Medical Loss Ratios For California's Dental Insurance Plans: Assessing Consumer Value And Policy Solutions.

As a consumer protection, the Affordable Care Act (ACA) requires that large-group health plans spend at least 85 percent of all premium dollars on health services and quality improvement activities-thus giving the plans a medical loss ratio (MLR) of 85 percent. Small-group and individual plans must have an MLR of at least 80 percent. The ACA did not set minimum MLRs for dental plans. California passed a law in 2014 requiring dental plans to report MLRs but stopped short of setting minimum thresholds. We analyzed dental plans' MLRs reported in California for 2014 and 2015. The average MLR, weighted by covered lives, was 76 percent, with wide variation across product types and sizes. Few products sold by dental plans met the MLR thresholds set by the ACA, but many did meet or exceed other proposed thresholds. While millions of Californians were in large-group plans that achieved high MLRs, millions more were in other plans with relatively low MLRs. A legislatively mandated MLR would provide a standardized financial tool and potentially ensure value for dental insurance products. Given the multiplicity of dental products and the varying numbers of covered lives in those products, setting MLR thresholds poses a challenge for stakeholders.

[Medicines and oral healthcare 3. Insurance coverage and qualification to prescribe]. / Medicamenten en mondzorg 3. Vergoeding en bevoegdheid tot voorschrijven.

On the advice of the National Health Care Institute in the Netherlands and the institute's Board of Scientific Advisors, the minister of Health, Welfare and Sport decides whether a certain drug will or will not be included in the list of drugs covered by the basic health insurance plan mandated for all Dutch citizens. In making this decision emphasis is placed on the therapeutic value of that particular drug compared to that of the standard drug for that disorder, the impact that the inclusion of the drug would have on the budget and the drug's cost-effectiveness. In the case of disorders that do not respond or respond insufficiently to the standard treatment, however, one comes up against the limitations of this system and in some cases a necessary treatment is not reimbursed. With respect to prescribing medications, dentists are qualified to prescribe, provided they are enrolled in the so-called BIG register [that recognises the qualifications of healthcare professionals in the Netherlands]. Dental hygienists, by contrast, are not qualified to prescribe and have to limit themselves to at most recommending over-the-counter medicines. In prescribing medicines, dentists are of course limited to those about which they have comprehensive knowledge and sufficient experience. If a dentist wants to prescibe a drug that is outside his or her own experience, then he or she should consult with an oral and maxillofacial surgeon, general practitioner or medical specialist to determine whether the medication can be prescribed and if so, by whom.

The demand for preventive and restorative dental services.

Chronic tooth decay is the most common chronic condition in the United States among children ages 5-17 and also affects a large percentage of adults. Oral health conditions are preventable, but less than half of the US population uses dental services annually. We seek to examine the extent to which limited dental coverage and high out-of-pocket costs reduce dental service use by the nonelderly privately insured and uninsured. Using data from the 2001-2006 Medical Expenditure Panel Survey and an American Dental Association survey of dental procedure prices, we jointly estimate the probability of using preventive and both basic and major restorative services through a correlated random effects specification that controls for endogeneity. We found that dental coverage increased the probability of preventive care use by 19% and the use of restorative services 11% to 16%. Both conditional and unconditional on dental coverage, the use of dental services was not sensitive to out-of-pocket costs. We conclude that dental coverage is an important determinant of preventive dental service use, but other nonprice factors related to consumer preferences, especially education, are equal if not stronger determinants.

Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule.

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

Dental care plan assessment using the CAHPS Dental Plan Survey.

OBJECTIVES: The performance of a recently developed survey instrument that inquires about patients' experiences with the receipt of dental care was examined to evaluate its potential utility as a patient-reported outcome measure for dental care plans. METHODS: Individuals with dental insurance (n = 1,216) were surveyed using the Consumer Assessment of Health Care Providers and Systems (CAHPS) Dental Plan Survey. The instrument's pre-established composite and rating scores were compared across dental insurance carriers (6 most common and all others combined) using ANOVA. In addition, each score was analyzed separately using multivariate regression with respondent and plan characteristics as independent variables. RESULTS: There was significant differentiation among dental insurance carriers for three of the six scores (dental care composite, access to care composite, and dentist rating). Several respondent characteristics were associated with higher scores, including age, race, income level, and oral health self-rating. Having a choice of dental plans, and years with one's dental plan were associated with higher dental plan ratings, while having to find a new dentist to use the plan tended to lower all scores except the cost and services composite. CONCLUSIONS: The results reported here reflect differences among dental insurance carriers, rather than among the many different dental plans offered by those carriers. Nevertheless, the CAHPS instrument scores reflected differences among patients' experiences (composite scores) and ratings (rating scores) across carriers, suggesting both that the instrument should be a useful tool for assessing patient-reported outcomes, and that comparisons of these outcomes should control for respondent characteristics as well as specific plan characteristics.

[Head movements during simulated direct digital radiography]. / Kopfbewegungen während simulierten direkt digitalen Fernröntgenaufnahmen.

The aim of this study was to simulate direct-digital cephalometric procedures and to record the head movements of probands. This study was prompted by the Committee for Insurance Matters of the Swiss National Invalidity Insurance which does not accept scanned digital cephalometric radiographs as a basis for its decisions. The reason for this is the required scanning time of several seconds during which even slight head movements can lead to kinetic blurring and landmark displacement. Incorrect angular measurements may result. By means of a Sirognathograph and a cephalostat of non-ferromagnetic material, the head movements of a total of 264 subjects were recorded in three dimensions, with a scanning time of up to 25 seconds. In a second series, the influence of a chin support to reduce head movements was also tested. The results of the first series of tests showed that, with an increasing scan time, movements became greater, mostly in the sagittal plane, and that maximum displacements could occur already at the start of the recording. With a scan time of 10 seconds the median movement amplitude in the vertical dimension was 2.14 mm. The second series of tests revealed a significant reduction in head movements in all dimensions owing to an additional stabilizing chin support. To minimize head movements, scanning times must be reduced and additional head stabilizing elements together with existing ones are necessary.

The development and testing of a survey instrument for benchmarking dental plan performance: using insured patients' experiences as a gauge of dental care quality.

BACKGROUND: There is no standard, nonproprietary method for providing national benchmarks of dental care quality as described by patients. The purpose of this research was to develop such a tool following guidelines of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) initiative. METHODS: The authors identified domains of dental care quality via qualitative methods, including a literature review, stakeholder interviews and focus groups with beneficiaries, and they cognitively tested draft questions with patients to yield a pilot survey. Psychometric analyses of pilot data (n = 3,264) identified summary indexes and guided survey revisions. The authors used two waves of subsequent data collection (n = 4,221) to test the validity of the revised survey. RESULTS: The mean response rate across three rounds of data collection was 51 percent. Statistical analysis indicated that 17 questions could be reliably collapsed into three composite measures: "Care From Dentist and Staff" (reliability = 0.89, scaling success = 100 percent); "Access to Dental Care" (reliability = 0.78, scaling success = 100 percent); and "Dental Plan Coverage/Service" (reliability = 0.84, scaling success = 100 percent). CONCLUSIONS: The validity of the survey was supported in mail and Internet modes for the American English language, and the instrument was approved by the CAHPS consortium for distribution as the CAHPS Dental Plan Survey. PRACTICE IMPLICATIONS. A tool is available now for assessing dental care quality by measuring adult patients' experiences with their dental care and coverage. The authors tested this instrument only in a population with third-party coverage, however, which is a potential limitation that should be considered.

Incentives and remuneration systems in dental services.

The aim of this study was to examine the effects of an incentive-based remuneration system on number of individuals under supervision and on quality of public dental services in Norway. The basis for the study was a natural experiment in which all public dental officers in one county were given the opportunity to renegotiate their contract from a fixed salary contract to a combined per capita and fixed salary contract. Comprehensive data were collected before and after the change. A main finding is that the transition to an incentive-based remuneration system led to an increase in the number of individuals under supervision without either a fall in quality or a patient selection effect.

Análisis y perspectivas del IOMA en su 50º aniversario: entrevista a Alberto J. Mazza, Presidente de IOMA / Analysis and perspectives of IOMA at its 50th anniversary: an interview to Alberto J. Mazza, President of IOMA

En el marco del Congreso Nacional Interinstitucional que se desarrolla del 14 al 16 de junio, participó como disertante el Lic. Alberto Mazza, Presidente de IOMA. Entrevistado por Salud Bucal, el funcionario describió la situación de la Obra Social, que actualmente tiene 1.700.000 afiliados, y que en los últimos tiempos realizó una serie de reformas en la organización, como la acreditación de calidad de los prestadores, entre ellos, los odontólogos.

Análisis y perspectivas del IOMA en su 50º aniversario: entrevista a Alberto J. Mazza, Presidente de IOMA / Analysis and perspectives of IOMA at its 50th anniversary: an interview to Alberto J. Mazza, President of IOMA

En el marco del Congreso Nacional Interinstitucional que se desarrolla del 14 al 16 de junio, participó como disertante el Lic. Alberto Mazza, Presidente de IOMA. Entrevistado por Salud Bucal, el funcionario describió la situación de la Obra Social, que actualmente tiene 1.700.000 afiliados, y que en los últimos tiempos realizó una serie de reformas en la organización, como la acreditación de calidad de los prestadores, entre ellos, los odontólogos.(AU)