Community dental clinics: providers' perspectives.

OBJECTIVES: Not-for-profit community dental clinics attempt to address the inequities of oral health care for disadvantaged communities, but there is little information about how they operate. The objective of this article is to explain from the perspective of senior staff how five community dental clinics in British Columbia, Canada, provide services. METHODS: The mixed-methods case study included the five not-for-profit dental clinics with full-time staff who provided a wide range of dental services. We conducted open-ended interviews to saturation with eight senior administrative staff selected purposefully because of their comprehensive knowledge of the development and operation of the clinics and supplemented their information with a year's aggregated data on patients, treatments, and operating costs. RESULTS: The interview participants described the benefits of integrating dentistry with other health and social services usually within community health centres, although they doubted the sustainability of the clinics without reliable financial support from public funds. Aggregated data showed that 75% of the patients had either publically funded or no coverage for dental services, while the others had employer-sponsored dental insurance. Financial subsidies from regional health authorities allowed two of the clinics to treat only patients who are economically vulnerable and provide all services at reduced costs. Clinics without government subsidies used the fees paid by some patients to subsidize treatment for others who could not afford treatment. CONCLUSIONS: Not-for-profit dental clinics provide dental services beyond pain relief for underserved communities. Dental services are integrated with other health and community services and located in accessible locations. However, all of the participants expressed concerns about the sustainability of the clinics without reliable public revenues.

Industry structures in private dental markets in Finland.

OBJECTIVE: To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. DESIGN: Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. RESULTS: Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. CONCLUSIONS: Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

Complete denture services: clinical technique, lab costs, manpower, and reimbursement. One-year review.

Complete denture services at comprehensive care public health clinics are not common in part because of clinician concerns regarding outcomes. Educational debt forgiveness has attracted recent dental graduates to public health dentistry; however, not all recent graduates receive denture education experiences necessary to attain proficiency. While fundamental patient assessment and denture construction are taught, psychological assessment and communication with denture patients requires experience. A thorough understanding of occlusion, phonetics, esthetics and laboratory steps is also necessary. Expecting recent dental graduates to become proficient providing complete dentures at minimal reimbursement levels, with no mentorship or on-site laboratory support, is unrealistic. Public health dental clinics operate at full capacity performing emergency, preventive and restorative procedures. Complete dentures come with a laboratory fee approximately one-half the total reimbursement, meaning a remake drops clinic revenue to zero while doubling expenses. It is understandable that full schedules, marginal reimbursement, unpredictability and the risk of an occasional failure block clinician interest in providing denture services. This one-year report of services describes a three-appointment complete denture technique offering improved patient and laboratory communication, reduced chair time and controlled cost, resulting in high-quality complete dentures.

Changes over 5 years in utilization of dental care by a Swedish age cohort.

OBJECTIVE: The purpose of this study was to investigate the temporal development of the utilization of dental care, in relation to socio-economic factors and also considering perceived oral health, attitudes to dental care, dental anxiety, care organisation and changes in the way that dental care is paid for. A conflict model was used as a theoretical framework. METHODS: In 1992, a mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergotland, as part of a cross-sectional study. This study group numbered 8888 persons. In 1997, the same population was sent a new questionnaire. There were 5363 persons who completed the questionnaire in both 1992 and 1997. Changes in utilization of dental care were analysed. RESULTS: An increase in personal expenditure for care was obvious, 42% paid more in 1997 compared with 1992. In the study, 7% had prolonged their time since most recent visit and 12% had less frequent visits. In regression models, education, occupation, place of residence, country of birth, marital status, gender, dental anxiety, having poor perceived oral health and poor general health were associated with utilization. Care organisation factors showed there was a greater probability of having higher utilization and higher cost of care when private practitioners provided the care. CONCLUSION: Small changes in the utilization of dental care occurred during this study time. Inequality in utilization existed and socio-economic factors affected utilization as well as health perception and dental anxiety. Changes in the cost of care did not affect utilization appreciably, probably because of a selected population with high price elasticity. Having a private care provider compared with one in the public system affected the probability of having higher utilization and higher cost for care.

Fund allocation within Australian dental care: an innovative approach to output based funding.

BACKGROUND: Over the last 15 years in Australia the process of funding government health care has changed significantly. The development of dental funding models that transparently meet both the service delivery needs for data at the treatment level and policy makers' need for health condition data is critical to the continued integration of dentistry into the wider health system. METHODS: This paper presents a model of fund allocation that provides a communication construct that addresses the needs of both policy makers and service providers. RESULTS: In this model, dental treatments (dental item numbers) have been grouped into eight broad dental health conditions. Within each dental health condition, a weighted average price is determined using the Department of Veterans Affairs' (DVA) fee schedule as the benchmark, adjusted for the mix of care. The model also adjusts for the efficiency differences between sectors providing government funded dental care. In summary, the price to be applied to a dental health condition category is determined by the weighted average DVA price adjusted by the sector efficiency. CONCLUSIONS: This model allows governments and dental service providers to develop funding agreements that both quantify and justify the treatment to be provided. Such a process facilitates the continued integration of dental care into the wider health system.

Costos en odontología / Costs in dentistry

El análisis minucioso y aplicación de los verdaderos costos de la odontología, son el camino posible para solucionar los problemas actuales de la profesión, a partir de la categorización y acreditación ya propuesta por numerosos autores(3,10). En este sentido, y teniendo en cuenta que la mayoría de los autores reconoce la gran influencia tanto de los costos indirectos como de los costos directos, en la estructura arancelaria, es en este momento de profunda crisis que sería importante lograr un amplio consenso entre los mismos, para asesorar objetivamente a las instituciones y empresas de salud en la conformación de convenios que sean realistas y beneficiosos para todos los sectores intervinientes en la atención odontológica (pacientes, empresas, odontólogos). (AU)

Costos en odontología / Costs in dentistry

El análisis minucioso y aplicación de los verdaderos costos de la odontología, son el camino posible para solucionar los problemas actuales de la profesión, a partir de la categorización y acreditación ya propuesta por numerosos autores(3,10). En este sentido, y teniendo en cuenta que la mayoría de los autores reconoce la gran influencia tanto de los costos indirectos como de los costos directos, en la estructura arancelaria, es en este momento de profunda crisis que sería importante lograr un amplio consenso entre los mismos, para asesorar objetivamente a las instituciones y empresas de salud en la conformación de convenios que sean realistas y beneficiosos para todos los sectores intervinientes en la atención odontológica (pacientes, empresas, odontólogos).

O exame odontológico inicial sob a óptica do paciente / The initial dental exam under the patient optical

Alguns detalhes contribuem para o descrédito profissional, a começar pela velha questão: a consulta inicial deve ou não ser cobrada? Freqüentemente os pacientes se surprendem quando o profissional apresenta o valor da consulta, porque foram acostumados aos chamados "orçamentos gratuitos". Assim, é propósito deste trabalho avaliar a opinião de uma amostra da população com relação à cobrança de honorários profissionais durante o exame odontológico inicial. Para tanto, foram entrevistados 448 (quatrocentos e quarenta e oito) indivíduos de Araçatuba, selecionados aleatoriamente, sem realizar uma classificação social prévia. Foi possível constatar que, independentemente da classe socioeconômica, 78 por cento dos entrevistados são contrários à cobrança de honorários profissionais durante essa fase, pois não reconhecem a sua importância

Social inequality in oral health and use of dental care in Sweden.

OBJECTIVE: To describe oral health and use of dental care in relation to socio-economic determinants over time in Sweden. METHODS: Cross-sectional study based on interview data on two randomly sampled sequential populations consisting of 7,610 Swedish adult (25-64 years) residents and 4,315 children (3-15 years) in their households from the Survey of Living Conditions 1996-97, and 7,649 adult Swedish residents (25-64 years) from the survey of 1988-89. RESULTS: Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996-97 survey in the adult study population (adjusted odds ratios 1.6-2.9). The same socio-economic determinants were associated with caries in children (adjusted odds ratios 1.2-1.5). The socio-economic differences in dental treatment and problems with chewing were greater in the age group 45-64 years compared to 25-44-year-olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5-8.1) in the 1988-89 survey to 9.1% (8.4-9.8) in the 1996-97 survey. A similar increase, from 2.4% (2.2-2.6) to 4.4% (3.9-4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio-economic distribution of oral health and use of dental care in the adult population was similar in the two surveys. CONCLUSION: This study demonstrates that socio-economic differences in oral health and use of dental care are most marked in older (45-64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.

The dash for dentures: the turbulent introduction of NHS dentistry.

With the formal launch of the National Health Service on the evening of Sunday, July 4, 1948, the pattern of dental treatment in Britain changed dramatically. This change altered the lives of everyone connected with the provision of this treatment and, for dentists in particular, working life would never be the same again. But how did they come about?

Changes in utilization of dental services of Alberta's universal dental plan for the elderly.

Since 1973, Alberta's dental plan for the elderly has made government-sponsored, premium-free comprehensive care by dentists and denturists available to all residents of the province over age 64. Details on the numbers and types of different services provided were previously unavailable from the annual reports. However, an examination of the plan's six-million records, covering nearly 260,000 different patients from 1978 to 1992, has now made it possible, for the first time, to conduct a detailed analysis of these dental services. Many time-related changes have occurred in the types of services provided. The number of removable prosthodontic services declined from 14 per cent of all services offered by dentists in 1978-79 to five per cent of these services in 1991-1992, but the services provided by denturists increased by a factor of four. The relative number of surgical and restorative dentistry services offered by dentists also declined. Preventive services grew modestly, but periodontal services grew dramatically from three per cent of all services provided by dentists to 22 per cent. These shifts in services from prosthodontics, restorative dentistry and oral surgery to preventive and periodontic services have important implications for the planning and administration of dental plans for the elderly.

Cost-effectiveness of homoeopathic treatment in a dental practice

Dentists who accept social security patients in Germany today are bound by a large number of rules and regulations which impose severe limits on their free choice of treatment, cost-effectiveness being a prime consideration. The treatment of acute conditions predominates in a modern compulsory insurance practice. The author analysed his own case record and the statistics provided by the KZV (association of dental practitioners for patients with compulsory insurance) for the period from 1983 to 1990 to establish the effect of introducing consistent use of homoeopathic treatment from the end fo 1984 on the frequency with which certain standard treatments were required. The results were compared with the average figures of other dentists and a computation made of potential economic advantages at a national level