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HMO's and dentistry
- Thread starter robf
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HMO's stepped in and filled a need when employers became concerned about the rapidily rising costs of providing health insurance for their employees. At about the same time, the USA had begun cranking out increased numbers of primary care physicians via med schools and residencies for foreign trained MD's. So, I think the HMO's were able to take advantage of the large increase in number of licensed primary care physicians because the HMO's had also been handed the keys to the gate (via company sponsored medical insurance plans) through which primary care physicians had to pass in order to gain access to the vast majority of customers seeking such services.
Dentistry is in a different ball game. On the demand side, the costs of company sponsored dental insurance plans are much easier for companies to anticipate from one budget cycle to the next because such costs stay in line with the general cost of living. Another reason that dental insurance costs are more stable than medical insurance costs is that dental insurance benefit outlays per insured per year are routinely capped.
On the supply side, dental schools now only put out about 4000 graduates per year which is down from a peak of about 6000 per year that was reached some years back. Furthermore, foreign trained dentists have to compete for acceptance to a North American dental school and must then complete at least the last two years of training at such a school before they are eligible to seek licensure to practice dentistry in the USA.
So, in summation, there is less market opportunity for the HMO's to exploit in the field of dentistry than there was in the field of primary care medicine.
Dentistry is in a different ball game. On the demand side, the costs of company sponsored dental insurance plans are much easier for companies to anticipate from one budget cycle to the next because such costs stay in line with the general cost of living. Another reason that dental insurance costs are more stable than medical insurance costs is that dental insurance benefit outlays per insured per year are routinely capped.
On the supply side, dental schools now only put out about 4000 graduates per year which is down from a peak of about 6000 per year that was reached some years back. Furthermore, foreign trained dentists have to compete for acceptance to a North American dental school and must then complete at least the last two years of training at such a school before they are eligible to seek licensure to practice dentistry in the USA.
So, in summation, there is less market opportunity for the HMO's to exploit in the field of dentistry than there was in the field of primary care medicine.
Groundhog hit it exactly on the head. There is such a demand for dentistry today, and dentistry as a whole has opposed insurance domination of the field via the HMO, that in the forseeable future, the HMO WON'T happen to dentistry 
Frankly, with the feeling of dentists in my area, if the HMO raping of dentistry attempted to occur, most of us would just drop insurance plans all together and go strictly fee for service. So what if we lost a few patients, most dentists currently have more patients that we know what to do with right now, so loosing a few patients right now might only mean that the wait to get in to see us now would go from 2 months to 1 month.
I personaly feel that one of the large factors of why HMO's hasn't taken over dentistry has to do with the strong membership percentage that are in the ADA. Roughly 2/3's of all dentists in the US are members, and that gives the ADA some real solid lobbying power. In comparison to the medical field where roughly 20% of MD's belong, there isn't same strength as a whole to represent the entire field, not just specialty fields.
Frankly, with the feeling of dentists in my area, if the HMO raping of dentistry attempted to occur, most of us would just drop insurance plans all together and go strictly fee for service. So what if we lost a few patients, most dentists currently have more patients that we know what to do with right now, so loosing a few patients right now might only mean that the wait to get in to see us now would go from 2 months to 1 month.
I personaly feel that one of the large factors of why HMO's hasn't taken over dentistry has to do with the strong membership percentage that are in the ADA. Roughly 2/3's of all dentists in the US are members, and that gives the ADA some real solid lobbying power. In comparison to the medical field where roughly 20% of MD's belong, there isn't same strength as a whole to represent the entire field, not just specialty fields.
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Managed care in medicine got really big once the large private sector companies started demanding affordable health care for their employees. But most of them until recently were not demanding the same from the dental and allied health care fields simply because dental coverage was not a part of a standard benefits package. Only in the last 5-6 years some employers have started paying for dental coverage like delta dental plans.So I believe there will be a rising curve of dental HMO's but it will be a lot less compared to medicine precisely because of what dr jeff mentions -- fee for service, non-hospital based care.
The major reason, in my opinion, that medicine succumbed to HMOs while dentistry did not is that there is generally more at stake in medical patients than dental patients. What I mean by that is that refusing patients as a physician results in much more harm than in dentistry. As one of the above posters mentioned, many dentists would stop taking insurance if HMOs moved in. If doctors did this peoples lives would be at stake, not just the health of their teeth. Can you imagine the public uproar if a big chunk of doctors refused to help people if they couldn't pay out of pocket? "Sorry sir, I can't take out your appendix, I don't take insurance" is a lot harder to say than "I can't fill your cavities, I don't take insurance." I am not trying to underestimate the service that dentists provide, just pointing out a major difference between them and physicians that has led to the current situation.
As a side note, HMOs are not that terrible, especially if you are a younger person. They are much less expensive to be a part of. My options for medical coverage included 3 HMOs with monthly payments of $0-$20 / month ($200 is covered by employer) or 2 regular insurance plans which would have cost me $120 or $200 per month (on top of the $200 my employer picks up). I almost forgot, all three HMOs covered basic dental coverage.
As a side note, HMOs are not that terrible, especially if you are a younger person. They are much less expensive to be a part of. My options for medical coverage included 3 HMOs with monthly payments of $0-$20 / month ($200 is covered by employer) or 2 regular insurance plans which would have cost me $120 or $200 per month (on top of the $200 my employer picks up). I almost forgot, all three HMOs covered basic dental coverage.
•••quote:•••Originally posted by Whisker Barrel Cortex:
•The major reason, in my opinion, that medicine succumbed to HMOs while dentistry did not is that there is generally more at stake in medical patients than dental patients. What I mean by that is that refusing patients as a physician results in much more harm than in dentistry. As one of the above posters mentioned, many dentists would stop taking insurance if HMOs moved in. If doctors did this peoples lives would be at stake, not just the health of their teeth. Can you imagine the public uproar if a big chunk of doctors refused to help people if they couldn't pay out of pocket? "Sorry sir, I can't take out your appendix, I don't take insurance" is a lot harder to say than "I can't fill your cavities, I don't take insurance." I am not trying to underestimate the service that dentists provide, just pointing out a major difference between them and physicians that has led to the current situation.
As a side note, HMOs are not that terrible, especially if you are a younger person. They are much less expensive to be a part of. My options for medical coverage included 3 HMOs with monthly payments of $0-$20 / month ($200 is covered by employer) or 2 regular insurance plans which would have cost me $120 or $200 per month (on top of the $200 my employer picks up). I almost forgot, all three HMOs covered basic dental coverage.•••••Just try and find a dentist though (outside of the dental clinic at your hospital) that accepts an HMO plan. Most dentists won't because plain and simple there are so many folks out there with higher reimbursing plans that most dentists just won't sign up for/accept HMO's.
•The major reason, in my opinion, that medicine succumbed to HMOs while dentistry did not is that there is generally more at stake in medical patients than dental patients. What I mean by that is that refusing patients as a physician results in much more harm than in dentistry. As one of the above posters mentioned, many dentists would stop taking insurance if HMOs moved in. If doctors did this peoples lives would be at stake, not just the health of their teeth. Can you imagine the public uproar if a big chunk of doctors refused to help people if they couldn't pay out of pocket? "Sorry sir, I can't take out your appendix, I don't take insurance" is a lot harder to say than "I can't fill your cavities, I don't take insurance." I am not trying to underestimate the service that dentists provide, just pointing out a major difference between them and physicians that has led to the current situation.
As a side note, HMOs are not that terrible, especially if you are a younger person. They are much less expensive to be a part of. My options for medical coverage included 3 HMOs with monthly payments of $0-$20 / month ($200 is covered by employer) or 2 regular insurance plans which would have cost me $120 or $200 per month (on top of the $200 my employer picks up). I almost forgot, all three HMOs covered basic dental coverage.•••••Just try and find a dentist though (outside of the dental clinic at your hospital) that accepts an HMO plan. Most dentists won't because plain and simple there are so many folks out there with higher reimbursing plans that most dentists just won't sign up for/accept HMO's.
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