ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

MANAGED CARE PLANS

Preferred Provider Organizations have experi-
enced 20-30% annual growth in membership from
1994 to 1999. In contrast, enrollment in Dental
HMOs leveled off in 1997 to about 19% of the
employer group prepayment population. Forty-
seven percent of Dental HMO members are from
three states: California, Florida, and Texas
(National Association of Dental Plans, 2000).
Dentists who participated in PPO plans reported
that just over one-quarter (25.9%) of their patients
were enrolled in PPO dental plans. Dentists partic-
ipating in capitation dental plans reported a similar
percentage of their patients in capitation plans
(20.7%). However, a 1994 ADA survey of all den-
tists found much lower levels of patient participa-
tion in these two types of plans (ADA, 1995). At
that time, only 3.1% of dentists' patients were
enrolled in capitation dental plans and 2.1% of their
patients were enrolled in PPOs.
A 1998 ADA survey of dentists in private prac-
tice, 1998 Survey of Capitation and Preferred
Provider Dental Plans, showed that dentists' partic-
ipation in PPO plans has increased since a previous
survey conducted in 1996 (ADA, 1997 and 2000).
Almost 50% of responding dentists (47.7%) report-
ed participating in PPO dental plans in 1997 com-

pared to 33.7% in 1995. (See

Figure 4.5.)

Capitation dental plans (or Dental

HMOs) showed a different trend,

with the percentage of dentists

declining in the period covered by

the two ADA surveys. One of the

reasons frequently mentioned for

the decline in Dental HMO plans

is that the cost of providing the serv-

ices is greater than the remuneration

received. As a result, some dentists

left the programs. Others felt the

way to resolve this imbalance was

to limit the type and/or amount of

treatment provided. Still other den-

tists offered services, procedures or

materials that were not covered

benefits, requiring the patients to

assume greater financial burden

than they had previously expected.

The ADA's 1998 Survey of

Capitation and Pre-ferred Provider Dental Plans

also asked dentists about their satisfaction with the

plans (ADA, 2000). The largest percentage of den-

tists who participated in a PPO plan (44.5%) were

somewhat satisfied with their largest PPO plan.

About one-quarter of participating dentists (27.8%)

were somewhat dissatisfied with the plan. Of those

dentists reporting some level of dissatisfaction, the

Financing of and Access to Dental Services

Percentage of Dentists Participating in

Preferred Provider Organization (PPO) and

Capitation (Dental HMO) Plans, 1995 and 1997

Source: ADA, 1997 and 2000.

60

50

40

30

20

10

0

1995

1997

PPO

33 .7

4 7. 7

Capitation

18. 1

15. 3

FIGURE 4. 5

P

ER

C

E

NT

Indemnity Plans

Preferred Provider Organizations

Dental Health Maintenance Organizations

Source: National Association of Dental Plans, 2000.

90

80

70

60

50

40

30

20

10

0

FIGURE 4. 4

Enrollment in Indemnity Plans, Preferred Provider Organizations,

and Dental Health Maintenance Organizations for

Members with Employer-Based Prepayment, 1994-1999

M

ILL

IONS

YEAR

1994 1995 1996 1997 1998 1999