Devil in the detail of scheme

OF all the several bold ideas contained in the interim report from the federal Government's National Health and Hospitals Reform Commission, released this week, the plan for a universal dental scheme is the one that has, perhaps, captured the public's imagination the most.

Over the past two years the nation has been bombarded with horror stories of pensioners nursing mouths filled with rotting teeth which they can't afford to get fixed, and of others lingering for months, even years, on waiting lists for public treatment.

There is wide support for some sort of re-think. But the NHHRC's proposal has not been greeted with open arms on all sides.

Famously, the Australian Dental Association -- the nation's peak group for private dentists -- attacked the plan almost immediately as "impractical, nonsensical, (and) overly simplistic" and declared it "flies in the face of much of the deliberations that have taken place on this issue over the past decade".

Responses from individual dentists have been more moderate, although still widely diverging. Tony Burges, a dentist in Sydney's inner-west suburb of Drummoyne, says the NHHRC's proposal is "a reasonable suggestion" but the "devil will be in the detail".

The ADA made a number of specific criticisms, including the claim that the costs of the scheme would be "crippling" and unaffordable, potentially costing over $11 billion.

However, a modelling report prepared by consulting firm PricewaterhouseCoopers at the NHHRC's request, and published this week, makes clear that based on certain assumptions about claiming patterns, the extra cost to government would be just $3.9billion a year. This amount would be more than covered by the proposed 0.75 percentage point increase in the Medicare levy.

But it turns out this affordability comes at a price.

The PwC report outlined three variations of what specific dental services the proposed Denticare scheme might cover, ranging from a fuller coverage to lesser. But none is truly comprehensive.

All exclude root canal treatments, crowns and bridges, periodontic care (involving cases of advanced gum inflammation leading to bone loss) and orthodontic treatments (including braces).

Crowns and bridges have been blamed for the soaring costs of the Howard government's Medicare-based dental scheme, which the Labor government has so far failed to scrap due to opposition in the Senate.

The existing Medicare scheme pays $2150 in Medicare rebates for private dental treatment per year, provided the patient is referred to the dentist by a GP who has assessed them as having a potentially life-threatening chronic condition that is being exacerbated by their dental problems. An analysis of spending in the Medicare scheme last year showed patients enrolled in it were making claims for crowns and bridges at a higher rate than would be seen in the normal dental patient population: about 7.4 per cent of total Medicare treatments, on a per-tooth basis.

However, the affordability means that basic dental treatment, which would be covered by any of the foreseen Denticare options, would be much more equitable.

At present, individuals going to private dentists spend an average of 0.79 per cent of their income on out-of-pocket charges to private dentists, an amount that rises to 0.96 per cent of taxable income once the cost of private health insurance premiums for dental cover are added in. Together this accounts for 78 per cent of total expenditure on dental services.

Under Denticare, individual funding of dental services would shrink to an average of 0.37 per cent of taxable income, equivalent to 29 per cent of spending on dental services.

The Denticare scheme, funded by the increased Medicare levy, would allow patients to choose cover under private insurance plans, in which case Denticare would pay the premium and the policy would cover 85 per cent of the fees, leaving the patient to pick up the remaining 15 per cent.

Other patients who wished to avoid the 15 per cent gap could elect to be covered under the public system, where treatment would be totally free, with the downside of some waiting.

Patients opting for private treatment would no longer need to pay separately for dental premiums. Overall, the average proportion of income spent on dental would rise from 1.24 per cent at present to 1.3 per cent under Denticare, with the increase due to the expansion of programs such as school dental and oral health promotion.

But this conceals the fact that according to PwC, equity -- meaning access for the poorest -- would be substantially increased under the proposal.

According to the modelling, taxpayers with annual household income of up to $25,218 currently pay just under 2 per cent of their taxable income on dental costs, or $11.25 per taxpayer per week.

This would fall to $8.94, just under 1.5 per cent of taxable income, under Denticare.

Those in households with annual income between $25,219 and $44,286 would be better off by 74 cents per taxpayer per week, and taxpayers in households with income between $44,287 and $67,129 would be $1.15 better off per week.

Taxpayers in households with income over $67,130 would be paying more under Denticare ($1.37 per taxpayer per week more, rising to $2.74 per week for income over $108,277).

Yet there are many assumptions in the Denticare modelling, and unexpected changes in consumer behaviour could have a significant effect on the impact of any scheme, should one be approved by the federal government.

For example, it's not easy to predict how many more dental services will be provided as a consequence of making dentistry more affordable for the less well-off. Also, about 35 per cent of people who visit the dentist do not at present have private dental cover, even though they visit a private dentist. How their needs will be met if they continue to eschew the private option, and rely instead on the public Denticare scheme, is not totally clear.

Burges feels that Denticare will come unstuck in the details.

"My personal view has always been that private dentists are probably best placed to treat most people in the population," he says.

"The NHHRC has budgeted about $4.5billion (for Denticare) ... but it could easily blow out and be very expensive to run. I think there's real potential for any universal scheme to blow out and be very expensive, and that might lead the government to cut costs."

Most unusual credit card deals

What do you have in your wallet? I bet at least one credit card! Nowadays you can hardly find a person having no plastics at all. The average U.S. consumer carries from three to six credit cards in his/her wallet. It seems that many people start to forget what cash looks like!
According to statistics, there are about 900 million debit and credit cards in circulation. It is obvious that lenders need to offer something really beneficial and interesting in order to draw attention to their products and snag new customers.
We have analyzed the credit card market to find three most unusual credit card offers that will really surprise you! If you are tired of standard zero-APR-no-annual-fee-cash-back-rewards-program plastics, consider the offers below: they provide innovative features and unique rewards!

1. Credit cards that smell

Commerzbank AG, one of Germany's major banks, has launched a range of Visa and MasterCard branded credit cards in four aromas – coffee, mint, cinnamon or orange. Now you know how money smells!

Marketing gurus have always known that smell is a powerful persuader to buy. For example, newsagents use the smell of bakery outside their stores to attract customers. Travel agencies spray coconut aroma in their offices – it makes customers think about exotic far away countries and book trips.

Credit cards with aroma will definitely draw attention to your plastic money. They will become a conversation opener at every checkout: "What pleasant smell! Is it really a scented credit card? I have never seen – and smelled - such cards before!"

Coffee, mint, cinnamon and orange are a good choice for credit card aroma because all these scents are food related. You will like at least one aroma out of four! Plus, they will suit both man and women.

Scented credit cards can lower your level of stress and ensure a better state of mind due to their aromatherapy effect. Orange fragrance is stimulating and energetic. Coffee and cinnamon are considered to be comforting and warming. Mint has a relaxing effect.

There is one more important psychological aspect of scented credit cards. Every time you open your wallet, you will smell your favorite fragrance and feel positive. However, it can make you spend more than you have planned!

2. Finance your plastic surgery!

Plastic surgery, for example breast augmentation and rhinoplasty, has become as common as teeth whitening. So no wonder that a credit card designed for plastic-surgery patients had to appear in the market one day.

CareCredit is issued by GE Money Company. This plastic is targeted at consumers who want to finance various medical procedures typically not covered by insurance. They include dental treatments, cosmetic surgery, cosmetic treatments, vision care and laser eye surgery, hearing aids, and even veterinary medicine for your pets.

The credit card spending limit is equal to the price of the procedure you want to finance. It gives you the freedom to get the healthcare now and pay for it later. But be careful: just because you have money for plastic surgery, it doesn’t mean that you really need it!

CareCredit can only be used for healthcare services. No Interest financing program will let you cut down your borrowing costs. Just make regular on time minimum monthly payments and eliminate the entire balance by the end of your promotional period. If you need more time to pay off your credit card balance in full, you can take advantage of several extended payment plans.

If you are interested in this offer, you can fill out an application form at participating doctors' offices. At the present moment there are over 100,000 healthcare providers in this program, for example American Dental Association, Society for Excellence in Eyecare and American Society of Plastic Surgeons.

3. The American Dream

Do you like to participate in lotteries? Now you have a chance to get sweepstakes entries and win a large cash jackpot just for using your plastic! How is it possible?

American DreamCard™ MasterCard® issued by HSBC Bank Nevada, N.A. offers the unique rewards program. It offers sweepstake entries just for making day-to-day purchases. You will earn one entry for each dollar spent for merchandise, cash advances and balance transfers during the promotion period. As you see, there is no need to be a big spender to win big!

Monthly winners will receive 50% of the total amount of dollars spent by all American DreamCard holders during each drawing period. It means that the monthly sweepstakes jackpot depends on the number of credit card users and the amount of money they spend.

The credit card comes with no annual fee and a variable interest rate on all transactions. It is necessary to mention that all interest rates are tied to the highest Prime Rate during a three-month period.

The secret to cheap dental care

By Connie Thompson

You may be able to cut hundreds of dollars off your dental bills, even if you have dental insurance.

Some folks around here call it a best kept secret. But this money saver is available to just about everyone.

When Marie Meadows needs dental care, she heads to the
University of Washington School of Dentistry. She's been going for years.

"I've had experiences where the dental work is not anywhere near as good as I get here," she said.

Linda Crumpacker is a new patient at the same office. She heard about it from a friend.

"And the financial end of it is so much more accommodating," she said.

As associate dean of clinic services, Dr. Daniel Chan oversees dental school operations.

"A children's dentistry, we have orthodontics to straighten out teeth. We have root canal service." said Chan.

Chan says contrary to what some people think, the dental fees are not based on a sliding scale. The costs are just lower than most typical dental offices because it's a teaching clinic.

Patients say they save 40 to 50 percent or more compared to the regular dentist, and dental students get hands on training they need.

"They're learning, but they're very good and the professors oversee the work that they do," Crumpacker said.

Meadows thinks the students are great. She says the dental school took care of all her children's needs when they were young. Now they're grown adults.

"All these years I've never really had any bad experiences, never," she said.

The biggest trade-off to dental school clinics is time. The dental students are closely supervised by experienced dentists who are School of Dentistry faculty members. Their work is double checked, and that means longer time in the dentist chair.

"You go to a dentist, and maybe the appointment will take one hour. And maybe here it will take twice as long, maybe three hours long," Meadows said.

But Meadows, Crumpacker and thousands of other patients say the added time is worth the savings.

In fact, the school treats more than 60,000 patients a year.

Like other dental offices, the UW School of Dentistry takes insurance. But because they deal in comprehensive care, you have to qualify as a "teachable" case, someone who'll be a long term patient for ongoing dental care, just like you would at your regular dentist.

"So when you come in, we don't just do one specific treatment. We look at you as a whole patient and we'll treat you from beginning to the end. And we hope you can come back every year," said Chan.

Are Dental Hygiene Clinics Doomed to Fail?

Dentists' expenses are increasing, leaving many dental practices struggling. About one in four practices have raised their dental fees due to the current economy, finds a dental management survey by The Wealthy Dentist.


San Francisco, CA, January 18, 2009 --(PR.com)-- Only 2% of dentists said they had ever seen a successful, private, independent dental hygiene clinic. When asked why, 76% of dentists think it's not a profitable business model, whereas 22% think hygiene practitioners' hands are tied by state laws, found a poll by dental marketing resource The Wealthy Dentist.

Dentists are protective of their role as the gatekeepers of health care. "In California, only a licensed dentist can diagnose and treatment plan. So all hygiene would be by dentist prescription or referral," said a California dentist. "Bad for the public, good for hygienists. How much more are we willing to give up? We are health care providers. not just a good business model!" seethed a New York prosthodontist.

The biggest obstacle is money. "Financially, I don't see how a hygienist clinic could pay for itself," said a general dentist. "Instead of using our equipment and waiting room and parking lot, l think it's a splendid idea for dental hygienists to rent their own space, buy their own chair, supplies and equipment, and then sign up for a few insurance companies and make a fraction of each dollar," an Alaska dental office manager said sarcastically.

Many worry the independent dental hygienist could compromise dental care. "The whole concept is flawed," opined a Connecticut dentist. "They cannot diagnose and read X-rays, and this will definitely lower the standard of care. It will also make it cost more since the doc will have to charge more to do dental exams."

The fact is, dentists can charge more for their time than hygienists. "I don't see how hygiene offices make sense," said a Nevada dentist. "You need the possibility of a higher revenue procedure base, like if hygiene is set up as the front end to feed the dentist in the back. Could a dentist set up 10 hygiene salons with the purpose of referring patients to his office? That would be smart. Otherwise, it is dumb from both a practical as well as professional model."

Traditionally, dental hygienists have been a crucial part of every dental practice. "Within a health-centered practice, a dentist wants their practice to serve the entire oral needs of their patients," said a California dentist. "A hygienist is an invaluable team member due to close and continuous communication, which is not able to happen in remote hygiene settings. Even in a traditional dental practice that sees hygiene as a means of patient circulation that keeps the work coming in, it is more effective to have the hygienist on premises."

"Dentistry and hygiene go hand-in-hand," said Jim Du Molin, dental patient marketing expert and founder of continuing dental education resource The Wealthy Dentist. "Trying to separate the two will only lead to higher costs and reduced care. The money's just not there to support an independent hygiene practice."

Du Molin invites readers to visit his blog at http://www.thewealthydentist.com/blog/654/dental-hygiene-clinics/ and comment on this survey.

NYS Can Save Millions Creating Healthier Toothier New Yorkers

Submitted by Sally Stride on December 17, 2008 - 5:08pm.

New York State's Governor Patterson is proposing extensive tax increases to offset revenue shortfalls. But I have a better idea. Stop fluoridation.

This win-win decision would save multi-millions of dollars and benefit every New Yorker – except maybe legislators beholden to special interest groups.

Science shows ending fluoridation saves teeth, money, preserves health and will reduce the carbon footprint, to boot, but it would irk organized dentistry. That’s the rub.

After 60 years of water fluoridation (adding cavity-preventing fluoride chemicals into water supplies) and over 50 years of fluoridated toothpaste, tooth decay is epidemic in the United States because 80% of dentists refuse to treat Medicaid patients and over 108 million Americans lack dental insurance (1). Children have died from untreated tooth decay. (2)

Diverting attention from their greed and heartlessness, dentists focus too-willing legislators on fluoridation, as if that would solve the problem. (3)

Far from fluoridation putting dentists out of business, as was once predicted, today’s dentists work fewer hours and days doing less critical work but make more money than many physicians. (4)

Seventy-two percent of NYS is fluoridated even though statistics show it’s failing to thwart cavities. (5) New York City, alone, spends approximately $14 million or more yearly on fluoridation chemicals, equipment and manpower.(6) Yet, NYC residents have among the highest cavity rates in the nation. (7)

Unfortunately, organized dentistry’s PAC money and political might speaks louder than science.(8)

One might argue that stopping fluoridation will cause higher dental costs. But studies show that, when fluoridation ends, cavities actually go down. (9) And the most highly fluoridated states have the highest rates of tooth loss. (10) Cavity crises are occurring in most fluoridated cities and states (See: http://www.FluorideNews.Blogspot.com )

Modern science shows that fluoride ingestion confers no benefits as early fluoridationists thought. Besides, today fluoride is in virtually all foods and beverages, (11) almost all toothpastes, some medicines, many dental products and is now a known component of air pollution.

No one disputes that too much fluoride is a bad thing. And there’s loads of evidence showing that Americans are over-fluoridated. For example, the Centers for Disease control reports that 48% of 12 - 15 year-olds have dental fluorosis – white spotted, yellow, brown and/or pitted enamel – from too much fluoride ingestion when their teeth were forming. (12) We can’t see what fluoride is doing to their bones. (13)

For this reason, both the CDC and the American Dental Association advise that infant formula NOT be mixed with fluoridated water.

The National Kidney Foundation also advises kidney patients to avoid fluoridated water as malfunctioning kidneys can allow a toxic build up of fluoride in bones causing them to weaken and break. (14)

New York State is not spending the money to get this information out. Fluoridation is outdated, unnecessary and harmful. It must be stopped.

Contact your local and state legislators and tell them wasteful, ineffective fluoridation must stop

On the National level, tell Congress you want fluoridation stopped and to hold hearings about why federal officials continue to promote fluoridation in the face of growing evidence of harm and ineffectiveness here: http://congress.FluorideAction.Net

END

References:

1) http://www.surgeongeneral.gov/news/pressreleases/pr_oral_52000.htm

2) “For Want of a Dentist,” by Mary Otto, The Washington Post, February 27, 2007
http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html

3) How California Deceptively Passed a Statewide Fluoridation Mandate http://www.edhtelegraph.com/detail/89290.html

Louisiana Mandates Fluoridation Despite Evidence of Harm http://www.bio-medicine.org/medicine-news-1/Louisiana-May-Mandate-Fluoridation-Despite-Evidence-of-Harm-20853-1/

4)”New Drill - Tale of Two Docs: Why Dentists Are Earning More,” by Mark Maremont, The Wall Street Journal, Monday, January 10, 2005
http://www.flapsblog.net/2005/01/new-drill-tale-of-two-docs-why.html

5) NYS Department of Health statistics show that fluoridation fails to reduce tooth decay. See chart: http://tinyurl.com/NYSchart

6) Fluoridation Does Not Save Money or Teeth
http://fluoridedangers.blogspot.com/2005/11/fluoridation-does-not-save-money-or.html

7) Evidence that Fluoridation Has Failed New York
http://www.freewebs.com/fluoridation/fluoridationfailsnewyork.htm

8) “Open Wide for $25K” NY Daily News, by Elizabeth Benjamin, July 12, 2008
http://www.nydailynews.com/blogs/dailypolitics/2008/07/open-wide-for-25k.html
“In Rift Among Dentist Groups, a Tale of Political Clout.”
By Sam Roberts, New York Times, June 23, 2008
http://www.nytimes.com/2008/06/23/nyregion/23dentist.html?_r=2&pagewanted=print&oref=slogin

9) When Fluoridation Ends So Do Cavities
http://thyroid.about.com/cs/relatedconditions/a/flushot.htm

10) More Fluorde = Less Teeth
http://www.freerepublic.com/focus/f-news/1002581/posts

11) USDA Fluoride Database 2005 http://www.ars.usda.gov/Services/docs.htm?docid=6312

12) http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/s403a1t23.gif

13) http://groups.google.com/group/Fluoridation-News-Releases/browse_thread/thread/20b328821b24dcc4/9882f8d2ce4caad5?lnk=gst&q=fluorosis+fractures#9882f8d2ce4caad5

14) National Kidney Foundation, “Fluoride Intake in Chronic Kidney Disease,” April 15, 2008
http://www.kidney.org/atoz/pdf/Fluoride_Intake_in_CKD.pdf