Costs of providing dental services for children in public and private practices.
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This study compares the costs of providing children's dental services in three practice settings: private practices, public mobile clinics, and public fixed clinics. Some 15,000 children were provided comprehensive dental care over a three-year period. Results indicate that costs per visit and per child were lowest in mobile clinics and highest in private practices. The differential was partially explained by differences in productivity but mostly by the fact that the price of services in public practices represented costs of production, whereas in private practices they represented market values. (+info)
Comparison of orthodontic treatment outcomes in educational and private practice settings.
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An accredited graduate orthodontic program provides advanced specialty education to meet standards of care mandated by the ADA, including both didactic and clinical components with defined outcome measures. To quantify these measures, the quality of care provided by graduate orthodontic students was compared to that of orthodontists in private practice. The quality of care was studied in two different delivery settings in the Columbus, Ohio, area-private practice orthodontists (PPO) and the OSU graduate orthodontic clinic (GOC). The Peer Assessment Rating (PAR) Occlusal Index was used as a measure of malocclusion severity and post-treatment occlusal outcome. Quality of care was measured using post-treatment PAR, percent PAR reduction, and treatment duration. At baseline, no differences were seen in the gender and pre-PAR scores of patients treated by the PPO and GOC, but statistically significant differences were seen in patients' pre-treatment age, race, and starting dentition. When the post-treatment occlusal results were compared, no statistically significant differences were seen in post-PAR scores and percent PAR reduction between the PPO and GOC. A statistically significant difference was seen in treatment duration (p = 0.002), which was longer in the PPO even after controlling for confounding factors such as pre-treatment age, gender, race, starting dentition, and treatment stages. Our conclusion is that there was no statistically significant difference in the occlusal outcome between the PPO and GOC, but there was a significant difference in the treatment duration. (+info)
Dentists in general and community practice: a Scottish survey.
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OBJECTIVES: To identify the available workforce in general dental practice and to describe the job satisfaction, career and retirement plans of dentists in general and community practice. DESIGN: A postal cross-sectional survey. SETTING: Primary care dentists practising in Scotland in 2000. MATERIALS AND METHODS: Semi-structured questionnaires were sent to all primary care dentists identified from the Scottish Dental Practice Division as being in practice in Scotland. RESULTS: The response rate was 70% (1,335 GDPs and 187 CDPs). Although most dentists in both the GDS and CDS stated that they enjoyed their work, 35% of GDPs would not now choose dentistry as a career. Eighty-three per cent of the GDPs' time was spent on clinical work, of which 5% was not NHS-funded. Daily demotivation was reported by 70%, most commonly citing the job itself and the NHS 'treadmill'. Two-thirds of CDPs were women, as were half of GDPs aged less than 30. Only 35% of CDPs planned early retirement but 80% of them felt underused. Two-thirds of GDPs planned to retire in their mid-50s, and a further quarter planned to work part-time. Of the former, only a quarter agreed that nothing would induce them to work beyond this time. CONCLUSION: Conditions of work within primary care dentistry require modification to retain the current workforce and accommodate the increasing proportion of women. Part-time employment packages may encourage older practitioners to work for longer, and allow younger practitioners to fulfil family or personal commitments. (+info)
Meeting the demand for future dental school faculty: trends, challenges, and responses.
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This report presents data from ADEA's 2001-02 survey of vacant budgeted faculty positions and examines challenges likely to exacerbate faculty shortages in the immediate future. The fifty-four dental schools responding to the survey reported 344 vacant budgeted positions, a decrease of 4 percent from 2000 to 2001. Seventy-nine percent of these vacancies are for full-time positions. Approximately one out of four dental schools has ten or more vacancies. Of just over 1,000 faculty separations during 2001-02, 53 percent were reported to be individuals leaving to enter private practice. There is no indication of a near-term reversal of the decade-long trend toward increasing budgeted vacancies, and the current economic environment along with other factors delineated in this report makes the challenge to recruit and retain dental faculty more difficult. ADEA and other stakeholders are currently pursuing a number of strategies to meet the demand for future dental school faculty. (+info)
Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center.
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BACKGROUND AND PURPOSE: Patients referred to tertiary care centers frequently arrive with images obtained at outside institutions; these images require reinterpretation. We assessed the clinical value of reinterpreting cross-sectional imaging studies of patients with head and neck cancer, in the setting of a multidisciplinary cancer center. METHODS: Outside CT and MR images of 136 patients with known or presumed head and neck cancer were reinterpreted by a neuroradiologist. Clinical history and findings on physical examination were available. Reinterpretation was performed before review of outside reports, which were subsequently compared with those generated at the cancer center. Changes in interpretation were noted, and their effects on TNM staging, patient care, and prognosis were assessed. Reliability and statistical significance of rates of change in diagnosis were analyzed with 95% confidence intervals (CIs) and the sign test, respectively. Verification of change in diagnosis was confirmed by pathologic analysis (75%), characteristic radiologic findings (18%), or clinical and imaging follow-up (7%). RESULTS: Change in interpretation occurred in 56 patients (41%) (95% CI: 33-49%, P <.001). Forty-six patients (34%) had a change in T, N, and/or M staging (26-42%, P <.001). Change in T stage occurred in 27 cases (20%) (13-27%, P <.001) (upstaged in 22, downstaged in five), and a change in N stage in 26 cases (19%) (12-26%, P <.001) (upstaged in 20, downstaged in six). Two patients (1.5%) had missed systemic metastases. Three patients with an initial diagnosis of cancer were found to be cancer-free, and six patients had a diagnosis of new second primary cancers that were missed at original interpretation. One patient had a missed middle cerebral artery aneurysm. Changes in image interpretation altered treatment in 55 (98%) of 56 patients and affected prognosis in 53 patients (95%) (P <.001). CONCLUSION: Reinterpretation of cross-sectional images in the setting of a multidisciplinary cancer center has a significant effect on staging, management, and prognosis in patients with head and neck cancer. (+info)
Quality and equity of private sector care for sexually transmitted diseases in South Africa.
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The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case study. Private general practitioners (GPs) were interviewed by telephone. Each was presented with a set of STD syndromes and requested to describe how s/he would manage the patient, first if the patient was insured, then secondly if the patient was paying cash (uninsured). Reported prescriptions were costed and assessed for effectiveness against main causative pathogens using local standard clinical guidelines. Knowledge of recent developments in STD syndromic management and effectiveness of prescribed drugs was poor, especially for genital ulcer and pelvic inflammatory disease, and less than half the prescriptions overall were judged as effective. Although the effectiveness of prescriptions for insured and uninsured patients were similar, for most syndromes uninsured patients were offered significantly cheaper and less convenient antibiotic regimens. Effective regimens were also significantly more expensive than ineffective regimens. The results suggest that GPs' perceptions of patients' willingness or ability to pay for drugs have a bearing on quality of care. The paper concludes that STD patients who present to GPs are often offered poor quality of care, and the choice of inconvenient antibiotics impacts disproportionately on the poor. Improvements in the quality and equity of GP care will require interventions that address the factors that determine their behaviour. (+info)
Equity, privatization and cost recovery in urban health care: the case of Lao PDR.
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Along with the shift from a planned to market-oriented economy, as in many other developing countries, Lao PDR has promoted health care partnerships with the private sector, and cost recovery in public hospitals, to increase resources in the public sector, while at the same time attempting to ensure appropriate access to health care for those without means to pay. In a multi-case design, this study compares two neighbourhoods of different socioeconomic status comprising 10 households, representing urban districts in three provinces. In-depth interviews were conducted over a 1-year period with three visits to each household. Members of the households were interviewed on their perceptions and utilization of health care services. Focus group discussions of public providers and individual interviews of private providers, leaders of the villages and hospital administrators provided complementary perspectives. The study found that both socioeconomic groups utilized private health services as their first choice, including private clinics and treatment abroad for those with high socioeconomic status, while the low socioeconomic group preferred private pharmacies. The unwelcoming attitudes of health staff and procedural barriers have led both groups to meet their health care needs in the private sector. Here the health care they receive is strictly limited to what they can pay for. For the poor, in most cases, this means drugs alone, i.e. no examination, no diagnosis and only limited advice. Limited financial resources often means receiving inappropriate and insufficient medication. Equity in health care remains theoretical rather than practical and the social goals of the reform have not been achieved. (+info)
Characteristics of eye care practices with managed care contracts.
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OBJECTIVES: To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts. STUDY DESIGN: Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%. RESULTS: Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of groups derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs. CONCLUSIONS: Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care. (+info)