Getting the Incentives Right
Improving Oral Health Equity With Universal School-Based Caries Prevention
Bibliographic Data
Despite significant financial, training, and program investments, US children’s caries experience and inequities continued to increase over the last 20 years. We posit that (1) dental insurance payment systems are not aligned with the current best evidence, exacerbating inequities, and (2) system redesign could meet health care’s triple aim and reduce children’s caries by 80%. On the basis of 2013 to 2016 Medicaid and private payment rates and the caries prevention literature, we find that effective preventive interventions are either (1) consistently compensated less than ineffective interventions or (2) not compensated at all. This economic and clinical misalignment may account for underuse of effective caries prevention and subsequent overuse of restorative care. We propose universal school-based comprehensive caries prevention to address this misalignment. Preliminary modeling suggests that universal caries prevention could eliminate 80% of children’s caries and cost less than one fifth of current Medicaid children’s oral health spending. If implemented with bundled payments based on cycle of care and measurable outcomes, there would be an alignment of incentives, best evidence, care, and outcomes. Such a program would meet the Healthy People Oral Health goals for children, as well as health care’s triple aim
Business · Dental insurance · Economic growth · Environmental health · Equity (law) · Family medicine · Health care · Incentive · Medicaid · Oral health · Payment · Psychological intervention · Dental Health and Care Utilization · Finance · Healthcare Policy and Management · Medicine · Nursing · Primary Care and Health Outcomes
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| Unique citing works | 5 |
|---|---|
| Citations per year | 0,63 |
| Citation span | 2018 - 2021 (4) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 5 |