Writing off copayments.

Professions are accorded respect and autonomy by society in exchange for their willingness to enforce their own professional standards. A case is discussed where an associate discovers that the principal dentist is routinely not collecting the 20% copayment required by insurance contracts. Analysis shows that this practice is unethical, illegal, and unprofessional. Practical advice is offered for how such an issue should be addressed.

Facing a moral dilemma--introducing a dental care insurance within the public dental service.

Through the reform entitled "Dental care insurance-dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvård).This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic.The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.

Writing off the copayment.

Three dentists who have been involved in teaching ethics comment on a case where an associate discovers that the 40% of collections she was expecting as compensation is being reduced because of the practice in the office of routinely writing off patient copays. The commentators note legal requirements and professional codes, but generally seek alternatives that do not require that patients pay the amount agreed by insurance contracts.

How did we get here? Where are we going? Hopes and gaps in access to oral health care.

This article reviews the history and future good of acceptance ethics and helps frame the publication of papers presented at the workshop on Professional Promises: Hopes and Gaps in Access to Oral Health Care. Discovery and development of Universal Patient Acceptance (UPA), a practical application of acceptance ethics, is key to systematizing access to oral health; UPA expands partnerships among professional volunteerism, culture, and economic structures. A Veterans' Administration health services preventive dentistry research project and a West Virginia school children's preventive dental program raised awareness of acceptance. A state insurance crisis revealed an underlying systems ethics problem that was not purely legal, political, educational, economic, or scientific in nature. Key players were identified for dialogue, and questions were ranked. UPA was articulated and proposed as a unique, practical, and positive professional promise. The experience involved PEDNET, a dental ethics education group. An intensive applied dental ethics course for practicing dentists was developed; it attracted the American College of Dentists (ACD) and American Dental Association (ADA). Annual ACD LeaderSkills helped expand continuing education of ethics; several dental ethics summits were initiated. Concepts like discourse, adequate care, and viewing organizations as both persons and machines motivated further exploration of acceptance. Separating acceptance from diagnosis, treatment, and payment improves discourse on the various philosophical notions and practical applications that dominate each area.