The Quality of Dental Care and HMO

The quality of dental care is a multidimensional concept that can be perceived differently by patients. As it was already noted, indemnity and Health Maintenance Organization (HMO) plans present different opportunities as the former does not limit patients in the selection of oral services, and the latter reimburses dentists for the particular service provided. However, the unlimited services create the potential for unnecessary issues or overtreatment. In this regard, it seems essential to reveal how patients identify the concept of quality. In their study, Chang and Chang (2013) argue that “the physical characteristics of the structural aspect and administration of the process aspect are regarded as must-be attributes at the top of patient priorities” (p. 247). In other words, patients assign a special role to the technical point of care, especially to sufficient dentists for selection, healthy appearance of dentists, and their high-quality reputation (Chang & Chang, 2013). As for the administration, such dimensions as soliciting of patient opinions, effectiveness in handing patient complaints, and ease in making an appointment are rated above all.

With this in mind, it is possible to suggest that indemnity plans can provide a higher level of quality rather than those of HMO as the former offers more opportunities in terms of dentist selection and accessibility of appointment. Furthermore, it is essential to emphasize that the elimination of overtreatment is necessary to ensure the quality of dental services and meet patients’ requirements. In its turn, HMO plans are also likely to offer quality services, focusing on the improvement of administration and the process of care. The outcome of treatment, however, remains the key indicator of the quality extent to which oral services are provided.

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The staff model HMOs are associated with the direct agreements contracted between HMO and a certain dentist along with a hygienist. For example, the dental health insurance scheme is organized primarily through a staff model in Nigeria. According to the study by Mohammed et al. (2014), such a mechanism creates the limited satisfaction of patients due to the ineffectiveness of the provided services. At this point, the optimal-resource-use (ORU) instrument was used to collect and analyze the evidence, as stated by Mohammed et al. (2014). In effect, the authors revealed that the socially oriented national health insurance scheme (NHIS) implemented in Nigeria needs to be improved, considering the contextual issues, active monitoring, and appropriate payment for contracts.

The group model HMO, by the very definition, implies a contract with a group of dentists and hygienists as well as a capitation premium assigned to the whole group. For example, these contracts may be concluded with hospitals or private clinics. The captive group model is applied only in relation to HMO beneficiaries. The most evident example of the mentioned model is the Kaiser Foundation Health Plan, according to which all the members of the organization are provided with care from Permanente Medical Groups. In its turn, the independent group model HMO focuses on contracts with a multispecialty and self-governing group of experts to provide services to its members. As an example, the Geisinger Health Plan of Danville, PA can be noted. The Geisinger Clinic is a multifaceted facility that also covers dental services and operates in terms of the Geisinger Health Plan of Danville. Along with providing services for the organization members, the independent group may also be engaged in non-HMO business to assist non-HMO patients in their needs.

References

Chang, W. J., & Chang, Y. H. (2013). Patient satisfaction analysis: Identifying key drivers and enhancing service quality of dental care. Journal of Dental Sciences, 8(3), 239-247.

Mohammed, S., Souares, A., Lorenzo Bermejo, J., Babale, S. M., Sauerborn, R., & Dong, H. (2014). Satisfaction with the level and type of resource use of a health insurance scheme in Nigeria: Health management organizations’ perspectives. The International Journal of Health Planning and Management, 29(4), 309-328.

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