The economic health of dentistry: past, present, and future

Article Abstract:

In spite of many achievements in dentistry, including the virtual elimination of caries (cavities), a high level of effectiveness, and utilization of services by almost everyone in the United States, the future of this profession is considered by some to be unstable, or even doubtful. The number of dentists is perceived to exceed demand and dental schools have cut back on class size. Between 1965 and 1985, the total value of dental services used in the United States increased approximately tenfold, while the number of dentists increased by about one-third. The general population grew by 23 percent over the same period, and the dental labor force increased by seven percent. Dentists' average gross income increased from $29,200 to $212,700; with adjustments for inflation, the national expenditure per dentist doubled. National expenditures for physician services grew at approximately the same rate, an the number of physicians increased at a greater rate. The gross income per physician increased substantially less than for dentists which increased between 51 and 133 percent. Utilization of dental services is also variable, with consumer/dentist ratios higher in the East North Central Area than in New England. Future trends are likely to be similar to those observed in the past two decades; when the decline in the number of dental school students and applicants is considered, the economic picture looks even better. With such a short supply of dentists, administrators of dental insurance plans can apply little pressure on dentists to participant in payment plans other than fee-for-service arrangements, except in poor areas of the country. Overall, dentists' economic future appears extremely favorable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Supply and demand, Dentists

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Understanding managed care

Article Abstract:

Dentists must understand the principles of managed care. Managed care cuts costs by reducing insurance payments and transferring financial risk to care providers. In dentistry, managed care uses two cost-control mechanisms: capitation-based payment and discounted service-based payment. In a capitated payment scheme, dentists receive a fixed monthly sum per patient to provide a set of services as needed. The dentist bears the financial risk that treatment costs will exceed predictions. In discount service-based payment schemes, dentists who are called preferred providers accept discounted payments for services. The insurer bears the financial risk in case costs will exceed predictions. Dentists participate in managed care plans in response to market competition, to increase patient load, or to retain patients who enroll in a managed care plan. Reimbursement schemes must not influence the quality of dental care.

Models, Prices and rates, Managed care plans (Medical care), Dental insurance

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Commentary: ergonomically related disorders in dental practice

Article Abstract:

A number of factors contribute to the development of overuse disorders. Published literature reports a wide range of injury rates, from 1% to 54%, for repetitive strain injuries in dental hygienists. This may reflect a lack of sophisticated and comprehensive analysis of the problem. The health and fitness of the worker, conditions at the job site, and work practices all may contribute to injury. Ergonomic research in dentistry must consider all of these. Dental hygiene may be relatively safe because the job tasks typically vary throughout the workday.

Injuries, Risk factors, Overuse injuries, Repetition strain injury, Dental hygienists

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