Dental health maintenance organizations also referred to as capitation plans accounted for eight percent of the benefits offered to the United States dental market in 2010. Under these agencies, dentists are contracted and pre-paid a given amount of money each month for every patient assigned or designated to them. Dentists are in return required to offer particular contracted services at zero or reduced costs to their assigned patients. Patients benefit by not making co-payment for preventive and diagnostic services. However, they are supposed to make co-payment for other services that are not spelled out in the organization’s summary of benefits (Schechter, 2013). Several issues are associated with DHMOs. This paper identifies and discusses these issues.
Impacts of DHMOs on Dentist-Patient Relationships
DHMOs are likely to result in reduced dentist-patient relationships due to various aspects of the plan. The plans deny patients the autonomy to make decisions about changing dentists when they deem it necessary. They do not allow reimbursement for individual services to dentists or patients with the objective of steering patients to dental offices of participating dentists. Since patients receive benefits by seeking treatment from a contracted office, they are forced to search for dental care from participating dentists so that they can reduce the out of pocket expenses (Ireland, 2015). Alternatively, if the contracted office cannot solve the patients’ problem, the participating dentist is required to recommend them to a specialist. The plans’ inability to acknowledge the need for patients to make informed choices based on their values and wishes, without being influenced or coerced to follow a particular direction strains the doctor-patient relationship. A good rapport between the two would require developing a partnership that can help to nurture trust. In a healthy partnership, the dentist offers knowledge and skills about dental care that is beneficial to the patient. On the other hand, the patient comes with values and beliefs from their environment. Both partners then establish a common ground to negotiate the best treatment course for the patient. Lack of patients’ autonomy hinders the development of such a partnership. Research findings also support that patient-centered decision-making enhances the adherence to treatment and improvement of outcomes (Ireland, 2015). Therefore, lack of patients’ autonomy in making decisions hinders a healthy dentist-patient relationship in the DHMO setting.
Dental Insurance Companies
DHMOs help solves various dental care problems in patients that can, in return, reduce chances of severe health issues in the future. However, they present a possibility of hindering dentists from offering quality services. Dental health insurances make payments to dentists regardless of whether their offices provided any services. They ensure that the dentist facilities have a predictable cash flow and source of income. Dentists are in return expected to take up the financial risks associated with the provision of dental care services. If a few patients visit their office, dentists retain more income as they do not spend it on taking care of clients’ needs. Conversely, if many patients require dental care, the dentists are obligated to offer services for the same payment. Hence, the inability to balance costs and incentives may affect the delivery of appropriate services. Plan managers and sponsors do not have a way of knowing the amount and value of services that are provided by the dentists (Schechter, 2013).
The participating dentists may try to reduce costs using any available means. For instance, they can make more profit by serving increasingly healthier patients who require less care and referring those with serious problems to specialists. Additionally, they may fail to recommend certain treatments for dental problems if they feel that patients will not be in a position to afford the, services and if the insurance does not cover them. According to Ireland (2015) organizations in managed care, which offer professional health care providers financial incentives for the provision of services, lure them to place their interests before those of the patients. These issues are an indication that DHMOs are not in the business of dental care since they only assist in solving some problems and dentists have a likelihood of ignoring patients’ needs.
In conclusion, DHMOs provide some benefits to patients. However, they also have various disadvantages. For instance, they provide extremely low-cost services for users within their networks. Clients are not required to file claim forms or undergo a waiting period. They restrict the number of choices for a patient, which is not fair to most people, particularly if the participating providers are not ideal for meeting their needs. Additionally, the low costs may affect the quality of services offered by doctors. Therefore, the society would benefit more if the DHMOs were improved or replaced with better plans. Improved DHMOs would ensure that clients receive more services at fair prices and have the liberty to make their decisions when selecting a provider. They would also guarantee that valuable services are offered to patients without considering their costs. The fact that DHMOs are one of the cheapest insurance options makes them ration care. A plan that is considered as the least expensive option reduces benefits by offering solutions with least costs compared to other possible alternative treatments, even when a dentist is aware that an individual procedure is in better suited to solve a patient’s problem.
Ireland, E. (2015). 2014 State of the dental benefits market. Medical Benefits, 32(14), 6-15.
Schechter, B. (2013). A DHMO value checker and understanding drivers of dentists’ behavior. Employee Benefits Journal, 24(4), 24-37.