Dental office structure and treatment outcome--related or independent?

This study was designed to test the hypothesis that the physical and organizational structure of a dental office is a reliable predictor of dental treatment outcome. A supervised self-evaluation instrument was developed to evaluate the physical and organizational structure of a dental office. Seventy dental offices-50 offices previously identified as delivering acceptable care and 20 offices previously identified as delivering less than acceptable care-were tested with this instrument. The authors concluded that there were no significant structural differences between dental offices giving "acceptable care" and "less than acceptable care."

An economic analysis of managed fee-for-service and direct reimbursement.

This economic analysis compares the direct reimbursement approach with the managed fee-for-service approach to the delivery and payment for dental care. Asymmetrical distribution of information between patients and dentists characterizes the market and gives rise to a principal-agent problem. To solve this problem, third-party payers have devised various methods for managing delivery and payment for dental care by monitoring and encouraging providers to assure a certain level of quality at defined costs. Direct reimbursement has been promoted by dental care providers as an alternative to the traditional third-party payer model and has at its core the elimination of many of the currently used managed care control mechanisms. The authors conclude that managed fee-for-service plan concepts deal with current economic issues more realistically than do direct reimbursement arrangements. Furthermore, the authors predict that direct reimbursement prevalence would lead to higher average prices for dental care and a change in the mix of services skewed toward high cost, marginally beneficial treatments.

Introduction to some fundamental concepts in the economic analysis of dental care delivery.

This paper discusses some basic economic principles and concepts and how they relate to the analysis of dental care delivery. The fundamental theories of consumer behavior, profit maximization, information and transaction costs, and agency are considered. It is asserted that the information gap existing between patients and providers gives rise to a principal-agent problem, the operative element of this paper. The authors conclude that while under managed fee-for-service (MFFS) delivery systems, third-party administrators use financial, administrative, and utilization management tools to guide consumer and provider behavior, to reduce the size of the information gap, and achieve a more efficient allocation of resources, this does not occur under direct reimbursement (DR).

Endo-N-acetyl-beta-D-glucosaminidase activity in rat liver. Studies on substrate specificity, enzyme inhibition, subcellular localization and partial purification.

Endo-N-acetyl-beta-D-glucosaminidase (EC 3.2.1.96, endoglucosaminidase) has been partially purified (520-fold with respect to the cytoplasmic activity) by using concanavalin A-Sepharose, CM-Sephadex and Bio-Gel P-150 chromatography. From the influence of exogenous glycopeptides on the endoglucosaminidase activity it can be concluded that this activity consists of one enzyme hydrolysing both N-acetyl-lactosaminic-type and oligomannosidic-type substrates. Glycoproteins present in the homogenate inhibit the endoglucosaminidase activity. On re-examination of the subcellular distribution of endoglucosaminidase (after removal of inhibiting glycoproteins from the respective subcellular fractions), its cytoplasmic localization was confirmed.

Lysosomal beta-hexosaminidase is highly resistant towards proteolytic degradation in vitro.

1. A partially purified enzyme preparation of beta-hexosaminidase from human fibroblasts was treated with proteases and the effect on its molecular weight and enzymatic activity was studied. 2. Both the forms A and B of the enzyme appeared to be resistant to a protease treatment that degraded the majority of the contaminating proteins to a large extent. 3. The same result was obtained with enzyme preparations from cells treated with tunicamycin. 4. Also the molecular weights of the individual polypeptide chains of the enzyme were not decreased, as was shown by SDS-PAGE, followed by immuno-blotting.