A closer look at disparities in earnings between white and minoritized dentists.

OBJECTIVE: To examine the factors that account for differences in dentist earnings between White and minoritized dentists. DATA SOURCES: We used data from the American Dental Association's Survey of dental practice, which includes information on 2001-2018 dentist net income, practice ZIP code, patient mix between private and public insurance, and dentist gender, age, and year of dental school graduation. We merged the data on dentist race and ethnicity and school of graduation from the American Dental Association masterfile. Based on practice ZIP code, we also merged the data on local area racial and ethnic composition from the American Community Survey. STUDY DESIGN: We used a linear Blinder-Oaxaca decomposition to assess observable characteristics that explain the gap in earnings between White and minoritized dentists. To assess differences in earnings between White and minoritized dentists at different points of the income distribution, we used a re-centered influence function and estimated an unconditional quantile Blinder-Oaxaca decomposition. DATA EXTRACTION METHODS: We extracted data for 22,086 dentists ages 25-85 who worked at least 8 weeks per year and 20 hours per week. PRINCIPAL FINDINGS: Observable characteristics accounted for 58% of the earnings gap between White and Asian dentists, 55% of the gap between White and Hispanic dentists, and 31% of the gap between White and Black dentists. The gap in earnings between White and Asian dentists narrowed at higher quantiles of the income distribution. CONCLUSIONS: Compared to other minoritized dentists, Black dentists have the largest earnings disparities relative to White dentists. While the level of the explained component of the disparity for Black dentists is comparable to the explained part of the disparities for other minoritized dentists, the excess percentage of the unexplained component for Black dentists accounts for the additional amount of disparity that Black dentists experienced. Persistent income disparities could discourage minoritized dentists from entering the profession.

New York State Dental Establishments and Dentists: 2007-2012. Economic Survey.

Every five years a series of studies is carried out by the Census Bureau which provides an opportunity to review the basic economic well-being of the many industries at the national, state and county levels. A comparison of dental economic data from the 2007 and 2012 studies for the period that encompassed the 2007-2009 "Great Recession" details the general economic difficulties faced by the dental profession during this period.

[Reimbursement of public dental care in Germany, the United Kingdom, Hungary and Poland]. / A fogászati ellátás finanszírozása Németországban, az Egyesült Királyságban, Magyarországon és Lengyelországban.

INTRODUCTION: Dental treatments have the highest rate among medical interventions and their reimbursement is also significant. AIM: The aim of the study was to compare the outcome of the reformed healthcare system process on public dental services in four European countries. METHOD: Assessment base for the comparison of reimbursement of dental treatments and dental fee schedules provided by the health insurance funds were used. The following indicators were examined: the ratio of public dental services and the main oral health indicators. Among dental fee schedules, reimbursement of general dental activity, prevention, operative dentistry, endodontic and oral surgery were selected. RESULTS: The lowest value of population to active dentist ratio was found in Germany (population to active dentist ratio: 1247) and the highest in Hungary (population to active dentist ratio: 2020). Oral health indicators showed significant differences between the West-European and East-European countries. On the other hand, the ratio of completely edentulous people at the age of 65yrs did not show great variations. Reimbursement of public dental treatments indicated significantly higher value in Germany and the United Kingdom compared to the other countries. CONCLUSIONS: Reimbursement of public dental services varies considerably in the selected European countries.

Simple indicators for projecting short-term dental market fluctuations.

BACKGROUND: There have been fluctuations over time in dental care expenditures in the United States. This project aims to develop simple indicators that are easily available to people and that can be useful to predict short-term market fluctuations. METHODS: The authors analyzed data concerning 30 variables for the period of 1980 through 2012 for correlations with dental care expenditures during that period, looking for factors that historically moved in a highly correlated manner, either positively or negatively, with dental care expenditures. The authors lagged the factors to determine their potential predictive value for dental care expenditures. RESULTS: Personal consumption expenditures and gross domestic product emerged as valid leading indicators for predicting short-term dental market fluctuations. CONCLUSION: Two simple measures that are easily available to dentists and others can serve as indicators of short-term fluctuations in the dental marketplace. Their validity as indicators can, and should, be monitored regularly. PRACTICAL IMPLICATIONS: These indicators can be of significant value for practitioners in being alerted to potential market changes and planning to accommodate these changes. Combined, these factors can tell what changes are coming and when they have arrived.

Global Economic Impact of Dental Diseases.

Reporting the economic burden of oral diseases is important to evaluate the societal relevance of preventing and addressing oral diseases. In addition to treatment costs, there are indirect costs to consider, mainly in terms of productivity losses due to absenteeism from work. The purpose of the present study was to estimate the direct and indirect costs of dental diseases worldwide to approximate the global economic impact. Estimation of direct treatment costs was based on a systematic approach. For estimation of indirect costs, an approach suggested by the World Health Organization's Commission on Macroeconomics and Health was employed, which factored in 2010 values of gross domestic product per capita as provided by the International Monetary Fund and oral burden of disease estimates from the 2010 Global Burden of Disease Study. Direct treatment costs due to dental diseases worldwide were estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. Indirect costs due to dental diseases worldwide amounted to US$144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death. Within the limitations of currently available data sources and methodologies, these findings suggest that the global economic impact of dental diseases amounted to US$442 billion in 2010. Improvements in population oral health may imply substantial economic benefits not only in terms of reduced treatment costs but also because of fewer productivity losses in the labor market.

New York State after last recession. Dentists and dental establishments.

Data from the U.S. Census Bureau and the New York State Office of the Professions indicate an increase in emigration and immigration, resulting in slowing in the overall growth of New York State's population, with accompanying modifications in the numbers of dentists and dental establishments in state counties. In addition, ADA data suggest that per capita dental spending has not rebounded since the end of the last recession. While there have been many changes at the county level, there does not seem to have been dramatic changes in the overall state numbers of dental practitioners and establishments through the early years of the current decade.

Análise dos custos da saúde bucal na atenção básica no município de Vitória de Santo Antão, Pernambuco / Cost analysis of oral health in primary care provided in the city of Vitória de Santo Antão, Pernambuco, Brazil

Objetivo: Analisar os custos da saúde bucal na atenção básica no município da Vitória de Santo Antão, Pernambuco, no ano de 2010. Materiais e Métodos: Trata-se de um estudo de caso, onde foi utilizada ametodologia do custeio por absorção, sendo somados os custos com recursos humanos, com materiais odontológicos e de pensos com finalidade odontológica, com manutenção de equipamentos odontológicos e os custos prediais das unidades de saúde. Calculou-se o percentual do financiamento por ente federativo (União, Estado e Município), o custo médio do procedimento odontológico e o custo médio da saúde bucal de atenção básica por habitante. Estabeleceu-se a representatividade do custo total sobre a despesa com a atenção básica e sobre a despesa total com saúde. Resultados: O custo total foi de R$ 1.340.307,80, sendo 85,6%(R$ 1.147.048,00) referentes aos recursos humanos, 8,5% (R$ 114.000,00) à manutenção de equipamentos, 3,2% (R$ 42.635,27) aos custos prediais e 2,7% (R$ 36.624,53) aos recursos materiais. Quanto às fontes de financiamento, 37,5% dos recursos foram provenientes da União e 62,5% do próprio Município. Não se observou repasse de recursos provenientes do Estado. O custo médio do procedimento foi de R$ 14,88 e ocusto médio da saúde bucal de atenção básica por habitante foi de R$ 17,61. O custo total representou 15,3%da despesa total com atenção básica e 6,7% da despesa total com a função saúde. Conclusão: os custos comrecursos humanos foram os mais representativos, sendo esta uma limitação para a ampliação da cobertura do serviço, diante da Lei de Responsabilidade Fiscal. O modelo de pacto federativo brasileiro continua conferindo ao município a maior responsabilidade pelo financiamento das ações e serviços de saúde bucal, ainda que estes tenham baixa representatividade nos custos com a saúde.

Evolving trends in size and structure of group dental practices in the United States.

In this study, the authors examined recent trends in the growth of dental establishments and dental firms, including geographic location. In this article, they also present information about the demographic characteristics of dentists who work in a dental practice that is part of a larger company that delivers dental care in multiple locations. The number of dental establishments (single locations) and the average size of these establishments grew from 1992 to 2007. Large multi-unit dental firms grew in terms of number of establishments and the percentage of total receipts. Large multi-unit dental firms represent a small but growing segment of the dental market. Dentists less than thirty-five years old were most likely to work in a practice that was part of a larger company, and females were more likely than males to work in such a setting. The percentage of dentists working in these settings was also found to vary by region and state. The authors present a typology of dental group practice and suggest that future research should take into account the differences so that appropriate conclusions can be drawn and generalizations across categories are not made.

Mapping dental establishments in New York State just before the recession.

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior the recent recession. During this same period, the combination of a relatively limited increase of the population in New York State and increasing numbers of dentists and dental establishments resulted in decreases in population ratios, particularly in New York City. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.

Desigualdades socioeconômicas e saúde bucal / Socioeconomic inequalities and oral health

Esta tese tem como foco os efeitos da desigualdade de renda na saúde bucal. Qualquer injustiça social, pelo caráter moral, é digna do estudo, porém nem toda desigualdade de renda é socialmente injusta. Ela se torna injusta quando as pessoas com menos recursos são penalizadas com pior saúde pela sua condição de pobreza. Sociedades injustas são aquelas que permitem que as desigualdades econômicas afetem direitos humanos, como o direito a um nível de vida que assegure ao indivíduo e a sua família uma vida saudável. As desigualdades de renda foram estudadas em duas vertentes: a) efeitos contextuais da desigualdade de renda na saúde bucal; e b) tendências na diferença de saúde bucal entre pessoas com maior e menor renda. A primeira parte contém quatro artigos originais que estudaram a associação e os mecanismos contextuais pelos quais a desigualdade de renda afeta a saúde bucal. Para isso, foram utilizados dados do inquérito em saúde bucal SBBrasil de 2002. Os resultados mostraram que: a) a associação entre desigualdade de renda e saúde bucal é mais forte em relação à cárie dental do que a outras doença bucais (e.g, doenças periodontais e maloclusões); b) seus efeitos estão mais fortemente associados a doenças bucais de menor latência; c) os efeitos associados à cárie dental afetam pobres e ricos igualmente; e d) a ausência de políticas públicas parece ser a melhor explicação para os efeitos da excessiva desigualdade de renda no Brasil. Ainda em relação às políticas públicas, foi encontrado que os ricos beneficiam-se mais de políticas públicas municipais do que os pobres. A segunda parte desta tese contém dois artigos originais que descreveram as tendências em saúde bucal e o uso dos serviços odontológicos em grupos de maior e menor renda, no Brasil e na Suécia...

Household expenditure in dental health care: national estimations in Mexico for 2000, 2002, and 2004.

OBJECTIVE: To estimate the expenditure on dental care of Mexican households, analyze their trends, and determine the factors associated with the decision to spend and the amount of money spent in 2000, 2002, and 2004. MATERIAL AND METHODS: Using the National Survey of Household Income and Expenditure for 2000, 2002, and 2004, the national dental health care expenditure was calculated. To facilitate comparability across years, all expenditure was converted to pesos of 2004, using the National Consumer Price Index (11.201 pesos per USD). Proportion of households incurring catastrophic expenditures was also estimated. To evaluate the association between environmental, household, and individual characteristics with the amount of dental health care expenditure, the Heckman regression model was used to control for self-selection bias. RESULTS: More than 6,467 million pesos (MP) were spent in 2000 (8.5 percent of all households had some expenditure), over 3,925 MP in 2002 (4 percent households), and above 5,136 MP in 2004 (5 percent households), with an average expenditure of $806, $1,000, and $987 pesos, respectively. Prevalence of catastrophic expenditure because of dental health care was 0.8 percent in 2000 compared to 0.01 and 1.8 percent in 2002 and 2004, respectively. The Heckman model showed that municipal development, stratum, and age of the head of household significantly influenced the amount spent on dental care in all 3 years. Household capacity to pay and wealth index had a positive and statistically significant association in the 3 years with the preceding decision to spend. CONCLUSIONS: Variables associated with the amount of expenditure and the decision of spending support the existence of inequities in health care financing in the Mexican population.

[The appreciation of the medical students' knowledge concerning the role and work of medical care funds in Polish health care system]. / Ocena wiedzy studentów medycyny na temat roli i funkcjonowania kas chorych w systemie ochrony zdrowia w Polsce.

The aim of the research was verification and comparison of the present state of knowledge among the students (of different departments and years ofstudy), about the role ofMedical Care Funds in the up-to-now healthcare system and the patient's rights as far as the students' future profession as doctors, dentists healthcare managers and medical rescuers is concerned. The research was carried out by means of anonymous questionnaire. A uniform "assessment" method was adopted following the principles of didactic measurement. The following were calculated: range, modal, mediana, arithmetic average, variance, standard deviation, easiness of the task, difficulty of the task, skip fraction, the task's differentiating power, reliability coefficient of the test using the own modification of the Excel programme. No significant differences among the particular groups have been proven as far as the students present state of knowledge is concerned. The research showed different difficulty levels of the particular questions among examined groups. The assessment of the up-to-now work of the Medical Care Funds is negative in the opinion of the respondents, no matter which medical faculty they have represented.

A macroeconomic review of dentistry in Canada in the 1990s.

OBJECTIVES: To document the trends in expenditures on dental health care services and the number of dental health care professionals in Canada from 1990 to 1999. METHODS: Information on dental and health expenditures, numbers of dentists, hygienists and dental therapists, and the population of Canada and the provinces were obtained from the Canadian Institute for Health Information; data on numbers of denturists were obtained from regional bodies and from Health Canada. Information on the costs of other disease categories was taken from studies by Health Canada (1993 and 1998). International comparisons were made on the basis of data published by the Organisation for Economic Co-operation and Development (OECD). Indices of change over the decade (in which the 1990 value served as the baseline [100]) were calculated. RESULTS: By 1999, the supply of all types of dental care providers had increased to 1 for every 904 people. Dental expenditures during the 1990s increased by 64% overall and by 49% per capita, a rate of increase that exceeded both inflation and costs of health care. Although the public share of dental costs decreased from 9.2% to 5.8%, the direct costs of dental care increased to rank second (6.30 billion dollars) after those for cardiovascular diseases (6.82 billion dollars). Among the OECD nations, Canada had the fourth highest per capita dental expenditures and the second lowest per capita public dental expenditures. CONCLUSIONS: The direct economic costs of dental conditions increased during the 1990s from 4.13 billion dollars to 6.77 billion dollars. Over the same period, the public share for expenditures on dental health care services declined.

Survey of Dental Student Financial Assistance, 2001-02.

The American Dental Education Association's 2001-02 Survey of Dental Student Financial Assistance obtained data by which to report, in aggregate and by type of school, the amount of financial assistance being received by dental students, in the form of loans, grants and scholarships, and work-study programs. Over 90 percent of the dental students received financial assistance through one or more federal, state, and/or school source. The average amount of assistance per student was dollar 35,100, ranging from an average of dollar 27,700 at public dental schools to dollar 51,100 at private dental schools. Loan programs accounted for almost 88 percent of all financial assistance; grants and scholarships, for 12 percent; work-study programs, for 0.2 percent. Overall, financial assistance exceeded average tuition and fees by 102 percent. With such levels of reliance on financial assistance, it remains imperative that students, even at the undergraduate level, receive the counseling, monitoring, and advice that will help them judiciously seek and manage appropriate types and amounts of financial assistance as they obtain their dental education.

Will the real elasticity of substitution 'in Norwegian dentistry' please stand up?

The non-homothetic production cost structure in Norwegian private dentistry involves more than two factor inputs. Consequently, this paper implements-separately for solo and group practices-three conceptually different measures of factor substitutions to infer the precise nature of input associations using translog cost model estimates based on 1993 data. We calculate own- and cross-price elasticities of factor demands, pairwise elasticities of substitution and their approximate S.E.s. We find that: (1) dentists and dental assistants cannot be consistently aggregated as one homogeneous labour input; (2) input demands are inelastic; (3) the theoretically restrictive Allen-Uzawa and the less restrictive shadow and Morishima elasticities of substitution are not equivalent; (4) dentists and auxiliary dental personnel relate as significant substitutes in solo practices and as significant complements in group practices; (5) 'supplies' (e.g., dental materials) in the aggregate are substitutes for the two types of dentistry labour; and (6) there appears to be a wider scope for factor substitutions in group rather than solo practices. Due to inelastic factor demands, opportunities for cost controls are limited despite some tendencies for factor interchange. Finally, future researchers of production costs involving more than two inputs should investigate the less restrictive, alternative measures of factor substitutions.