Insurance plan effects on dental provider treatment patterns for elderly patients. An experimental economics approach

Three hundred forty-six dentists, randomly selected from the population of Washington State Dental Association members, volunteered to participate in a controlled experiment of treatment planning for elderly patients. Experimental oral health problems were designed that conform to the prevailing actual distribution of dental and related systemic disease among the elderly population of the United States. Each volunteer dentist constructed two treatment plans for the presenting dental problem: 1) a treatment plan to optimize oral health, ignoring the hypothetical patient's financial status and insurance coverage; and 2) a treatment plan given the particular dental insurance plan and patient financial status incorporated in the case. Results suggest that increasingly comprehensive insurance coverage does not necessarily lead to uniform, monotonic increases in total dental expenditures. Rather, the incremental substitution of different services for one another appears to be the dominant effect of increased coverage, with the singular exception of coverage for fixed prosthodontia . The key implication of these findings is that careful design of improved insurance benefit plans for the elderly could widen the range of dental services provided without necessarily increasing total treatment cost.