Administración del consultorio odontológico en contextos inflacionarios / Dental clinic administration in inflationary contexts

La administración es una herramienta fundamental que permite planificar, desarrollar y organizar cualquier empresa, independientemente del tamaño de la misma. Tener una sana administración del consultorio odontológico es imprescindi- ble para la toma de decisiones, más aún en contextos de crisis y alta inflación (AU)

Administration is a fundamental tool that allows plan- ning, developing, and organizing any company, regardless of its size. Having a healthy administration of the dental clinic is essential for decision making, even more so in contexts of crisis and high inflation (AU)

The effects of fee bundling on dental utilization.

OBJECTIVE: To examine dental utilization following an adjustment to the provincial fee schedule in which preventive maintenance (recall) services were bundled at lower fees. DATA SOURCES/STUDY SETTING: Blue Cross dental insurance claims for claimants associated with four major Ontario employers using a common insurance plan over the period 1987-1990. STUDY DESIGN: This before-and-after design analyzes the dental claims experience over a four-year period for 4,455 individuals 18 years of age and older one year prior to the bundling of services, one year concurrent with the change, and two years after the introduction of bundling. The dependent variable is the annual adjusted payment per user. DATA COLLECTION/EXTRACTION METHODS: The analysis was based on all claims submitted by adult users for services received at recall visits and who reported at least one visit of this type between 1987 and 1990. In these data, 26,177 services were provided by 1,214 dentists and represent 41 percent of all adult service claims submitted over the four years of observation. PRINCIPAL FINDINGS: Real per capita payment for adult recall services decreased by 0.3 percent in the year bundling was implemented (1988), but by the end of the study period such payments had increased 4.8 percent relative to pre-bundling levels. Multiple regression analysis assessed the role of patient and provider variables in the upward trend of per capita payments. The following variables were significant in explaining 37 percent of the variation in utilization over the period of observation: subscriber employment location; ever having received periodontal scaling or ever having received restorative services; regular user; dentist's school of graduation; and interactions involving year, service type, and regular user status. CONCLUSIONS: The volume and intensity of services received by adult patients increased when fee constraints were imposed on dentists. Future efforts to contain dental expenditures through fee schedule design will need to take this into consideration. Issues for future dental services research include provider billing practices, utilization among frequent attenders, and outcomes evaluation particularly with regard to periodontal care and replacement of restorations.

The demand for dental care: an assessment.

This paper reviews the existing literature on the demand for dental care and assesses its implications for the U.K., where such analysis has been lacking to date. The characteristics of the U.K. dental system are briefly outlined, and some observations on the theory of the demand for dental care are made. The main part of the paper consists of a review of empirical work, most of which is North American or Scandinavian. It is concluded that there is as yet no consensus on several empirical matters of major importance. Areas for future research, both in the U.K. and more widely, are presented.

Dental care in the NHS: reforms with teeth?

Dental services in the UK are currently undergoing a period of major upheaval. This paper examines recent policy initiatives with respect to patient charges, dentists' remuneration, information and patient choice, the supply of dental personnel, and the prevention of dental diseases. It is argued that changes in dentists' remuneration and the greater use of auxiliary personnel are likely to improve efficiency, whereas changes in patient charges are not. Water fluoridation remains the most efficient and equitable means of promoting dental health.

Charges for oral health care during a period of economic growth in the US: 1987-96.

OBJECTIVES: This study aimed to provide estimates of amounts charged for dental care during 1996 for the US adult population and its major sociodemographic subgroups, and to evaluate whether charges had increased since 1987. METHODS: We used data from the 1996 Medical Expenditures Panel Survey and report results for 12,931 adults aged 19-64 years. For comparison with previously published charges, we converted 1987 charges to their 1996 "constant dollar" value to control for inflation. Data were analyzed using SUDAAN and the results can be generalized to the US adult population. RESULTS: In 1996, 43.7 percent (95% CI=42.7%, 44.6%) of the US population incurred dental care charges, which did not differ significantly from the 1987 estimate of 44.5 percent. In 1996, mean per capita charge for dental care was 182 dollars (95% CI=171 dollars, 192 dollars), which did not differ significantly from the inflation-adjusted 1987 estimate of 174 dollars. The average charge per patient who incurred charges in 1996 was 416 dollars (95% CI=394 dollars, 438 dollars), which was only 7 percent greater than the inflation-adjusted 1987 estimate of 389 dollars (P=.08). Sociodemographic variations were observed in per capita charges, but were less apparent in mean charge per patient who incurred charges. CONCLUSIONS: During a period when economic growth and other market forces were expected to increase delivery of dental services, there was little or no change in percentage of US adults incurring charges or in mean per capita charges. The booming US economy did not raise dental charges significantly and did not increase utilization of dental care services.

Survey findings on dental fees. A comparison from 1982-93.

The cost of health care services, including dental services, continues to rise at a rate higher than the prices of all goods and services included in the CPI for urban consumers. Increases for physician services, medical care and hospital room rates exceed those for dental care. Dentists generally do not raise their fees across-the-board, but vary increases from procedure to procedure. Increases for certain common dental procedures and services were close to the CPI for consumer goods and services. Fees for such basic preventive and diagnostic procedures--including oral exams, prophylaxes and X-rays--increased at rates well below the overall CPI for dental services.

Economic growth of the dental profession: comparisons with other health care sectors.

This paper describes the economic growth of the dental profession and concludes, on the basis of increases in real output in excess of the GNP, that the dental services sector of the economy is a growth industry. The analysis shows that, on a relative basis, dentistry also appears to be growing with respect to other important health service sectors, including physician services. Changes in output appear to be related to the expansion of the supply of dental workforce, the increased productivity of individual general practitioners, population growth, and the increase in the portion of the population with dental insurance.

Capitation and fee-for-service dental benefit plans: economic incentives, utilization, and service-mix.

Insurance carriers, corporations, and labor groups are actively developing and marketing dental capitation benefit plans. Incentives to both dentists and patients in these plans differ from those in the traditional fee-for-service system used with conventional benefit plans. This paper describes the likely effects of these incentive differences on utilization and service-mix patterns in both systems. Data for a large (approximately 10,000), homogenous group of subscribers are presented and discussed. Faced with a dual option, at no cost to the employee, 60% of the subscribers chose the fee-for-service plan, and 40% chose the capitation plan. Observed differences in the utilization and mix of services between the two plans cannot be explained solely in terms of dentists' responses. Employee response to altered economic incentives appears to be strong.

Net income, gross billings and practice expenses of independent dentists.

One way to measure the vitality of a profession is to look at the trend in its practitioners' real incomes. During the 10-year period 1986 through 1995, the average real net income of all independent dentists rose 30.7 percent, or 2.7 percent annually, after being adjusted for inflation using 1995 U.S. dollars. The national per capita personal income (base = 1995) increased 10.1 percent during this same period, or about 1.0 percent annually [corrected]. Using real per capita income as a benchmark, the authors found that the purchasing power of dentists as a group has increased more rapidly than the purchasing power of the overall U.S. population.

Dental procedure fees 1975 through 1995: how much have they changed?

A shift toward diagnostic and preventive dentistry in the last two decades is evident from the change in the number of dental procedures performed, as well as the change in the percentage of time spent performing different types of procedures. During the period 1975 through 1995, the average nominal fees for selected dental procedures increased. Once inflation was taken into account, however, the increase in the average real fees charged was more modest.

Economic growth in the U.S. dental industry, 1950-1977.

This paper addresses the issue of economic growth in the U.S. dental industry. The rates of growth in real output in the dental industry and in the U.S. economy are compared for the period 1950-1977. The annual dental rate of 4.5 percent is significantly greater (P .001) than the 3.7 percent rate for the economy. In addition, inflation has been less in dentistry than in the economy. The consequences of growth of the dental industry are also discussed.