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

Relative value of dental procedures

This study was conducted to develop a relative value method for dental procedures, and to evaluate the differences in values assigned by private and public sector dentists. Samples of 90 general practitioners and 120 clinical specialists were systematically drawn to represent all actively working Finnish dentists. The dentists were asked to assess the required time and know-how for performing various procedures compared to performing a two-surface amalgam filling (AF2). At the end, the dentists were asked to divide the value of 200 between time and know-how for the reference procedure (AF2). These figures were then utilized to calculate the average relative value for each procedure. Private practitioners' weighted relative values were 55.3% higher than the prices, and among public sector dentists they were 27.9% higher. Overall, know-how constituted more of the total value of the procedures than did time. Private practitioners' time assessments correlated well (r = 0.72-0.95) with the recommended prices. However, significant differences were often observed both in time and know-how assessments of individual procedures. Both time and know-how seem to be important factors when determining values for dental services. For evaluation of the value of output in the private sector, the use of prices is justified. However, when the productivity of non-profit dental offices is evaluated, a value system which is not based on market prices is needed.

Replacement of amalgams with crowns: a cost-effectiveness analysis

No formal analyses comparing the treatment alternatives of replacing a failed amalgam with either another amalgam or crown have been done to determine the optimum treatment strategy based on lifetime costs to the patient. Using decision analysis, a computer model was developed of the lifetime restorative needs of an adult's posterior tooth. A cost-effectiveness analysis of large amalgams vs crowns was then done to determine the optimum strategy. According to the analyses, the optimum treatment decision is to attempt to replace the failed first amalgam with another amalgam, instead of with a crown. When this amalgam restoration fails, then the subsequent replacement may be with a crown. Potential lifetime cost savings were between 11% and 24% if the first replacement was an amalgam. This study concludes that the technique of decision analysis provides the dental community with an effective evaluation tool for the study of clinical decision-making, taking into account all levels of clinical uncertainty.

An analysis of onsite versus offsite dental care for an institutionalized population

The Job Corps is a program for disadvantaged youths between the ages of 16 and 22 in need of general education and vocational training. During fiscal 1978, 61 residential centers had a total enrollment of 33,732. Despite differences in size, location, and organizational structure of the centers, uniform requirements for health services have been established. The administration at each center must ensure emergency dental care, arrange for examination of all corps members, and make routine treatment available on a priority basis. Because of uniqueness of local situations, various mechanisms are used to accomplish these goals. The most fundamental difference is the provision of care by means of onsite clinics with salaried dentists as opposed to offsite arrangements with fee-for-service in private dental offices. An analysis of cost and utilization data for the 1978 FY indicated that onsite care ($96.19/CMY) was significantly more expensive than offsite care ($72.24/CMY). The difference in the mean number of visits, however, was also statistically significant. Onsite care resulted in 4.78 visits/CMY; corps members made 2.24 visits/CMY when offsite care was provided. Furthermore, even taking into consideration the initial expenses involved in establishing clinical facilities, the cost of an onsite visit, $22.30, was less than an offsite visit, $33.62. The cost and utilization patterns were the same at small centers as large centers.

On-center vs off-center dental care for Job Corps members: cost and utilization

While Job Corps Centers vary in size, location, and administrative structure, they are subject to uniform requirements for health services, established by federal regulation and must make individual decisions about whether to furnish dental care on-site or by some alternative arrangement in the community. Analysis of cost and utilization data indicated that expenditures for on-site dental care are greater than for off-center care. However, on-center care results in more dental visits and a lower cost/visit. These observations hold even for the smallest size centers.

Combination of school-based primary and secondary preventive dental programs in the United States and other countries

School-based programs in the United States are very limited. Other countries in the world have established programs for many years which provide comprehensive services to school-age children. In this country philosophical and professional pressures have maintained school-based programs only in the area of primary prevention. Most treatment programs involving secondary prevention are not school-based and are targeted at specific population groups rather than all children. The basic questions of whether primary and secondary preventive school-based programs can be successful have been examined in this paper. The evidence based on the pilot program presented here is that these programs can be successful. They are well accepted by parents and children, they provide quality care at a reasonable cost, and, most importantly, they can reduce dental disease. It's time for a committment by the profession and the nation to establish school-based dental programs for the health and welfare of our children.

Aspects of planning and evaluation of children's dental care in Appalachia

The dental public health literature contains almost no information on caries experience and treatment needs of Appalachian children, and little information concerning resource requirements for children's dental care programs in general. Data from three dental treatment programs in Appalachia are summarized for purposes of planning and evaluation of similar programs. Age specific caries and service experiences are presented, and evaluation criteria and planning considerations are discussed. Resource requirements, including time, cost and manpower are also presented, and special considerations for planning programs are discussed.

Expenditures for the dental care of indigent children in the Chattanooga project, 1971-1975

This paper is part of a continuing study of the cost of children's dental care in a publicly funded model program. The Program--the Chattanooga Project--was designed to provide information and experience necessary for the development of similar programs elsewhere in the United States. From 1970 to 1975 comprehensive dental care was provided, at no charge, to an average of 5,500 indigent children per year. Children were treated in private practices (39%), public fixed clinics (20%), and public mobile clinics (41%). Costs were defined as public expenditures for purchasing care from private practitioners or producing care in public practices. As a framework for the analysis, program activities and their respective costs were divided into direct and indirect components. The former relate to the provision of care and the latter to noncare-oriented activities. Direct (indirect) costs per patient were $46.56 ($16.31) in private practices, $40.17 ($16.11) in fixed clinics, and $35.49 ($13.41) in mobile clinics. These results substantiate previous findings from a shorter period. A priori reasons for differences among the three modes in terms of patients' health status or the type of care provided have been specified and are currently under investigation.