StudentShare
Contact Us
Sign In / Sign Up for FREE
Search
Go to advanced search...
Free

Managed Care and Policy at Dental Health Maintenance Organization - Assignment Example

Cite this document
Summary
The paper "Managed Care and Policy at Dental Health Maintenance Organization" asserts the implementation of this policy will enhance public health efforts to promote the wellbeing of the public in line with the Protection and Affordable Care Act and reduce the burden on the Medicaid program…
Download full paper File format: .doc, available for editing
GRAB THE BEST PAPER93.5% of users find it useful
Managed Care and Policy at Dental Health Maintenance Organization
Read Text Preview

Extract of sample "Managed Care and Policy at Dental Health Maintenance Organization"

? Managed Care and Policy Papers Managed Care Paper Dental health maintenance organisation (DHMO) plans were established with the intention of providing an acceptable alternative to the fee-for-service payment system as well as assisting in restraining the cost of dental care. The various DHMO plans have influenced the dentist-patient relationship in different ways based on the terms that dictate the services provided under every plan. There are four basic organisational modes under which dental care can be provided. These modes impact how the dentists relate to their patients or clients. In the staff model, patients receive dental care services from dentists, dental hygienists and dental assistants salaried by HMO (Marya, 2011). HMO also contracts directly with a group practice, partnerships or corporations for the provision of dental services. The various HMO models contain numerous clauses, contractual limitations and bureaucratic processes which affect the relationship between the dentists and their clients. The HMO insurance plans have been significantly focused on the medical sector with limited investment in the dental sector. This has significantly undermined the motivation among dentists to service patients seeking dental care services. The financial compensation provided to dentists is significantly low compared to what other healthcare professionals receive from HMO (Gluck & Morganstein, 2002). This has really impacted negatively the motivation of dentists, especially those serving in community health facilities. Bureaucracies surrounding reimbursement of dentists and dental hygienists are dictated by the DHMO plan terms and contractual agreements. In some cases, dental hygienists need approval by other professionals within the organisation they are working for, including senior dentists. Delays associated with the DHMO reimbursement process has seen some dentists within the general health care setting avoid providing dental care services to patients seeking services under the DHMO insurance plan. As such, the majority of dentists prefer serving customers seeking dental care under the fee-for-service payment method. The dentist-patient relationship is at times limited by the DHMO contractual terms which dictate and limit dental care services provided by the dentists and dental hygienists. As such, DHMO undermines the individual consent of the patient as one of the key ethical principles of healthcare practice. In essence, patients are not given an opportunity to provide an informed consent to what should be done about their dental health. Dentists can only provide those services included in the DHMO plan rather than what the patients need done about their dental health. Dentists are compelled by the insurance plan terms and conditions to limit the extent of dental care services provided, with most patients only receiving essential dental services while they may be in need of advanced care. Therefore, DHMO to a great extent introduces limitations in the dentist-patient relationship in which the patient is required to discuss issues about their dental health and agree on the best intervention to diagnosed dental health problems. Unlike in the fee-for-service payment method where dentists rely on their requests to provided dental care, patients under the DHMO plan receive services outlined by the HMO insurance. The dentist-patient relationship is further undermined where the dentist is dealing with many patients seeking dental care under the DHMO insurance. Under such circumstances, dentists are forced to limit the time spent with patient to better understand their dental health problem and provide lasting solutions. In this case, the rapport between the dentists and the patients required to guarantee effective intervention does not develop as the dentist rushes to serve as many patients as possible in order to receive better financial reimbursement. DHMO raises quality issues which consequently undermine the dentist-patient relationship and that between the patients and dental care facilities (Gluck & Morganstein, 2002). Patients are sensitive about the quality of care provided by individual dentists and dental facilities, a phenomenon that may contribute to a poor reputation especially for dentists and dental facilities compelled by DHMO insurance terms to provide limited dental care services. Insurance companies have begun appreciating the increasing focus on dental care within the health care system as part of promoting general wellbeing of the society. In response to this, several private insurance companies have introduced dental insurance packages to tap on the growing demand for dental care services. Most of the insurance companies provide dental insurance packages ranging from basic to major insurance packages. Unlike DHMO insurance, patients are provided with adequate freedom to establish long-term relationships with their dentists as well as the freedom to change assigned dentists to their preferred choice dentist. Upon realisation of the limitations associated with DHMO insurance plans, an increased number of patients now prefer private dental insurance companies which provide them with significant freedom in their quest for dental care services. Indeed, insurance companies have begun acknowledging the increasing demand for insurance packages to replace the traditional HMOs characterised by several contractual limitations and inefficiencies. Some of the insurance companies in the business of dental care include the DeltaCare, Aflac, and MetLife (Delta Dental, 2012). Insurance companies have embarked on the process of creating and offering a wide range of competitively priced dental insurance plans in order to compete effectively in the increasingly competitive dental insurance market. Although DHMO plans have been characterised by several limitations, the society cannot be better without them. This is because not all people are able to secure a private insurance package themselves. HMO has played a critical role in promoting access to essential dental care services especially among the middle and low socioeconomic population. Therefore, HMO remains crucial in the provision of dental care services as well as controlling the pricing of dental care services. The society needs HMO to put checks on the pricing of insurance packages offered by the private companies. However, there is a need to address limitations associated with HMO including bureaucracies involved in the reimbursement of dentists, and rationing of dental care services provided by dentists under the HMO plans. Improvement of the terms and standards in HMO plans and focus on quality would be better for the society than abolishing the plans. Indeed, DHMOs ration care by limiting the type of dental care services that can be provided to patients with the HMO insurance. Dentists are instructed on the level and extent of dental care services that they can provide to patients seeking services under the HMO plans. Patients and dentists are not given the opportunity to negotiate the best intervention, but the dentist is guided by the service guideline provided by the insurer. Patients are entitled to services outlined under the plan and the dentist can provide services beyond the limitations provided by the insurer. The patient’s autonomy is not recognised in this plan because dentists can only provide services that are outlined in an HMO insurance plan. Dentists are denied the freedom to decide what is best for the patient in negotiation with patient rather than following the insurer’s guidelines which have been constituted without consulting the dentist and the patients. Health Policy Children from disadvantaged families are the worst hit by dental health problems, especially tooth decay, which can be prevented through establishment of effective policies and programmes. In respect to such experiences, the Patient Protection and Affordable Care Act (P.L.111-148), Sec. 4102 (a), acknowledges the importance of establishing science-based strategies such as provision of fluoridated water and sealants to prevent tooth decay and related dental health problems (Wolters Kluwer, 2010). The bill mandates the secretary in the health sector to implement the Affordable Care Act in order to ensure promotion of general wellbeing of the society. The bill recognises the importance of school-based sealant dental programmes in enhancing better dental health for all children regardless of their socioeconomic backgrounds. However, formulation of science-based dental health promotion policy would play a great role in preventing dental health problems especially among the disadvantaged children who are highly likely to develop dental health complications. Sealants and fluoridation of water are some of the most cost effective strategies that could be effectively exploited to reduce the limitations in access to dental care among low-income, minority and disabled children (Kelly, Binkley, Neace & Gale, 2005). The policy should provide for inclusion of parents or involvement of communities in the school-based sealant and fluoridation programmes as a way of ensuring that the programmes are effective in addressing disparities in dental care access among these populations. The prevention policy will play a critical role in reducing the number of children in need of dental care services and cultivate a strong culture of good oral hygiene not only among the children but also in the communities where the children come from (Kelly, Binkley, Neace & Gale, 2005). Policy Statement The policy on the promoting scientific dental health prevention programmes such as provision of sealant and fluoridation of water is crucial in addressing the problem of tooth decay specifically among the low income, disabled and minority group children. These children face the greatest tooth decay challenges as well as limited access to dental care services. As such, this policy is aimed at addressing the problem of tooth decay and disparity in the access to dental care by emphasising preventive measures among the worst hit populations. The prevention measures are expected to reduce the number of children from these groups in need for dental care services (Kellogg, 2010). In addition, the policy will enhance the attention given to school-based dental programmes and provide avenues for funding such programmes in order to enhance their effectiveness in addressing the dental health challenges faced by the American children. The policy is in line with the Protection and Affordable Care Act which aimed at promoting improved health among the Americans. Affected Population This policy targets low income children, children from the minority groups, disabled children and the communities where these children come from. This population is worst hit by the disparity in dental care access. The population faces significant dental health challenges with tooth decay as one of the major challenges. Support for the Policy The policy on science based dental health prevention programmes such as the sealant and fluoridation programmeme is crucial in address the problem of tooth decay as well as reducing disparities in dental access among the low income, minority and disabled children. According to (Kellogg, 2010), about 17 million from low income children face the problem of simple cavity which triggers increased dental health challenges for lack of access to dental care services. Although the government has made significant efforts in addressing this problem, such challenges can be addressed through relatively low cost strategies such as the school-based sealant and provision of fluoridation of water services to communities and schools where children are at a great risk of suffering from tooth decay. Studies have shown that about $106 billion were spent in 2010 to cater for dental care services ranging from filling to root canals (Kellogg, 2010). This can be partially attributed to lack of basic dental care capable of preventing dental cavities that lead to the high cost of treatment in later days in the child’s life. In addition, the national dental health crisis has been attributed to limited access to proven preventive measures such as sealants and fluoridation among children, lack of enough dentists to provide dental care at the community level, and a limited number of dentists willing to provide dental care to Medicaid-enrolled children. In this case, such challenges can be circumvented by putting increased effort in cost effective measures such as sealant and fluoridation programmes. Sealants have been shown to prevent about 60 percent of decay in molars. Another advantage that could be used to support the application of sealants is that such services can be provided by dental hygienists through the school-based sealant programmes (Kellogg, 2010). Therefore, implementation of the policy to promote the sealant and fluoridation programmes could play a critical role in addressing challenges in the access of dental care among targeted populations. The process is not only cost effective but also guarantees provision of preventive dental care services to the majority of disadvantaged children. The CDC has suggested that for every $1 invested in water fluoridation about $38 is saved on dental treatments (Kellogg, 2010). Therefore, community water fluoridation has emerged as one of the most effective strategies that could drastically reduce dental problems currently experienced among the disadvantages populations. If the public health sector is willing to win the war against the dental health problems experienced by the identified populations, then it must consider investing heavily in preventive rather than treatment measures. Medicaid is currently experiencing increased pressure from increasing demand for dental care services among the children. It is, therefore, important to look for alternative and cost effective ways to reduce the burden on such programmes. Preventive measures are essential in assisting the government in reducing the providing of dental care to children and people with disabilities (Kelly, Binkley, Neace, & Gale, 2005). As discussed earlier, these populations are worst hit by dental health problems as well as limited access to dental care services. The proposed policy will play a critical role in increasing the public health commitment to reducing the dental health problems among children through the use of cost effective scientific measures such as the school-based sealant programme and the community water fluoridation. Effective limitation of tooth decay among these groups will significantly reduce the number of children in need of dental care services. In conclusion, the implementation of this policy will enhance public health efforts to promote the wellbeing of the public in line with the Protection and Affordable Care Act. The policy will also reduce the burden on the Medicaid programme. References Delta Dental. (2012). DeltaCare USA. Retrieved from http://www.deltadentalins.com/business/deltacare-usa.html. Gluck, G., & Morganstein, M. (2002). Jong's community dental health (2nd ed.). New York, NJ: Elsevier Health Sciences. Kellogg, K. (2010). The cost of delay: State dental policies fail one in five children. The PEW Center on the States. Retrieved from www.wkkf.org/.../the%20pew%20center%20on%20the%20states%20the...? Kelly, S., Binkley, C., Neace, W., & Gale, B. (2005). Barriers to care-seeking for children’s oral health among low-income caregivers. American Journal Public Health, 95(8), 1345- 1351. Marya, J. (2011). Textbook of public health dentistry Pb. London: JP Medical Ltd. Wolters Kluwer. (2010). Law, explanation and analysis of the Patient Protection and Affordable Care Act: Including Reconciliation Act Impact, Volume 1. New York, NY: CCH Incorporated. Read More
Cite this document
  • APA
  • MLA
  • CHICAGO
(“Managed care paper/ Policy Assignment Example | Topics and Well Written Essays - 2000 words”, n.d.)
Retrieved from https://studentshare.org/health-sciences-medicine/1477771-managed-care-paper-policy
(Managed Care Paper/ Policy Assignment Example | Topics and Well Written Essays - 2000 Words)
https://studentshare.org/health-sciences-medicine/1477771-managed-care-paper-policy.
“Managed Care Paper/ Policy Assignment Example | Topics and Well Written Essays - 2000 Words”, n.d. https://studentshare.org/health-sciences-medicine/1477771-managed-care-paper-policy.
  • Cited: 0 times

CHECK THESE SAMPLES OF Managed Care and Policy at Dental Health Maintenance Organization

The British Health Service

Exploring the Rationale for Change Public institutions that are managed by the government are sought to be less likely to change, instead when it is said to bring change in any public organization what really is meant is the uplift in the performance of that system or an attempt to increase the capacity of that government resource for better output.... The rationale for change in any organization revolve around improving the effectiveness of the services that are delivered to the people, increasing the accessibility therefore every citizen is able to get the required services at the shortest distance possible, uplifting the capacity for the existing services to envelope more service areas keeping the effectiveness of the previous services provided....
23 Pages (5750 words) Essay

State mental health care management

Most Americans however cannot afford private care and thus depend on the publicly offered mental care.... Among the changes that have been noted is the increased access to a wide array of people, the expansion in the number of services that are provided, the consistency in care and decision making due to centralized care aided by the formulation of specific goals, increased accountability and emphasis on the positive outcomes and decrease in the use of inpatient care which may not be necessitated....
12 Pages (3000 words) Term Paper

The Basics of Managed Care

After the enactment of the health maintenance organization act of 1973, HMOs grew in large numbers (Patel & Rushefsky, 2006).... The writer of the following essay would investigate the aspects of managed care, and, moreover, investigate its impacts on health maintenance organizations.... When one mentions managed care, health maintenance organizations automatically come to mind.... In a nutshell, managed care implies the techniques employed to reduce the cost of providing health care....
6 Pages (1500 words) Essay

Management of Health Care Practice

The practice manager's role in a hospital in running GP practice in a multicultural diverse area like Newham, a London borough involves understanding of the responsibilities related to a whole host of activities in an organization such as finance, HRD, housekeeping, front office management apart from the support services relating to GP.... organization of staff, logistics, supplies, and services in providing efficient health care with minimum waiting time and discomfort to the patients need to be achieved by reducing inequalities under safe and clean environmental conditions for enhancing the level of the patient experience....
9 Pages (2250 words) Essay

Vocational Rehabilitation for People with Mental Illness in the UK

Though managed care is the existing buzzword in the human services, frequent health care organisations, supported by provisions of the health maintenance Organisation Act of 1973, have been experimentation with this move toward for many years.... This research discusses the managed care proposal sweeping the nation and their thoughtful belongings on the way social workers transport services to people with severe mental illness (Bachrach, L.... Evolution of managed care Many experts described the development of managed care as include five distinct phases: (1) carrying out consumption reviews and confine access, (2) managing advantage use, (3) supervision care with a most important importance on cost control, (4) running outcomes, and (5) put together managed care systems parallel and upright....
9 Pages (2250 words) Essay

HIV and the Use of Self-Managed Care

The paper "HIV and the Use of Self-managed care" discusses that the concept of self-management by increasing patient's confidence and enhancing the self belief and self-efficacy to ultimately changing behavior was first developed in the 1960s and 1970s.... An organization called Living Well, which is funded by the National Health Service the public health system in the United Kingdom has embraced this concept of wellness and successfully lead a great number of those suffering from HIV and AIDS through the problems resulting from the diagnoses....
9 Pages (2250 words) Coursework

Managing Financial Resources in Health and Social Care

With the advancements and innovation, not only profit driven organization are making use of financial and administrative resources, but the service organizations have also adopted the utilization of advanced methods and resources.... very organization, whether profit-drive or non-profit, have finance as an Financial Management is therefore an important aspect which refers to the effective and efficient management of funds (money) in such a way that the objectives and goals of the organziation are accomplished....
12 Pages (3000 words) Essay

The Emergence and Evolution of Managed Care

This paper "The Emergence and Evolution of managed care " tells that the concept of managed care is duly regarded as a revolutionary aspect within the domain of health care.... The concept of managed care intends to enhance the level of quality care being provided to the patients and also making better use of the available resources in an optimal manner.... The idea of managed care has evolved from age-old traditions of providing quality care to the people....
5 Pages (1250 words) Essay
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Contact Us