week 3

Question 1

What are the major entities involved in the financing of dental care today ?

Answer 1

Financing dental care involves patients, dental practitioners, and several other entities, including public programs and insurance companies.

Question 2

What significant act was created in 1965 that impacted dental care funding?

Answer 2

The Social Security Act of 1965, which established public funding like Medicaid.

Question 2

When was insurance for dental care first introduced, and when did it become widely accepted?

Answer 2

Dental insurance began in the early 1900s but was not widely accepted until the 1970s.

Question 2

What percentage of U.S. health care expenditures was spent on dental services in 2020?

Answer 2

Only 3% of health care expenditures were spent on dental services, and 86% of this amount was from private funds.

Question 3

What dental coverage requirements exist for Medicaid regarding children?

Answer 3

States are required to offer Medicaid dental coverage to children from low-income families, though coverage for adults varies by state.

Question 4

What are the four types of payment methods in dental care?

Answer 4

Fee-for-service, capitation plans, encounter fee plans, and barter system.

Question 5

What is a capitation plan?

Answer 5

A dental provider contracts to provide most services to subscribers in return for a per capita payment, typically on a monthly or yearly basis.

Question 6

What are the two main types of private dental insurance?

Answer 6

Fee-for-service, PPOs and HMOs.

Question 7

What is a characteristic of PPO dental plans?

Answer 7

PPOs offer lower costs for services within a network but restrict patient choice.

Question 8

What are the two forms of payment in an indemnity plan?

Answer 8

The dental provider bills the patient, and the patient seeks reimbursement, or the provider bills the insurance, and the patient pays any difference.

Question 9

What are direct payments in dental care?

Answer 9

Payments made by patients for services not covered by insurance, including copayments, deductibles, and coinsurance.

Question 10

What responsibilities do dental hygienists have regarding insurance codes?

Answer 10

Dental hygienists are legally responsible for choosing the correct codes for services provided and must maintain accurate documentation.

Question 11

Why is financing a critical factor in accessing dental care?

Answer 11

Financing affects the availability and quality of dental care. Historically, financing was the responsibility of the patient and dental practitioner, but now it involves insurance companies and public funding.

Question 12

What major public funding program was created in 1965, and who does it serve?

Answer 12

Medicaid was created by the Social Security Act in 1965. It serves patients who meet disability requirements, with dental coverage for children from low-income families and, in some states, adults.

Question 13

What are the four types of payment methods in dental care?

Answer 13

The four types are Fee-for-Service, Capitation Plans, Encounter Fee Plans, and the Barter System.

Question 14

How does a fee-for-service plan work?

Answer 14

A fee-for-service plan is based on a fee scale for all covered services. The patient or the insurance company pays the fee for the services rendered. A sliding fee scale is available for lower-income patients.

Question 15

What is a capitation plan in dental care?

Answer 15

In a capitation plan, a dental provider contracts with a program to provide all or most dental services to subscribers in return for a per capita payment, often monthly or yearly.

Question 16

How does the encounter fee plan differ from fee-for-service?

Answer 16

In an encounter fee plan, payment is based on an office visit, and the fee remains the same regardless of the services provided.

Question 17

What is the barter system in dental care payment?

Answer 17

The barter system involves the dental provider and the patient negotiating payment by exchanging goods or services, without using money.

Question 18

What is the difference between PPOs and HMOs in dental insurance?

Answer 18

PPOs offer lower costs for in-network services but limit provider choice, while HMOs focus on preventive care and also limit provider options, emphasizing cost control through managed care organizations (established in 1973 by the HMO Act).

Question 19

How does an indemnity insurance plan work in dental care?

Answer 19

An indemnity plan operates through a submission and reimbursement method, where the dental provider bills the patient and the patient seeks reimbursement from the insurance company. Providers may offer discounts to target populations.

Question 20

What are direct payments in dental care, and what are some examples?

Answer 20

Direct payments are costs patients pay for services not covered by insurance, including copayments, deductibles, and coinsurance.

Question 21

What are some cost barriers to dental care?

Answer 21

High costs can deter individuals from seeking necessary care, particularly when out-of-pocket expenses are high or insurance coverage is limited.

Question 22

What is insurance fraud in dental care, and how can it occur?

Answer 22

Insurance fraud occurs when incorrect codes are entered to falsely obtain payment. It can happen by entering a false date of service or coding for a procedure that was not performed. Dental hygienists are responsible for selecting the correct codes and maintaining documentation.

Question 23

What services are covered under Medicaid, and how does it vary by state?

Answer 23

Medicaid covers preventive and restorative services, but coverage varies by state. Medicaid primarily serves low-income individuals, children, and pregnant women.

Question 24

What dental services are covered under Medicare?

Answer 24

Medicare offers limited dental benefits, often only covering medical emergencies or specific procedures, such as those required during hospitalization.

Question 25

What are some examples of government programs that provide dental care?

Answer 25

Medicaid, the State Children’s Health Insurance Plan (CHIP), Medicare, the Department of Veterans Affairs, and Tricare. These programs vary in terms of coverage and eligibility.

Question 26

What are some current trends and challenges in dental care financing?

Answer 26

Rising costs of dental procedures and materials, changes in insurance coverage and reimbursement rates, and economic factors like downturns that affect individuals’ ability to afford care.

Question 27

What strategies can be used to improve access to dental care?

Answer 27

Strategies include policy changes to expand insurance coverage, community programs offering sliding-scale fees, and financial assistance programs to help low-income individuals manage dental costs.

Question 28

How does legislation impact dental hygienists?

Answer 28

Many legislative initiatives affect the scope and practice of dental hygiene by making their treatment more or less effective. These rules and regulations change annually in most states, and dental hygienists must stay informed.

Question 29

What are the three major areas of public health law?

Answer 29

The three areas are police power (enforced by governmental agencies like dental boards)
disease and injury prevention (regulations like those from OSHA), and
population law (using epidemiology to analyze health issues).

Question 30

What is advocacy in dental care?

Answer 30

Advocacy involves working to educate, promote, or lobby for policies, programs, or funding related to dental care. Advocacy is usually carried out by individuals with a personal stake in the issue.

Question 31

Who is a social advocate, and what is their role in dental care?

Answer 31

A social advocate is someone who causes change in social, cultural, or behavioral aspects of dental care. They take proactive actions based on clear goals and objectives, often collaborating with others.

Question 32

What roles do dental hygienists play as change agents?

Answer 32

Dental hygienists serve as catalysts (motivating change), solution givers (solving problems creatively), resource linkers (connecting people and resources), and process helpers (guiding through the change process).

Question 33

What are the steps in implementing planned change?

Answer 33

The steps are: Assessment (recognizing the need for change), Diagnosis (identifying the problem), Planning (developing solutions), Implementation (executing the plan), and Evaluation (assessing the outcome and stabilizing the change).

Question 34

What are the different levels of health policy, and who manages them?

Answer 34

National health policy manages overall funds and policies. State health policy develops programs supported by federal funds. Local health policy develops and implements health policies within the community

Question 35

What is lobbying, and how does it relate to dental care policy?

Answer 35

Lobbying is the process of attempting to influence legislators or others to take or support a desired position or action. This is crucial for enacting changes in dental care policy.

Question 36

What is a policy

Answer 36

a written description of rules regulations and stipulations to govern individual actions and procedures.

Question 37

What is a coalition, and how is it formed?

Answer 37

A coalition is an alliance of distinct organizations or individuals that work together toward a joint action. Coalitions are usually composed of stakeholders with a vested interest in a particular issue.

Question 38

What is collaboration?

Answer 38

efforts are strengthened by networking, sharing of resources or services to cultivate productive relationships.

Question 39

What are some common barriers to creating a coalition?

Answer 39

Barriers include turf issues, domination by professionals, poor community links, limited organizational capacity, funding shortages, and failure to demonstrate the benefits of collaboration.