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.

A closer look at disparities in earnings between white and minoritized dentists.

OBJECTIVE: To examine the factors that account for differences in dentist earnings between White and minoritized dentists. DATA SOURCES: We used data from the American Dental Association's Survey of dental practice, which includes information on 2001-2018 dentist net income, practice ZIP code, patient mix between private and public insurance, and dentist gender, age, and year of dental school graduation. We merged the data on dentist race and ethnicity and school of graduation from the American Dental Association masterfile. Based on practice ZIP code, we also merged the data on local area racial and ethnic composition from the American Community Survey. STUDY DESIGN: We used a linear Blinder-Oaxaca decomposition to assess observable characteristics that explain the gap in earnings between White and minoritized dentists. To assess differences in earnings between White and minoritized dentists at different points of the income distribution, we used a re-centered influence function and estimated an unconditional quantile Blinder-Oaxaca decomposition. DATA EXTRACTION METHODS: We extracted data for 22,086 dentists ages 25-85 who worked at least 8 weeks per year and 20 hours per week. PRINCIPAL FINDINGS: Observable characteristics accounted for 58% of the earnings gap between White and Asian dentists, 55% of the gap between White and Hispanic dentists, and 31% of the gap between White and Black dentists. The gap in earnings between White and Asian dentists narrowed at higher quantiles of the income distribution. CONCLUSIONS: Compared to other minoritized dentists, Black dentists have the largest earnings disparities relative to White dentists. While the level of the explained component of the disparity for Black dentists is comparable to the explained part of the disparities for other minoritized dentists, the excess percentage of the unexplained component for Black dentists accounts for the additional amount of disparity that Black dentists experienced. Persistent income disparities could discourage minoritized dentists from entering the profession.

The Challenge of Dental Education After COVID-19 Pandemic - Present and Future Innovation Study Design.

The present work suggests research and innovation on the topic of dental education after the COVID-19 pandemic, is highly justified and could lead to a step change in dental practice. The challenge for the future in dentistry education should be revised with the COVID-19 and the possibility for future pandemics, since in most countries dental students stopped attending the dental faculties as there was a general lockdown of the population. The dental teaching has an important curriculum in the clinic where patients attend general dentistry practice. However, with SARS-CoV-2 virus, people may be reluctant having a dental treatment were airborne transmission can occur in some dental procedures. In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are extremely important. Therefore, dental education has to adapt the curriculum to embrace new technology devices, instrumentations systems, haptic systems, simulation based training, 3D printer machines, to permit validation and calibration of the technical skills of dental students.

Impacto económico en el medio odontológico durante la pandemia del COVID-19: revisión integradora / Economic impact in the dental field during COVID-19 pandemic: integrative review

La pandemia por COVID-19 no sólo ha generado un impacto negativo en la salud, sino que la economía global también se ha visto mermada, afectando más a los países subdesarrollados. Con relación a estos daños en las finanzas de los profesionales de la salud, existen algunos efectos que derivan de la pandemia COVID-19, los cuales tienen una fuerte repercusión en la economía de todos los trabajadores a nivel mundial y el ámbito odontológico no es la excepción. Esta revisión se obtuvo mediante la búsqueda de la información en una exploración electrónica en las bases de datos PubMed, Cochrane Library, LILACS, SciELO y Latindex. El impacto económico derivado de esta pandemia, sin lugar a dudas, ha afectado la economía de los odontólogos de práctica pública y privada, por lo que la toma de decisiones en la odontología debe contemplar un uso equilibrado de los recursos financieros (AU)

The COVID-19 pandemic has not only generated a negative impact on health, but the global economy has also been reduced, being the underdeveloped countries the most affected ones. In relation to these damages in the finances of health professionals, there are some effects that derive from the COVID-19 pandemic, having a strong impact on the economy of all workers worldwide and the dental field is no exception. This review was obtained by searching the information through an electronic examination in databases like PubMed, Cochrane Library, LILACS, SciELO and Latindex databases. The economic impact derived from this pandemic has undoubtedly affected the economy of dentists in public and private practice, so that decision-making in dentistry must consider a balanced use of financial resources (AU)

Pricing in commercial dental insurance and provider markets.

OBJECTIVE: To examine the impact of commercial dental insurer and provider concentration on dentist reimbursement. DATA SOURCES: We utilized provider data from the American Dental Association, reimbursement data from IBM Watson MarketScan® Commercial Research Databases, submitted billed charges from FAIR Health® , dental insurance market concentration data from FAIR Health® , and county-level demographic and economic data from the Area Health Resources File and the Council for Community and Economic Research. STUDY DESIGN: We used the Herfindahl-Hirschman Index to separately measure commercial dental insurance concentration and dentist concentration. We studied the effect of provider and insurance concentration on dentist reimbursement. Using two-stage least squares, we accounted for potential endogeneity in dental insurer and provider concentration. PRINCIPAL FINDINGS: Across the dental procedures we examined, a 10 percent increase in dental insurance concentration is associated with a 1.95 percent (P-value = .033) reduction in gross payments to dentists. Conversely, a 10 percent increase in dentist concentration is associated with a more modest 0.71 percent (P-value = .024) increase in gross payments. A 10 percent increase in dental insurance concentration is associated with a 1.16 percentage point (P-value = .016) decline in the allowed-to-list price ratio, while a 10 percent increase in dentist concentration is associated with a 0.56 percentage point (P-value = .001) increase in the allowed-to-list price ratio. Similar patterns were found across dental procedure subcategories. CONCLUSIONS: Dental provider markets are substantially less concentrated than insurance markets, which may limit the ability of dentists to garner higher reimbursement.

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.

Perception of Dental Students of COMS-TH regarding Future of Dentistry in Nepal amid COVID-19 Pandemic.

INTRODUCTION: There is a global crisis which has been led by COVID-19. The patients undergoingdental procedures and dental professionals are at higher risk of contracting this disease owing toaerosols generated and a lot of face to face contact during the procedures. The aim of this study was to know the perceptions of dental students of COMS-TH regarding future of dentistry in Nepal amidCOVID-19 pandemic. METHODS: The present cross-sectional descriptive study was conducted at COMS-TH, Bharatpur by sending an online e-survey questionnaire to 146 dental students out of which 99 responded. The e-survey questionnaire consisted of three parts which consisted of questions about demographics, knowledge about COVID-19 and their perceptions about future of dentistry. RESULTS: The results of the study depicted that most of the students thought dentistry is good and noble profession and will recommend it to young medical aspirants. Most of them wanted to pursue post graduation courses in future giving preference to Oral and Maxillofacial Surgery. CONCLUSIONS: The study concluded that most of the dental students were satisfied with dentistry as their profession and wanted National Dental Association to fix the minimum charges of each dental procedure. Also there is a need to start more post graduation courses in existing institutions providing dental education as most of the students want to pursue it in future.

O caso do 'Brasil Sorridente' e perspectivas da Política Nacional de Saúde Bucal em meados do século XXI / 'Brazil Smiling' and the perspectives of the National Oral Health Policy in the middle of the 21st century / 'Brasil Sonriendo' y las perspectivas de la Política Nacional de Salud Oral a mediados del siglo XXI

O objeto do ensaio é a evolução histórica da política nacional de saúde bucal (PNSB) no Brasil, nas duas décadas finais do século XX e as duas primeiras décadas do século XXI. Ênfase especial é dada ao programa Brasil Sorridente, seu surgimento, apogeu e ocaso. Adicionalmente são feitas considerações sobre a PNSB após a ruptura de 2016, a evolução do seu financiamento e as disputas em torno do modelo de atenção à saúde bucal e as perspectivas da PNSB nos próximos anos, em meados do século XXI. Conclui-se que o 'Brasil Sorridente', tal como se concretizou, articulado a um conjunto de políticas sociais e econômicas nos governos de Lula da Silva e Dilma Rousseff, não existe mais. (AU)

The object of the essay is the historical evolution of the national oral health policy (PNSB) in Brazil, in the last two decades of the twentieth century and the first two decades of the 21st century. Special emphasis is given to the Smiling Brazil program, its emergence, heyday and sunset. Additionally, considerations are made on PNSB after the breakup of 2016, the evolution of its funding, and the disputes surrounding the oral health care model and the prospects of PNSB in the coming years, in the mid-21st century. It is concluded that 'Smiling Brazil', as it materialized, articulated with a set of social and economic policies in the governments of Lula da Silva and Dilma Rousseff, no longer exists. (AU)

El objetivo del ensayo es la evolución histórica de la política nacional de salud bucal (PNSB) en Brasil, en las últimas dos décadas del siglo XX y las dos primeras décadas del siglo XXI. Se hace especial hincapié en el programa Brasil Sonriente, su aparición, apogeo y puesta de sol. Además, se hacen consideraciones sobre la PNSB después de la ruptura de 2016, la evolución de su financiamiento y las disputas que rodean el modelo de atención de salud bucal y las perspectivas de la PNSB en los próximos años, a mediados del siglo XXI. Se concluye que 'Brasil Sonriente', tal como se materializó, articulado con un conjunto de políticas sociales y económicas en los gobiernos de Lula da Silva y Dilma Rousseff, ya no existe. (AU)

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.

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.

An RCT on clinical effectiveness and cost analysis of correction of unilateral posterior crossbite with functional shift in specialist and general dentistry.

OBJECTIVES: To evaluate the costs of quad-helix (QH) and removable expansion plate (EP) treatments performed either in specialist or general dentistry for the correction of unilateral posterior crossbite with functional shift in the mixed dentition. TRIAL DESIGN: Four-arm parallel group multicentre randomized controlled trial. MATERIALS AND METHODS: One hundred and ten patients with unilateral posterior crossbite with functional shift were recruited. The patients were randomized by an independent person not involved in the trial. The randomization used blocks of 20 and into the following four groups: QH treatments in specialist orthodontic clinics (QHS), QH treatments in general dentistry (QHG), EP treatments in specialist orthodontic clinics (EPS), and EP treatments in general dentistry (EPG). Blinding was accomplished of the outcome assessor and data analyst. A cost analysis was performed with reference to intention-to-treat (ITT), regarding direct costs, indirect costs, and societal costs (the sum of direct and indirect costs) for calculations of successful treatments alone and for retreatments when required. To determine which alternative has the lower cost, a cost-minimization analysis was undertaken, based on that the outcome of the treatment alternatives were broadly equivalent, so the difference between them reduces to a comparison of costs. RESULTS: In the QHS group, 28 of 28 patients were successfully corrected compared to 23 of 27 in the QHG group. Treatment with expansion plate was less successful: 18 of 27 patients in the EPS group and 18 of 28 in the EPG group. QH treatment performed in specialist orthodontic clinics had significantly lower costs than QH or EP treatment accomplished in general dentistry as well as EP treatments in specialist orthodontic clinics. LIMITATIONS: Costs depend on local factors and should not be directly extrapolated to other locations. CONCLUSION: Treatment of unilateral posterior crossbite in the mixed dentition is recommended to be performed by a specialist orthodontist using the QH appliance. TRIAL REGISTRATION: The trial was not registered.

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.
These are the views of the authors based on significant personal experience of the contract, both as practitioners and as dento-legal advisers.

[Health economics and oral care: an introductory anthology]. / Gezondheidseconomie en mondzorg: een inleidende bloemlezing.

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]. / Meningen over mondzorg: een online-onderzoek onder NTVT-lezers.

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.

[Sinking your teeth into economic evaluations: application and importance in oral health]. / Economische evaluaties aan de tand gevoeld: belang en toepassing in de mondzorg.

Health economics deals with issues about the use of scarce resources in healthcare. An important branch of health economics concerns economic evaluations, which consist of a comparison of the costs and effects of 2 or more treatments. The role and importance of economic evaluations in oral care are increasing but are not yet as evident as in other areas of healthcare (such as pharmacy). An economic evaluation provides a broad picture of the costs and health benefits of a particular diagnostic or treatment strategy, resulting in a cost-effectiveness ratio (expressed, for example, as costs per quality-adjusted life year gained). The results are intended for use in policy-making, such as decisions about in- or exclusion from the basic benefits package. To date, only a limited number of economic evaluations of oral care have been carried out, mainly focused on caries. It is important to be able to demonstrate that the treatment provided in oral care is cost-effective. Oral care may put itself in a vulnerable position in the distribution of scarce resources when the costeffectiveness of its treatments is uncertain.

[Costs and financing of oral healthcare in the Netherlands]. / Kosten en financiering van de mondzorg.

In the Netherlands, dental diseases are the third most expensive category of healthcare costs. The total cost of the consumption of oral care gives, however, no insight into the content of the care. Data from health insurers do provide such insight, but due to limitations in reimbursements the data from health insurers represent only part of all the costs of oral care. In this study an attempt was made, by means of an estimation, to gain insight into the total cost of oral care, financed both by basic and supplementary health insurance and by the patients themselves . This estimation was made at the level of UPT clusters and is based on data from the health insurers and a large factoring company for the years 2011, 2013 and 2014. Based on this estimate, one can conclude that on average between 21% and 32% of oral care consumption is financed privately. A complete picture of the costs of oral care is important in determining the contribution of oral care to public health. The structure of the current financial system, however, impedes transparency concerning oral care consumed.

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.