to a level that can be sustained by most communities.
Some locations are experimenting with different relationships between oral care professionals, e. g. hygienists working independently in offices, in patient' s homes and in institutions. Greater access is the main aim of such outreach activities.
Financing oral care.
Some of the different approaches being used to finance oral care are quality control
guidelines, fixed fee agreements, capitation schemes, health maintenance organizations, and rewarding.
Increased preventive care.
Using information about the duration of acceptable care procedures, quality control guidelines are being prepared that indicate the average number of years each type of care should last. If a care procedure does not last the specified time, the clinician is then obliged to give retreatment free of charge. Such guidelines are aimed at reducing unnecessary treatment, which causes progressive destruction of tooth substance and higher costs of oral care.
In some countries, for most procedures, dentists can only charge fixed fees that are agreed between the health authorities and the professionals. They can only exceed those fees for special treatment and after a review of the diagnosis and proposed procedure. In countries using this system costs of oral care are not rising and in some they are decreasing.
Capitation schemes pay the dentist a fixed sum for each person enrolled as a patient in their dental clinic. For this fixed annual fee a dentist contracts to maintain the oral health of the enrolled patients. However, patients must undertake to attend for checkups on a regular basis, or they lose their rights and have to pay for the treatment they need to restore their oral health. It seems likely that this type of programme will reduce costs.
Health maintenance organizations (HMO) contract with a group of oral care professionals to provide care to a group of communities or individuals, at agreed fees. HMOs are usually organized and managed by companies that specialize in health insurance. This has proved an effective way to limit the costs of providing comprehensive oral care.
In one country a project to encourage preventive care gives dental care managers a financial reward if disease levels do not increase in the patients in their catchment area.
Alternative approaches in developing countries
Whereas the various systems being tried in industrialized countries can be of universal relevance, the developing countries have special problems in actually providing care.
Although most care needed is of the first level, minimally invasive type - dentists usually provide all type of care. The most common moderate level care given is extraction and frequently dentists resist the training and use of other types of personnel for this and even less invasive tasks.
There are also situations where teeth with rather minor caries problems are extracted because that is the only treatment available, due to lack of supply of filling materials. In oral areas it is clear that, because of lack of oral care personnel of any type, most carious or infected teeth are not treated in time. Rather the disease progresses, causing intermittent pain that is end
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