Gordon J. Christensen, DDS, MSD, PhD
Over the past several years, so-called "managed care" has almost taken over medicine. Nearly half of physicians now work on a salaried basis. Medical treatment has been limited and controlled. "Big business" has found another major plum to pluck and use for its own financial purposes. Hospital stays are limited. Procedures have been reduced. Quality medical care now is difficult to find and private practitioners must be sought out deliberately. It is unbelievable that several years ago, a major worry in medicine/dentistry was that the "government" would take over and socialize health care, and now private enterprise has done the same thing while we stood back and watched.
Where is dentistry, the largest single "specialty" in health sciences, relative to managed care? I have been active in numerous groups to educate dentists and the public about managed care and its relationship to dentistry. PPOs and HMOs have made slight, but not impressive, moves into dentistry. Much of dentistry is elective, and these programs do not provide significant elective procedures. Therefore, managed-care programs offering only minimal payments are recognized as such by the public. However, underfunded managed-care programs still are a major threat to quality dental care.
Most professional groups attempting to preserve freedom of choice dentistry for the American public have decided that education of dentists and the public about these plans is the best way to impede their progress. The following information on managed care in dentistry was written by me to be distributed to any interested parties.
"In recent years, there has been a significant increase in so-called managed dental-health care. Insurance groups make contracts with local companies to provide dental care for specified fees and with numerous regulations and stipulations for patients. Your employer may decide to provide dental benefits for you using a managed-care program. The following information will help you to understand the managed-care concept and its advantages and disadvantages.
Other than paying for dentistry yourself, without any involvement with insurance companies, there are several payment concepts currently popular:
PPO contracts. These organizations offer dentistry at reduced fees as provided by specified practitioners. A professional provider organization (PPO) contracts with you r employer to provide dental care for you. The dentists who participate in the PPO plan agree to treat you for significantly reduced fees. They are called preferred providers. Usually, only a few dentists in any community participate. Often, they are younger dentists or a few mature dentists who have various reasons for their participation. Many dentists do not participate in PPOs because the reduced fees limit their ability to provide services at their usual level.
Dental-benefit companies administering PPOs are in business for profit. The profits go to the PPO owners. With the myriad of new innovations in dentistry, it is impossible for updated practitioners to provide a high-level standard of care on a continuing basis to you at reduced fee levels. Be careful! If you join one of these plans, you can expect only maintenance-level care, usually without elective services such as implants, esthetic dentistry, orthodontics and other treatment.
HMOs. These organizations offer minimal dentistry at low fees by specified practitioners. Perhaps the greatest threat to quality dental care in the U.S. are the currently popular, underfunded dental HMOs. An HMO makes a contract with your employer to provide overall dental care for you at very low fee levels. Capitation payments to dentists from many dental HMOs will not even provide the total of two dental cleanings (scaling and polishing) per year. The dentist receives a few dollars per patient per month, whether the patient is treated or not. Obviously, the dentist would rather not see the patient and certainly would rather not do any expensive treatment, almost all of which must be donated to the patient by the dentist.
Generally, the dentist only can survive financially in dental HMOs by not treating the patients. Who profits from dental HMOs? You guessed it - the HMO owners! As in some PPOs, if you elect to join a dental HMO, you have a group of preferred providers who participate in the plan for various reasons.
On the other hand, there are a few large dental HMOs with historical evidence of relatively acceptable levels of dental care. However, these are exceptions to the previous statement. Your dentist easily can tell you if the dental HMO you are considering provides adequate funding for dental services.
Traditional indemnity plans. These organizations offer standard dental treatment at normal fees with a choice of practitioners. These groups are the original managed-care organizations in dentistry. Many dental patients have been with these plans for decades.
They provide payment to dentists at fee levels which generally allow quality oral services to be provided. One of the only disadvantages to some of these plans is the high administrative costs charged to you and your employer. Thus, you receive less dentistry than the funds your employer pays into the benefit company.
Nevertheless, traditional fee-for-service dental plans have provided excellent dental service for Americans for decades.
Direct reimbursement. A newer form of payment, direct reimbursement, can be obtained by your employer to give you complete freedom of choice about practitioners and the quality level or type of service you want, without major cost to your employer. We will be pleased to provide information on DR if you want it for your employer.
Americans enjoy freedom in nearly all areas of their lives. I think you want to choose your health practitioner based on your own criteria, and you want the very best preventive care and treatment you can get. I doubt if you trust profit-motivated companies to select your practitioners, dictate their fees or limit their services. Only traditional indemnity plans and direct reimbursement preserve freedom-of-choice dentistry.
Thank you for your support. We look forward to serving you with high-quality, moderate-cost, freedom-of-choice dental services."
Dr. Gordon Christensen is the co-founder and currently senior consultant of Clinical Research Associates in Provo, Utah. He can be contacted at 3707 N. Canyon Road, Suite 6, Provo, Utah 84604; (801) 226-2121.
