Dental Use and Spending in Medicare Advantage and Traditional Medicare, 2010-2021

This cross-sectional study examines Medicare Advantage and traditional Medicare beneficiaries’ use of and spending for dental services.

The Management of Dental Practices in the Post-COVID 19 Era: An Economic and Operational Perspective

Background: In order to protect dental teams and their patients during the COVID-19 pandemic, dentists have had to adopt several measures (operating and post-operating procedures) which may increase the total treatment time and costs relating to individual protective measures. This paper will propose a thorough analysis of operating dentistry procedures, comparing the economic performance of the activity in a dental surgery before and after the adoption of these protective measures, which are required to contain the risk of SARS-COV-2 infections. Methods: The economic analysis is articulated in three approaches. Firstly, it assesses a reduction in markup by maintaining current charges (A); alternatively, it suggests revised charges to adopt in order to maintain unvaried levels of markup (B). And the third Approach (C) examines available dental treatments, highlighting how to profitably combine treatment volumes to reduce markup loss or a restricted increase in dental charges. Results: Maintaining dental charges could cause a loss in markup, even rising to 200% (A); attempting to maintain unvaried levels of markup will result in an increase in dental charges, even at 100% (B); and varying the volumes of the single dental treatments on offer (increasing those which current research indicates as the most profitable) could mitigate the economic impact of the measures to prevent the transmission of SARS-COV-2 (C). Conclusions: The authors of this paper provide managerial insights which can assist the dentist-entrepreneur to become aware of the boundaries of the economic consequences of governmental measures in containing the virus infection.

Competition and market structure in the dental industry

We use Survey of Dental Practice data from 1983 to 2012 to examine market power of dentists and hygienists in private practice. Our findings are consistent with a dental market wherein practices use hygienist services as a "loss leader" in order to steer patients into more lucrative dental services, which exhibit the ability to markup price above marginal cost. Both dental care exhibits an elasticity of demand of roughly - 0.2, while hygienist care exhibits and elasticity of demand of nearly - 0.6. Another theme that emerged from our findings is the evidence for significant economies of scale in the dental market. The overall returns to scale parameter of 2.1 suggests significant increasing returns to scale are available to the typical dental practice. Given that the typical practice has 1.5 dentists, the finding is not surprising. While returns to scale diminishes with visit volume, the largest quartile of practices still has meaningful increasing returns to scale of roughly 1.75.

Consolidation in the dental industry: a closer look at dental payers and providers

We examine the effect of commercial dental insurance concentration on the size of dental practices, the decision of dentists to own a practice, and the choice of dentists to work at a dental management service organization-a type of corporate group practice that has become more prevalent in the United States in recent years. Using 2013-2015 dentist-level data from the American Dental Association, county-level data on firms and employment from the United States Census, and commercial dental insurance market concentration data from FAIR Health^®, we find a modest effect of dental insurance market concentration on the size of dental practices. We also find that a higher level of commercial dental insurance market concentration is associated with a dentist's decision not to own a practice. There is inconclusive evidence that higher levels of dental insurance market concentration impact a dentist's decision to affiliate with a dental management service organization. Overall, our findings imply that dentists consolidate in response to increases in concentration among commercial dental insurers.

COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers

The novel COVID-19 came under limelight few months back (December 2019) and has recently been declared a pandemic by WHO. It has resulted in serious financial implications being faced by dental practices, hospitals and healthcare workers. Dental practice currently is restricted to provision of emergency dental care whereas, many hospitals have also cancelled elective procedures to save finances for COVID-19 treatment which is expensive and unpredictable. In addition, healthcare workers are also facing financial challenges in this difficult time. Competent authorities should step in to help dental practices, hospitals and healthcare workers in order to ensure the provision of all types of healthcare efficiently in these testing times and beyond.

Financial conflicts of interest in dentistry: how much money do providers receive from industry?

The purpose of this retrospective, observational study was to characterize the amounts and types of healthcare industry payments made to dental care providers in 2017. Data were collected from the Open Payments database of the US Centers for Medicare & Medicaid Services. Dentists were classified as providing general services or services in 1 of 9 specialties recognized by the American Dental Association (prior to the recognition of dental anesthesiology). The value and nature of each payment made to providers were recorded, and descriptive statistics were calculated. Distributions across dental specialties were compared with analyses of variance. In 2017, US dentists received a total of 321,627 industry payments totaling $110,750,601. The most money was spent on service fees ($37,333,870; 33.7%), followed by consulting fees ($12,983,013; 11.7%) and royalties and licenses ($11,426,776; 10.3%). Each provider received a median payment of $63.27 (range, $0.21-$22,931,027.12) spread over 2 payments (range, 1-285). Participation rates among dental specialists ranged from 19% to 62%, and the highest rates were found among orthodontists (61.8%), oral and maxillofacial surgeons (55.7%), and periodontists (54.6%). The greatest median payments per provider were made to specialists in oral and maxillofacial radiology ($187.52), periodontics ($127.31), and oral and maxillofacial surgery ($123.39). The mean number (P < 0.01) and amount of payments (P < 0.01) per provider differed significantly across all specialties. The majority of dentists in this study received less than $200; however, the distribution of payments was positively skewed by a few top earners. The effect of these payments on clinical practice remains to be determined.

Oral health of high-cost patients and evaluation of oral health measures as predictors for high-cost patients in South Korea: a population-based cohort study

OBJECTIVE

To examine the oral health conditions and oral health behaviour of high-cost patients and evaluate oral health measures as predictors of future high-cost patients.

DESIGN

A retrospective, population-based cohort study using administrative healthcare records.

SETTING

The National Health Insurance Service (NHIS) medical check-up database (a.k.a. NHIS-national health screening cohort database) in South Korea.

PARTICIPANTS

131 549 individuals who received biennial health check-ups including dental check-ups in 2011 or 2012, aged 49-88.

PRIMARY OUTCOME MEASURES

Current and subsequent year high-cost patient status.

RESULTS

High-cost patients, on average, incur higher dental costs, suffer more from periodontal disease, brush their teeth less and use secondary oral hygiene products less. Some of the self-reported oral health behaviours and oral symptom variables show statistically significant associations with subsequent year high-cost patient indicators, even after adjusting for demographic, socioeconomic, medical conditions, and prior healthcare cost and utilisation.

CONCLUSIONS

We demonstrate that oral health measures are associated with an increased risk of becoming a high-cost patient.

Grey Matters: 2006 and all that

The article is intended to put the current NHS dental contract in england into context and identify areas where there has been confusion about interpretation of certain clauses. the article describes these as grey areas and provides a rationale for logically interpreting these issues, such as urgent treatment, mixing NHS and private treatment and defining what a course of treatment is.<br/> These are the views of the authors based on significant personal experience of the contract, both as practitioners and as dento-legal advisers.

Modeling patient's value using a stochastic approach: An empirical study in the medical industry

BACKGROUND AND OBJECTIVE

The rapid growth of computer methods encourages and creates competitive advantages in the medical industry. Nowadays many health centers try to build successful and beneficial relationships with their patients using customer relationship management (CRM) methods, to recognize target patients, attract potential patients, increase patient loyalty and maximize profitability. Customer lifetime value (CLV) is a metric that can help organizations to calculate their customers' value or group them; therefore in this research we aim to develop a new CLV model for the medical industry that groups patients using computer-based methods.

METHODS

To model CLV for the medical industry, we will use two computer-based methods. First, to model patients' behavior, a data mining approach is required: the K-means algorithm is used to cluster patients and the decision tree technique is used to analyze patient clusters. Next, Markov chain model, a stochastic approach, is utilized to predict future behavior of customers RESULTS: This paper proposes a new CLV model for the medical industry that has some benefits over other CLV papers. It is patient behavior based, helping us to predict the future behavior of each patient as well as helping to modify managerial strategies for each type of patient. The derived CLV model includes less than 0.08 error rates.

CONCLUSIONS

Using the derived CLV model helps health centers to group their patients by computer-based methods, which makes their decision making more accurate and trustworthy. The present research helps organizations within the health industry to group and rank their patients by a new CLV model and fit their strategies to each patient group, based on his/her behavior type.

[Health economics and oral care: an introductory anthology]

Healthcare expenditures will continue to increase in the coming years, raising questions regarding the sustainability of the Dutch healthcare system and solidarity, but also about the optimal use of available resources. Given the issues in the oral care sector, attention for economic insights is appropriate there as well. Relevant issues in this regard are the design of the basic and supplementary health insurance schemes for oral care, the market structure and financing of oral care, questions regarding task shifting in oral care, as well as socio-economic inequalities in oral health. A closer cooperative relationship between oral care and the health economy can help in achieving an optimal and sustainable organisation of the Dutch oral care sector. In other words, an organisation contributing in an efficient and fair way to good oral care for all Dutch citizens.

[Opinions about oral care: an online questionnaire among readers of NTvT]

By means of a brief online questionnaire with 12 statements about the organisation, quality and impact of oral care in the Netherlands, the readers of the Netherlands Journal of Dentistry (NTVT) were asked to express their opinions on a number of important subjects concerning oral care in the Netherlands with respect to health economic matters. A total of 237 readers (61% men, 39% women) completed the online questionnaire. 70% of them were working as dentists and had been active in a practice for between 31 and 40 years. According to the study, a shift from curing to prevention was considered to be necessary. Most of the respondents also thought inequality in oral health in the Netherlands is increasing and people avoid going to the dentist due to the associated costs. In conclusion, most oral care providers appear to be reasonably positive about Dutch oral care. Attention for prevention, appreciation of oral health and the reduction of inequality in oral care continue to be necessary.

Dental Economics and the Increasing Hispanic Population in the U.S. and New York State

The continuing dramatic increases in the U.S. Hispanic population are considered relative to the economic concerns of dental practice. Oral health needs, limited finances and health insurance, together with varying cultural orientation, are reviewed in terms of the potential for growing Hispanic political strength.

Tennessee Dental Establishments: 2007-2012 Economic Survey

OBJECTIVE

To document the evolving economies of dental establishments in the State of Tennessee during a period of significant growth of the number of establishments before and after the "Great Recession."

METHOD

Published results from the five-year economic surveys by the U.S. Census Bureau on business receipts and salaries of employees (including dentists) for the State of Tennessee and its counties were used to construct a review of these developments.

RESULTS

Between 2007 and 2012, there were continued increases in average current dollar business receipts and employee salaries. However, in terms of standard dollars, removing the effects of inflation: 1) business receipts increased in 19 counties but decreased in 37 counties; 2) employee salaries increased in 13 counties but decreased in 30 counties.

CONCLUSIONS

Results are in line with the reports by the ADA Health Policy Institute, which indicate that nationally the percentage of dentists who report they are not busy enough has increased and dentists' earnings are stagnating. The need is to expand the delivery of care to underserved populations, including the poor, individuals with disabilities, minorities and new immigrant populations, for whom oral health services may not be a priority commodity.

Massachusetts Dental Establishments: 2007-2012 Economic Survey

Every five years, a series of studies is carried out by the U.S. CensusBureau that provides an opportunity to review the basic economic well-being of many industries at the national, state, and county level.-A comparison of dental economic data from the 2007 and 2012 stud es for the period that encompassed the 2007-2009 "Great Recession details the general economic difficulties faced by the dental profes-ion during this period. "While much of the economy has recovered since the Great Recession, the earnings of general [dental] practitioners have not, according to the ADA. In fact, 2014's average earnings of $174,780 for all GPs follow 2013's average of $183,885 and come at the end of a nearly decade-long decline since 2005's inflation-adjusted peak of $219,378"1¹Previous presentations in the JOURNAL OF THE MAsSSCHuUSTTs DENTAL Socimetyreviewed concerns regarding national dental economics and dental practice in relation to population changes in Massachusetts.2,3 More recent information is now available for business receipts for dental establishments with employees at the state and county levels that provides an opportunity to consider economic factors and dental practices from another perspective.

Ethics, Economics and Dentistry for Individuals with Disabilities in New York State

The ADA Principles of Ethics and Code of Professional Conduct is an expression of the obligation occurring between the profession and society to meet the oral health needs of the public. At a time of economic concerns for the profession, suggestions are made to bring together the ethics of the profession and the need to expand services to underserved populations, including individuals with disabilities and the poor. The profession's effort to secure economic support for such an effort is possible with increased legislative awareness of the magnitude of the problem. To this end, the number of individuals with disabilities was developed for each Congressional district in New York State in an effort to challenge members of Congress to recognize the need in terms of their constituents, rather than in terms of the tens of millions with disabilities in the United States-which become "just numbers," not actual people.

INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE. A PATHWAY TO BETTER PATIENT CARE, IMPROVED HEALTH, AND LOWER COSTS

Dentistry usually concerns itself with managing the scope of practice relationships with areas historically performed by dentists as solo practitioners. Many trends in health care-such as electronic records, Big Data, consolidated reimbursement systems, effective but expensive technology, the economies of group practice-are now overwhelming the boundaries of tasks performed in isolation. The Commission on Dental Accreditation has added a standard that dental education programs must prepare professionals to function in these new environments.

Systematic Review and Quality Appraisal of Economic Evaluation Publications in Dentistry

Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved (P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.

Health system characteristics and unmet care needs in Europe: an analysis based on EU-SILC data

Using survey data from the 2009 wave of the European Union Statistics on Income and Living Conditions, this study examines the determinants of unmet needs for medical and dental care in European countries. Special emphasis is put on the impact of health system characteristics. Four factors are taken into account: the density of doctors or dentists, the rules governing access to practitioners, the method of paying primary care physicians, and the amount of out-of-pocket payments. The analysis is carried out using multilevel logistic regression models. Separate regressions are estimated for medical and dental services. The dependent variable is whether respondents reported that, at least once in the last 12 months, they needed care but did not receive it. The estimation results show that the probability of experiencing unmet medical or dental needs varies noticeably across countries. This inter-country variability seems to be partly explained by the differences in the financing of health care. Indeed, a positive link is found between the share of households' out-of-pocket payments in total health expenditure and the probability of unmet needs. The other contextual factors do not seem to play a significant role.

A macroeconomic review of dentistry in Canada in the 2000s

OBJECTIVES

To describe trends in expenditures on dental health care services, the number of dental health care professionals and self-reported dental visits and cost barriers to dental care in Canada from 2000 to 2010.

METHODS

Data on licensed dental professionals; total expenditures on dental care, both public and private; and mean per capita amount spent on dental care were obtained from the Canadian Institute for Health Information. Information on self-reported dental visits and cost barriers to dental care were collected from the Canadian Community Health Surveys and the Canadian Health Measures Survey. To compare Canada with other countries, data from the Organisation for Economic Co-operation and Development (OECD) were used.

RESULTS

From 2000 to 2010, the number of licensed dental professionals increased by 35%, with a particularly large rise in the number of dental hygienists (61%). Total real expenditures on dental care, after adjusting for inflation, increased by 56%, while the percentage of dental care expenditures paid by private insurance and through public funds decreased. Mean per capita expenditures increased from $233.94 in 2000 to $327.84 in 2010. Compared with other OECD countries, Canada ranked among the highest in mean per capita spending on dental care, but among the lowest in terms of public share. The proportion of people reporting a dental visit in the past year increased from 60.3% in 2001 to 75.5% in 2009, and those reporting cost barriers increased from 15% in 2001 to 17% in 2009.

CONCLUSIONS

The dental care market appears to be growing, with increases in licensed dental professionals, total and mean per capita dental care expenditures and self-reported dental visits. However, these increases are not necessarily associated with greater effectiveness in meeting population needs and outcomes, such as equity in financing, delivery and improvements in oral health. Concerns with the financing of dental care and related issues of access may have implications for the future of dental care in Canada.

[The support of National Natural Science Foundation of China prompts the progress and development of basic research of dental and craniofacial research: a 25 years review]

OBJECTIVE

To investigate the effect of National Natural Science Foundation of China (NSFC) on the progress of dental research from 1986 to 2010.

METHODS

The data regarding the NSFC allocated to dental and craniofacial research from 1986 to 2010 were collected. Total expenses and numbers of the majority of programs and the situation of completed program finished in recent 7 years were provided.

RESULTS

From 1986 to 2010, a total of 922 projects and 204 401 thousands Chinese Yuan supported by NSFC were allocated to dental research. The detailed allocations were as follows: general program (564), young scientists fund (258), regional fund (40), key program (11), national science fund for distinguished young scholars (5), major international (regional) joint research program (1), others (43). The grants of talent training increased dramatically. Taking the projects (307) completed between 2003 and 2009 for example, 307 papers were published in Science Citation Index (SCI) included journals and 1049 papers were published on Chinese journals. By the time of completion of the projects, 39 post-doctoral students, 590 students for PhD degree and 670 students for Master degree had been trained.

CONCLUSIONS

Over the past 25 years, the continuous increase of NSF on dental research has led to substantial achievement, resulting in great progress of dental oral-cranio-facial research.

An investigation of the attitudes and fears of vocational dental practitioners in England and wales in 2007

AIM

The aim of this study was to investigate whether recent changes in the National Health Service (NHS) dental contract may have caused increased anxiety and concern among vocational dental practitioners (VDPs).

METHOD

A total of 606 questionnaires, which had previously been piloted, were distributed to VDPs across England and Wales at the end of the vocational training (VT) year in 2007. The questionnaires contained a range of questions about VDPs' attitudes and fears, the influence that they perceived the new dental contract for the General Dental Services of the NHS had on their VT training experience, and their expectations for the future.

RESULTS

A 71% response rate was achieved. The results reflected changes in opinion about the dental profession among VDPs between when they applied for university and six years later on their completion of VT. During this period, they reported that their feelings of job security had declined from 93.1% (n=390) to 34.1% (n=145) and financial security from 94.8% (n=405) to 51.5% (n=219). Anxiety about the potential lack of funding in the NHS was felt by 77.6% (n=330). The effect of increasing numbers of dental graduates on employment prospects produced anxiety in 72.5% (n=305) of VDPs. On completion of VT, 19.4% (n=83) of VDPs did not have employment for the following year.

CONCLUSION

At present, the future is more uncertain for new dental graduates than in the past. The dental profession needs to become more aware of the pressures that graduates are facing and further research is needed to investigate them and the effects that they are having on the future of dentistry.