This blog is about dental care, a not insignificant part of the economy. Dental care claims between 5% and 7% of total healthcare spending, and its major disease, dental decay, ranks amongst the most expensive diseases to treat. One can argue that America spends more on restoring diseased teeth than it spends on treating cancer. So in many ways, dental care is about the economy and vice versa.
In this context, recently I have been struck by some remarkable socio-economic trends which have both nothing and everything to do with the long-term viability of the conventional dental care model:
- The breakdown of marriage (or two-parent households): Out-of-wedlock births in America have risen from 18% in 1980 to 41% in 2009. The share of American children living with two parents has dropped from 82% in 1970 to 63% in 2009. This trend seems to be concentrated amongst the poorly educated. Indeed, it is described as creating a “fault line” in economic class. Kids from single-parent families do less well in school and in work life. The more the breakdown in marriage the more income inequality (Chart 1). The US and UK are the shining examples of this phenomenon.
Chart 1
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The growing gender gap in wages – men are struggling, women are OK: In the US, from 1979 to 2010, real hourly wages for men age 25 to 39 with only a high school diploma fell 20%, while the wages of similar women rose 1%. Among those with some college education, women’s wages were up 8 %; men’s were down 8%. As important, fewer men and more women proportionally have jobs. From 1979 to 2007 the share of male high school graduates with jobs fell 9%, job-holding by similar women rose 9%. For those with some college, men were down 6 %, women up by 12 %.
- The changing composition of the household: Since 2008, it has been reported that 35% of grandparents in Canada are now living in shared homes with their children or grandchildren and are the financial providers.
- Growing mistrust and pessimism: In 1960, about 58% of Americans believed that most people could be trusted; by 2006, that share had declined to 34% (Chart 2). These perceptions and values arise from inequality in opportunity and income.
Chart 2
These profound developments in the socio-economy undermine, it would seem, the traditional model of family dentistry. Increasingly, fewer people have the time, money or trust in a service which is very labour intensive, which has been geared to invasive care, and which (in a fee-for-service model) can put the provider in a different space than the patient.
So what might be the new models for dental service delivery which accommodate this different world? I submit there needs to be dramatically more engagement for the patient to overcome the malaise of mistrust. A patient who understands his/her risk of dental disease is also more willing to purchase services which address any risks. The labour intensity of dental services will decline with technologies such as Prevora and the growth of paraprofessional services. Finally, it would seem that fee-for-service dentistry will need to migrate to fee-for-outcomes. Patients will be attracted to those dental services which offer some measure of assurance (guarantee?) that oral health will be maintained for long periods.
Sourced: Ross Perry
Prevora Blog
