Public Policy Options for Better Dental Health Report of a Study (1980) / Chapter Skim
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The Supply of Dental Services
The Supply of Dental Services
Pages 47-72
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From page 47... ...
Accordingly, Chapter 4 discusses the number of dentists, their specialization and distribution, the number and kinds of auxiliary personnel and the range of services they can deliver, the types of practice settings in which services are delivered, and conditions that influence productivity. Three types of expanded function dental auxiliaries are described, with reflections of some of the committee's discussion and debate.
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From page 48... ...
The U.S. Bureau of Health Manpower estimates that there will be enough practitioners to meet the demand in 1990 even if third party dental insurance coverage is greatly increased 239/.
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From page 49... ...
118,330 54.0 1,851 Source: DREW, Health Resources Administration 240-242/ American Dental Association * Personal Communication with J.Ake 243/ 49
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From page 50... ...
The number of active specialists grew from 2,584 in 1953 to 15,003 in 1979 246/. This movement toward specialization in dentistry peaked in 1974 when new enrollees in dental specialty programs reached 1, 282 or about 26 percent of their graduating class.
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From page 51... ...
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From page 52... ...
APPOINTMENT DELAY AND PRACTICE ACTIVITY, BY SIZE OF CITY, 1975 % With Average Waiting Time of 1 Month or More ~ Who Perceive ~ Who Perceive for Initial Practice to be Practice to be City Size Appointment Too Busy Not Busy All independent dentists 8.6 14.0 22.3 Under 2,500 20.1 25.0 12.9 2,500 25,000 15.2 21.0 17.9 25,000 100,000 6.5 12.0 23.1 100,000 1,000,000 5.1 10.1 25.1 Over 1,000,000 3.1 8.7 27.0 Source: American Dental Association 249/ 52
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From page 53... ...
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From page 54... ...
Forty-eight states have at least one program. Dental Hygienists The traditional functions of the hygienist include the performance of prophylactic procedures, the exposure and processing of radiographs, the application of fluoride solutions, and the teaching of toothbrushing, flossing, and other preventive health measures.
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From page 55... ...
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From page 57... ...
Expanded Function Dental Auxiliaries Expanded Function Dental Auxiliaries (EFDAs) usually are certified dental assistants or dental hygienists who have received extra training of six weeks to six months duration.
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From page 58... ...
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From page 59... ...
There are similar bills pending in at least 12 other states. The Council of State Governments has recommended that dental technicians be allowed to perform the extraoral and intraoral procedures required in the fabrication of removable prosthetic appliances and other devices, but that the fitting of the device should be done under the direct supervision of a dentist.
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From page 60... ...
A comment relevant to this issue is appended following Chapter 6. Practice Settings Although most dental care is provided in the offices of independent solo practitioners, there are many other practice settings and differing arrays of support services and organizational characteristics.
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From page 61... ...
Table 25. PATIENT VISITS PER HOUR FOR DENTISTS REPORTING IN THE SAMPLE BY METHOD OF COMPENSATION Number Method of Compensation Total Practice Income Only Fixed Salary Only Fixed Salary Plus Equal Share of Practice Income Fixed Salary Plus Unequal Share of Practice Income Equal Share of Practice Income Only Unequal Share of Practice Income Only Source: Nash, et al.
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From page 62... ...
Of the 55 states and territorial health agencies or departments, 52 offered some type of dental care programs in 1975; two others incorporated dental services into other health programs. Table 26 shows the services provided in the various programs.
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From page 63... ...
NUMBER OF STATES AND TERRITORIES PROVIDING DENTAL SERVICES BY TYPE OF SERVICE, FISCAL YEAR 1978 Type of Service Number of States and Territories Reporting Services Dental Services Preventive Restorative Emergency Screening Prosthetic Orthodontic Dental Health Education Nutrition Education Hypertension Screening 52 52 40 38 39 20 19 41 19 Source: Association of State and Territorial Health Officials 294/ Other Practice Modes Most dental care in the United States is delivered in the settings that have been described. However, there are other models in this country and elsewhere that suggest options for the development of a dental health strategy in the U.S.
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From page 64... ...
The remainder was due to increased efficiency associated with increased utilization. In this demonstration, mobile clinics were an effective and low cost method of providing dental care to school children 299/.
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From page 65... ...
302/ Dental Practice Productivity The productivity of dental practice is important to this study because it indicates the efficiency of a practice in providing dental services. Comparisons among different types of dental practices enable the identification of factors that can increase productivity and thus increase the supply of dental services without increasing the supply of dentists.
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From page 66... ...
Use of Auxiliaries Perhaps the most frequently discussed, widely advocated, and thoroughly studied alternative for increasing the supply of dental services is the greater use of auxiliary personnel. The concept 66
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From page 67... ...
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From page 68... ...
Also there is little documentation regarding the magnitude of the productivity of dental laboratory technicians, denturists, and dental nurses in the United States.
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From page 69... ...
Thus, the more providers generating patient visits (i.e. dentists, dental hygienists, preventive therapists, EFDA's, etc.)
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From page 70... ...
An author of that study explained elsewhere that "greater demand apparently allows more efficient scheduling of patients from the producer's viewpoint and some substitution of patient waiting time for idle time of dentists, auxiliaries, and capital equipment 332/. Consumer Demand Considerations Many studies of the utilization of dental services discussed in Chapter 2 indicate that consumer demand is positively related to per capita income and educational attainment.
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From page 71... ...
Productivity of private dental practice was emphasized because recommendations to cover treatment services for the entire population will, at least in the short term, necessarily be delivered largely in the settings in which dentists currently practice. Many factors affect dental practice productivity and thus the supply of services.
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From page 72... ...
On the basis of the experience with the uses of dental hygienists and expanded function dental auxiliaries in providing preventive services in school-based preventive programs for children and adolescents, the committee recommends such auxiliaries be used to provide such care in the recommended school-based system.
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