services, including the concepts of an adequate minimum standard for personal health services, quality assurance, and rationing by need, are seen as providing some impetus for greater interest in need for dental care. Future directions in the estimation of dental needs will depend upon the validation of the approaches outlined, as well as general factors including costs of collecting data on dental status and need for dental care in population.

Diagnostic and preventive services in a national incremental dental plan for children

A modelling exercise was carried out to examine the potential expenditure in a national incremental dental program for children aged six to 13. Using Relative Value Units (RVUs) as a proxy for dollars, the relative expenditures for care per child in fluoridated and fluoride-deficient areas were assessed. Dental treatment requirements were taken from existing data as far as possible. Arrangements for the delivery of care were based on existing pocicies of the American Dental Association, an services delivered were based on the recommendations of the American Academy of Pedodontics and the American Society of Dentistry for Children. Orthodontic care was limited to space maintainers and simple interceptive care. Children were assumed to receive initial care at age six, and annual maintenance care from ages seven to 13. The results showed that although restorative care would be 49.8 percent less expensive for children in fluoridated areas, total care would be only 11.9 percent less expensive. The major reason for this difference was the high proportion of annual maintenance-care costs that would be absorbed by diagnostic and preventive services using UCR fees. The necessity for much of this care is questioned under the conditions of this model, and some methods by which the dental profession might control the relatively high cost of diagnostic-preventive services are suggested.

Costs of publicly financed dental care for children in three different types of practice settings

This analysis of the Chattanooga Program has provided preliminary findings on the relative cost of providing dental care through three different modes of care delivery: private practice, public fixed clinics, and public modile clinics. Significant differences in costs were found. It is reasonable to conclude, tentatively, that public services were being used more efficiently than private services in the delivery of dental care involved in this program. The results contest the findings of previous studies which indicated that mobile clinics were relatively inefficient. This study, however, based on a limited time period and refers to a specific program. It would, therefore, be inappropriate to generalize too hastily from the results. At this time, further research is being conducted to extend the period of analysis, and to deal explicitly with differences in patient characteristics, service mixes, and quality, to explain the economic reasons for the apparent differences in efficiency by delivery mode, and to consider the implications of the findings for dental policy.