Payment For Dental Care
PAYMENT FOR DENTAL CARE
Health care services have traditionally been provided on fee- for- service basis. But the costs of the treatment has been rising continuously, and majority of people cannot afford dental treatment. Methods have been sought to ease costs either by legislation or by the development of variety of funding approaches.
MECHANISM OF PAYMENT FOR DENTAL CARE
mnemonic: Phoebe Posted Smelly (cat in central) Perk Publicly.
- Private fee- for- service
- Post payment plans
- Private third- party pre payment plans
- Commercial insurance companies
- Non- profit health service corporations, (eg, Delta dental plans, Blue cross/ Blue shield)
- Prepaid group practice
- Capitation plans
- Public Programs
PRIVATE FEE- FOR- SERVICE
- It is a two-party arrangement
- The traditional form
- Most efficient
- It forms an integral part of private practice as a delivery method
- It is culturally acceptable
- It is a flexible system- fees can be altered according to the patient, "price discrimination".
- Administratively simple
Even though, this method is simplest and price discrimination can be practiced some patients cannot afford the treatment.
POST PAYMENT PLANS
- This service was 1st offered by "local dental societies in Pennsylvania and Michigan in the late 1930s.
- The patient borrows money from a bank or finance company to pay the dentist's fee.
- After approval from the lending institution, the dentist is paid the entire fee.
- The patient then repays the loan to the bank in budgeted amounts.
Only middle income group was benefited rather than the lower income group as they were not considered credit worthy by the lending institution.
Other problem was of defaulted loans, i.e., people did not repay the loan.
PRIVATE THIRD PARTY PREPAYMENT PLANS
- It is defined as "payment for services by some agency ratehr than directly by the beneficciary of those services".
- Dentist- 1st party, patient- 2nd party and the administrator of finances is the 3rd party, usually a insurance company.
- Third party may be defined as- party to a dental prepayment that may collect premiums, assume financial risk, pay claims and provide administrative services.
Insurance Principles and dental care
to be insurable, a risk must,
- Be precisely definable
- Be of sufficient magnitude that if it occurs, it constitutes a major loss
- Be infrequent
- Be of an unwanted nature
- be beyond the control of the individual
- Not constitute a 'moral hazard'.
All health insurance violates some principles, since illness is not predictable and health care is usually a wanted service.
Reimbursement of dentists
- Usual fee : Charged for a given service by the dentist to the private patients
- Customary fee : Fee is in the range of the usual fee charged by dentists of similar training and experience for the same service within the specific and limited geographic area.
- Reasonable fee : If the fees meets the above criteria or if it is justifiable considering special circumstances or the particular patient in question.
- A table of allowances : It can be defined as a list of covered services that assigns each service a sum that represents the total obligation of the plan with respect to payment for such service but that does not necessarily represent a dentists full fee for that service. If the dentist's fee is more then the rest is collected from the patient by the dentist.
Dentists in some group practices, those in armed forces and those employed by public agencies are salaried.
- It allows dentist to be largely free of the business concerns of running a practice, thereby allowing the dentist to concentrate on clinical matters.
- Fringe benefits are also often attractive.
- There could be a lack of financial incentive that some dentists need to be highly productive.
- Private practice is usually not able to meet the dental demands of all the people.
- A number of people programs aimed at meeting the needs of specific groups of recipients in this diverse society.
- The public programs are sponsored by the govt and also include community health centres.
- National Health Insurance