The value of adult orthodontics: Do the public's willingness-to-pay values reflect the profession's?

OBJECTIVE

To explore how the public and dental professionals would value an orthodontic service for adults by eliciting their willingness-to-pay (WTP), a standardised health economics technique which quantifies 'strength of preference' in monetary terms. Despite increasing demand, adults in the UK are only eligible for NHS orthodontic treatment if there is severe dental health or complex multidisciplinary need. Orthodontic services are provided to children aged under 18 years who are eligible by their Index of Orthodontic Treatment Need (IOTN) score. Consequently, many adults who may have a need for treatment as determined by IOTN are unable to access this service.

DESIGN

Cross-sectional survey.

SETTING

General dental practices in North East England and national specialists approached through the British Orthodontic Society (BOS).

PARTICIPANTS

Public participants were recruited from general dental practices. Dentists were recruited from local dental lists and members of the BOS.

METHODS

Participants were asked if they would be willing to pay to see an orthodontic service extended to all adults in England with a qualifying IOTN. Clinical photographs of three malocclusions were presented and maximum WTP in additional tax per household per year was elicited using shuffled payment cards.

RESULTS

A total of 205 dentists and 206 public participants were recruited. Pairwise tests showed a statistically significant difference in WTP between the public and professionals for all malocclusions, with the public giving higher valuations. In both groups, the Class III scenario elicited a higher WTP than the class I or II malocclusion. However, when all other factors were controlled for using a regression analysis, the group (public or profession) and the other variables did not significantly influence WTP.

CONCLUSION

The public and professionals were willing to pay for an adult orthodontic service. Due to this variability and unpredictability the allocation of healthcare resources will remain contentious.

Surviving orthodontic graduate debt: Making correct career choices to manage debt re-payment, reduction or forgiveness

Monetary pitfalls and traps await unwary residents upon graduation. The path to a financially satisfying personal and professional life is obtainable despite high student loan debt and limited income. Career and personal finance issues, student loan options, tax avoidance, bank lending policies, and practice purchases are reviewed. Career options of public service, salaried employee, per diem employee, and private practice ownership are compared in personal financial outcomes, taxation, and retirement consequences.

Community Orthodontists and Craniofacial Care: Results of a Washington State Survey

Background

Little is known about community orthodontists’ previous training in, experience with, or receptivity to caring for children with craniofacial disorders.

Objectives

(1) To characterize the current level of participation by Washington state orthodontists in craniofacial care; and (2) to identify factors that promote or impede community orthodontists’ involvement in caring for children with craniofacial conditions.

Design

Mail survey.

Methods

A 26-item questionnaire was designed and mailed to all active orthodontists in Washington state (N = 230). Question topics included practice characteristics, training and experience with craniofacial conditions, concerns related to public and private insurance, and communication with craniofacial teams.

Results

Of eligible respondents, 68% completed the survey. Most orthodontists’ patient panels were made up of patients who either have private insurance or pay cash for services. On average, 2% of respondents’ patients were Medicaid beneficiaries. Only 20% of respondents had seen more than three patients with cleft lip and/or palate in the past 3 years. Although a minority of orthodontists receive referrals from (27%) or are affiliated with (11%) craniofacial teams, most orthodontists perceived craniofacial care positively and were interested to learn more about craniofacial care and to accept additional patients with these conditions.

Conclusions

Results of this survey can inform potential strategies to increase access to orthodontic care for children with craniofacial disorders. These would include developing an organized training, referral, and communication system between community orthodontists and state craniofacial teams and considering a case-management approach to facilitate this process.

[THE NORMATIVE LEGAL SUPPORT OF ORTHODONTIC CARE OF POPULATION AT THE LEVEL OF SUBJECT OF THE RUSSIAN FEDERATION]

The article contends that in stomatology actual normative legal support does not handle all problems of both organization of orthodontic care of children population and control of quality of orthodontic treatment. It is assumed that in. conditions of updated federal health legislation additional efforts are to be made to enhance quality and accessibility of orthodontic care. Thereafter in the area of normative legal support procedures of organization of orthodontic care of population at the level of subject of the Russian Federation in conditions of orthodontic medical organization are to be developed additionally. The standards of curative diagnostic measures, standards of quality control, target indicators, and mechanism of audit of evaluation of effectiveness of orthodontic care at the stages of its provision.

[Comparative characteristic of sociologic study results in the field of orthodotia during the period from 2004 to 2009 (monitoring study)]

Monitoring of the results was carried out including own sociologic study in the field of orthodotia during the last 6 years. The investigation was done with the help of standardized specially developed questionnaire form reflecting the questions connected with orthodontic help appealability and population motivation to receive it. The received data let to evaluate in dynamics the orthodontic service status and prospects of its development.

[Health insurance benefits for dental and skeletal malocclusions]

In view of the large quantity of additional insurance for dental and skeletal malocclusions offered in Switzerland the benefits of 24 Swiss health insurance companies have exemplary been compiled in a table for an insured party of Zurich. This should provide an opportunity for the dentist or orthodontist to better brief his or her patient and facilitate the parents' choice of a suitable additional insurance for their child. There are great varieties in the offered benefits of the different insurance versions. The table embodies all crucial issues in a clearly presented form. All parameters were analyzed und some of them are critically discussed.

Dentistry's oldest specialty: orthodontics and dentofacial orthopedics

The American Association of Orthodontists (AAO) has 15,500 members worldwide and is the oldest and largest of the recognized dental specialties. A strategic planning process has identified six key challenges, and this article describes the progress that is being made in the areas of (a) consumer education, (b) volunteer leadership development, (c) recruitment and retention of orthodontic educators, (d) relationships with ADA and other healthcare organizations, (e) the AAO's role in international orthodontics, and (f) advocacy. The AAO is working for freedom of choice in dental healthcare providers; fee-for-service dental care; orthodontic insurance coverage as a benefit of employment, with direct reimbursement as the preferred plan; self-referred access to specialists; private and public funding that promote quality orthodontic care; and the retention of tax deductibility of dental healthcare benefits, including orthodontic care.

The success of orthodontic satellite practices

OBJECTIVE

To evaluate the financial success and personal satisfaction of orthodontists operating satellite practices.

MATERIALS AND METHODS

A questionnaire was e-mailed to 4426 members of the American Association of Orthodontists (AAO), and 817 completed surveys were returned, yielding an 18% response rate. Only replies from solo practitioner orthodontists were analyzed to limit variability among respondents.

RESULTS

Solo practitioner orthodontists with satellite practices reported an increase in net profit and started significantly more cases than orthodontists with one office. Yet, only 27% of respondents with one satellite and 48% of practitioners operating multiple satellites recommend opening a satellite practice. Ninety-two percent of orthodontists stated they were satisfied with the clinical aspects of their practice, and 99% of orthodontists described themselves as happy and satisfied individuals.

CONCLUSION

Despite the ability of a satellite office to expand a patient base and increase net income, most practitioners would not encourage young orthodontists to establish a satellite office.

Cost-effectiveness and patient satisfaction: Hawley and vacuum-formed retainers

In the United Kingdom (UK) over the last 10 years, there has been a significant increase in the use of vacuum-formed retainers (VFRs) rather than conventional Hawley retainers. There are currently no data to compare the cost-effectiveness of this change in practice. The two aims of this study were to compare (1) the cost-effectiveness of VFRs and Hawley retainers over 6 months, from the perspective of the National Health Service, orthodontic practice, and the patient and (2) patient satisfaction in the two retainer groups. A randomized controlled trial (RCT) was carried out in a specialist orthodontic practice. Three hundred and ninety-seven eligible patients were randomized to one of two retainer groups, and followed up for 6 months. All subjects were invited to complete patient satisfaction questionnaires. Additional data were collected for the cost analysis from the patient records and national databases. Descriptive and bivariate analyses were used to compare patient satisfaction between retainer groups. In all, 196 subjects were randomized to the Hawley group (mean age 14 years 8 months, 63 per cent female, 37 per cent male) and 201 to the VFR group (mean age 15 years, 59 per cent female, 41 per cent male). VFRs were more cost-effective than Hawley retainers from all perspectives. The majority of subjects showed a preference for VFRs compared with Hawley retainers. There were also fewer breakages than in the Hawley group.

Orthognathic treatment: how much does it cost?

The aim of this multi-centre retrospective study was to assess the cost, and factors influencing the cost, of combined orthodontic and surgical treatment for dentofacial deformity. The sample, from the south-west of England, comprised 352 subjects (109 males and 243 females) with an age range of 14 to 57 years treated in 11 hospital orthodontic units. Treatment costs were calculated for each subject by combining consumable costs with staff overhead and capital costs. The median total treatment cost was euro 6075.25 (interquartile range: euro 5139.41-euro 7069.68). Out-patient costs comprised 43 per cent. The median orthodontic treatment costs were euro 1456.23 (interquartile range: euro 1283.73-euro 1638.75). Orthodontic costs on average comprised 25 per cent of the total treatment cost. The cost of orthodontics for orthognathic patients in a hospital setting appears to represent excellent value for the state funded National Health Service in the United Kingdom.

How do we evaluate the economics of health care?

Economic evaluation has become an integral component of health service research in recent years and will no doubt become more influential. As resources are reduced in health services, more questions are likely to be asked on the costs and benefits of new treatments. Questions are also likely to be aimed at treatments that are currently provided. Economics related to health care is complex and numerous methods of economic evaluation exist. Full economic evaluation involves the assessment of both costs and outcomes and is ideal for comparing the efficiency of treatments. Partial evaluations can also provide useful information on the contribution of component costs to treatment costs as a whole. The aim of this review is to assess the various methods available to evaluate the economics of health care and to place in context how these methods may be used within dentistry.