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Dental Medicaid – 2012

This report consists of a review of the dental Medicaid literature organized in terms of seven major policy questions or issues:

  • Where do children covered by Medicaid receive dental services?
  • What methods are most effective to increase utilization?
  • What methods are used to monitor the provision of Medicaid dental services to children?
  • What is known about dentist participation in the Medicaid program?
  • What is the impact of reimbursement rates on state Medicaid dental expenditures?
  • The delivery of dental services to Medicaid children through managed care organizations.
  • Non-dentist providers of dental services.
  • What barriers continue to hinder state initiatives to improve access to Medicaid dental services?

The paper focuses on dental services provided to children under the Medicaid program, but also includes sections on the CHIP program and Medicaid dental programs for adults. It is an extension of earlier work published in 2003 by ADA Health Policy Resources Center entitled, “Medicaid and Dental Care for Children: A Review of the Literature.”

The contents of this report are being made available to the user in PDF format, whereby the user may download and/or print desired information.

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Geographic Distribution of Dentists in the United States

In this report, the author, Kent D. Nash, Ph.D., states that the purpose of this research project was to examine the economic factors associated with the geographic distribution of dentists across the U.S. That is, are there systematic economic reasons that account for the geographic location of dentists or are the conditions influencing location too complex for analysis?

The results presented include: a descriptive analysis of the geographic location of dentists in the U.S. aided by the use of Rural/Urban Continuum Codes (RUC); the development of an estimating multiple regression model based on several economic factors associated with the location decision of dentists including county population size, per capita personal income, commuting time to work and tax revenue, education levels, median population age, land area and density, the historical numbers of dentists in a county, distance to a dental school, distance to urban areas, state level fluoridation, racial composition of the county, and location of the counties; and, use of a form of demand threshold analysis (DTA)—a methodology that has been used to assess the demand conditions across geographic areas particularly where demand characteristics are important to the location of a business, or in this case the location of a dentist—to determine some economic conditions necessary to support a dentist in a geographic area.

The contents of this report are being made available to the user in PDF format, whereby the user may download and/or print desired information.

Hard copy also available.

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An Economic Study of Expanded Duties of Dental Auxiliaries in Colorado

In this report, the authors assess the effects of delegation on dental output (measured by gross billings, dental visits and value-added) and efficiency of general dental practices in Colorado. They provide estimates of the effect of various levels of delegation on gross billings, visits, value-added, efficiency, and net income of general dental practices in Colorado. Colorado was chosen as the site for the study because the range of procedures that can be delegated is among the most comprehensive in the U.S., and the state has permitted these forms of delegation for several years, so those practices that delegate have had time for that style of practice to be fully integrated into their operations.

The contents of this report are being made available to the user in PDF format, whereby the user may download and/or print desired information. Also included as a free download is document that highlights
some of the information in the report.  

Hard copy also available. 

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Rural Dentistry: Rural Patients, Travel Burdens & Rural Oral Public Health

The economists who authored this report worked with data from various sources to address the geographic component of access by comparing the travel burdens and experiences faced by rural and non-rural populations. Aggregate results are presented for dental practices located in: large (population ≥ 250,000) economically disadvantaged urban areas; small (population < 250,000) economically disadvantaged urban areas; rural areas; and suburban and not economically disadvantaged areas. Among the issues considered are: the adequacy of the number of dentists in rural areas; whether dentists should be subsidized to locate in rural areas; travel burdens of rural patients visiting the dentist; and “bundling” activities of rural patients when making a dental visit.

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American Dental Association Dental Workforce Model

Annually performs a long-term projection of the U.S. dental workforce using statistical transition models for retirements, occupation change, location choice, specialty education, and death, using data gathered from previous Distributions of Dentists and Surveys of Dental Graduates. Also uses enrollment trends from previous Surveys of Dental Education. Additional allocation models distribute new dental school graduates into dental occupations, locations, and specialty programs.

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Adequacy of Current and Future Dental Workforce

In 2005, the American Dental Association undertook a comprehensive study of the dental workforce supported by a grant from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS). The resultant reports are published in two companion volumes.

The first volume is entitled Adequacy of Current and Future Dental Workforce. This is a concise description of many aspects of dental workforce and includes an assessment of future adequacy.

The second volume is entitled Adequacy of Current and Future Dental Workforce: Theory and Analysis. This longer volume, detailing the theoretical foundations of dental workforce analysis, provides numerous findings from technical analyses and includes an extensive compilation of supporting data.

The author, L. Jackson Brown, DDS, PhD, suggests that the shorter version be read first. He hopes that these reports "offer an approach to dental workforce, based on data and analysis, that can be used on an ongoing basis to assure that the nation will maintain a dental workforce that can provide the care that the nation needs, wants, and demands."

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The Economics of Endodontics

This project was funded by the American Association of Endodontists (AAE). The report examines the current state of endodontics, including services and utilization, growth in the specialty, geographic location of endodontists, characteristics of endodontists, market for services, and referrals. This publication also includes a look at the future of endodontics, including trends in disease and treatment, workforce projections, and productivity.

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An Examination of Dentists' Fee Discounts and Prepayment Carrier Concentrations

The author, Donald R. House, Ph.D., describes the purpose of this study as a means of determining the extent to which carrier payments of reimbursement fees are consistent with monopsony purchasing as an exercise of market power assembled through carrier concentration. Monopsony theory is a buyer-side application of monopoly theory that is designed to explain the consequences of one buyer in a market with multiple sellers. Within the detailed empirical analyses conducted, Dr. House examines whether reimbursement fees paid by carriers are related to the degree of carrier concentration.

The contents of this report are being made available to the user in PDF format, whereby the user may download and/or print desired information.

Hard copy also available. 

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The Economic Aspects of Unsupervised Private Hygiene Practice and its Impact on Access to Care

The unsupervised practice of dental hygiene at locations remote from a dental office is a relatively new occupational choice in the United States. This article reports on a study that analyzed the economic aspects of unsupervised private hygiene practice and its impact on access to care.

Hard copy also available.

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The Economics of Dental Education

This report was initiated by the Association's Dental Economics Advisory Group (DEAG) in response to dental community concerns regarding the economic state of dental education in the U.S.

The chapters within this monograph, developed by a number of outstanding experts in the fields of dental education and economics, provide in-depth analyses of key economic issues and trends facing dental education.

The contents of The Economics of Dental Education report are being made available to the user in PDF format, whereby the user may download and/or print desired information.

Hard copy also available.

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Economic Impact of Dentists

While economic impact is made in the same locality as a dentist's office, the impact is not confined to this locality. The influence of any economic activity commonly spreads beyond a local economy. The total impact of dentistry can also be broken down at the industry level and, thus, industries that are most affected by this spending stream can be identified. The American Dental Association commissioned a study to be conducted by leading economists in order to measure the economic impact of dentists. Major findings from the study are presented in this downloadable brochure.

Hard copy also available.

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Medicaid and Dental Care for Children: A Review of the Literature

The authors of this report, well-known experts in the field of oral health care, described the two specific aims of the study as follows: (1) conduct an extensive literature search and identify those factors that contribute to the lack of access to Medicaid and to State Children's Health Insurance Program (SCHIP) for young children; and (2) identify dentistry-related literature that focuses on access to Medicaid and SCHIP programs.

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2005 Workforce Needs Assessment Survey: Chairside Assistants

Report contains information on dental practice's current staffing levels and anticipated needs for chairside assistants. Included are chairside assistants' salaries and benefits most frequently offered at a regional level. Data is presented either at state, regional, or national level. It also provides state-by-state analysis of a wealth of information about chairside assistants including work hours, numbers of current openings for chairside assistants, benefits offered to chairside assistants, and reasons for a shortage of chairside assistants. 

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2004 Workforce Needs Assessment Survey: Dental Hygienists

The report contains information on workforce levels of and anticipated needs for dental hygienists. Included are dental hygienists' salaries and benefits most frequently offered on a regional level. Information is presented either at state, regional, or national level. It also provides a wealth of information about dental hygienists reported state-by-state, including work hours, numbers of current openings for hygienists, benefits offered to hygienists, and reasons for a shortage of hygienists.

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1999 Dental Workforce Needs Assessment Survey

Report contains information on dental practice's current staffing levels and anticipated needs for chairside assistants, dental hygienists, and dental laboratory technicians. Included are non-dentist employee salaries at a regional level. Data is presented either at state, regional, or national level.

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Financing the Purchase and Sale of Dental Practices

The report provides a summary of issues pertaining to buying and selling dental practices, including the parties of interest and alternative financing methods. A bibliography and related web sites are also provided.

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Issues in Children's Access to Dental Care Under Medicaid

Written by W. Steven Barnett, PhD, and Kirsty Clarke Brown – individuals with expertise in economics and policy analysis for issues concerning early child development, especially among disadvantaged appropriate agencies. Report focuses on a study to identify what barriers might account for an apparent lack of access to dental care for young children in the Medicaid and Children's Health Insurance Programs.

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Unmet Needs and Access Among Our Nation's Children: Issues and Options (White Paper)

This report addresses the issue of dental access to dental services for children from different economic backgrounds. The report focuses on issues relevant to the establishment of legislation that intends to address the barriers faced by children from lower income families, taking into account the realities of the marketplace. Trend data from the NHANES I and NHANES III surveys are included in the analysis.

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Future of Dentistry

During its 1999 meeting, the House of Delegates of the American Dental Association (ADA) overwhelmingly agreed that it was imperative to address the dynamic health environment in which dentistry finds itself and to determine, to the best of its ability, what challenges the future will hold. In the face of advances in medical and dental technology, alterations in demographics and epidemiology, and ever-changing modalities of access to care and financing of health care services, it appeared that the dental profession had to prepare itself so that it could maintain the highest level of patient care. To that end, the House of Delegates commissioned the Future of Dentistry project. The resultant Future of Dentistry report evaluates the present state of dentistry, makes educated predictions regarding what challenges the profession will face in the future, and makes recommendations as to how dentistry can best address these challenges. The major topics of the report are as follows: Clinical Dental Practice and Management, Financing of and Access to Dental Services, Dental Licensure and Regulation of Dental Professionals, Dental Education, Dental and Craniofacial Research, and Global Oral Health.

Hard copy also available.

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Studies of Dental Workforce

The workforce monograph is the end-result of a two-year collaboration process among well-known experts in the fields of dentistry and economics. Each chapter of the monograph is written by individual authors. Each author (or groups of authors) presents excellent analyses within an area of expertise and interest in an effort to supply interested parties with the best available information on U.S. dentist workforce issues and policy – including but not limited to: regional workforce issues, aging and demographic changes, dentist productivity, allied dental personnel and the demand for dental services.

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