Online Program

325914
Dental benefit plans, then (1976) and now (2015): Progress but not panacea


Tuesday, November 3, 2015

Stephen D. Hooper, MBA, Health Economics Group, Inc., Rochester, NY
In 1976 the State of California commissioned a project: summarize the history of dental plans, create several plan designs, and project costs of each for State employees, retirees, and dependents. This study compares dental plans in the mid-1970s (as reported in that project report and elsewhere) with dental benefit plans forty years later. Although changes have occurred, much remains same. The plan design recommended most highly in 1976 (100% D&P, $50 Deductible, 80%/50%, $1,000 Annual Maximum) is common in 2015. In 1976 there were no widely-accepted standards of dental quality.  Insurance companies and TPAs were on their own dealing with quality.  They still are. In 2015 a committee of the ADA is meeting to develop a list of parameters intended to serve as the basis for quality assessment. During 1976 about half of the population visited a dentist at least once. By 2012 utilization had increased to approximately 60%, according to US governmental surveys. In the mid-1970s approximately 25% of the US civilian population had some form of dental insurance.  By 2012 67% had coverage (50% in private plans, and 17% in public plans).   After four decades utilization of individuals with dental plan coverage remains far less than 100%, higher than utilization by those without dental benefits, but not as high as anticipated in the mid-1970s. Forty years ago dental plan managers assumed that dentists would charge higher fees to patients with insurance.  Today the situation is reversed.  Due to the widespread presence of dental PPOs, often the patients who are billed the most are those without coverage.  Further, in many states dentists now are able to charge more than PPO-fee amounts after patients have reached annual maximum benefit levels.  Dental benefit plans, while important, have not been THE solution to increasing the demand for dental care to the almost-universal need for care.

Learning Areas:

Administration, management, leadership
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Differentiate dentists' billing/pricing approaches in 1976 and 2015. Discuss changes in overall dental utilization during the past 40 years. Compare overall utilization with utilization of patients covered by dental plans.

Keyword(s): Community Health Programs, Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was research director and a co-author of the State of California dental benefits study. I was author of a chapter in Dental Clinics of North America (July 1985) dealing with quality assurance. For several years I was a research associate in Community Dentistry at the Eastman Dental Center. My company has been designing and managing dental benefit plans since 1978.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Health Economics Group, Inc. Dental Benefit Plan Management Employment (includes retainer) and Stock Ownership

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.