|
The promise of consumer-driven cost control is that when consumers of health care manage their own expenses and see for themselves how much things really cost they'll shop around and take measures to reduce their utilization.
While the shape and scope of consumer-driven plans continue to evolve, their cost-saving models can already be called effective. That's because similar models have long been used in dental benefits, which have for decades featured consumer-based incentives that
drive patients toward preventive and early-treatment procedures and away from expensive cures and restorations. That's one reason why dental pricing is stable and cost increases are modest.
Making Prevention Pay
Most dental illness is preventable, which is why consumer-driven cost control works in dental benefits. When preventive care is 100% funded, consumers have every incentive to take that care - which is another way to say that it doesn't pay to skip that twice-yearly trip to the dentist.
That's because consumers who allow preventable disease to progress are on the hook for more out-of-pocket costs. Most dental plans cover 80% of basic dental care, such as fillings. When major care, including crowns, root canals, prosthetics, complex restorations and advanced oral or maxillofacial surgery, is required, consumers might have to pay as much as 50% of the bill. Remedies for oral diseases that have progressed further require greater out-of-pocket contributions from the patient. Few consumer products can offer a four-to-one rate of return, but the Institute of Medicine estimates that every dollar spent on preventive dental care cuts restorative expense by about four dollars.
Spreading Savings
Consumer-driven approaches to health care are clearly gaining ground in medical benefits. Congress included tax-sheltered health savings accounts (HSAs) in last year's Medicare reform law, and employers have for some time offered flexible spending accounts (FSAs) and health reimbursement accounts (HRAs) to help employees cover health-care costs.
The shift toward savings accounts for dental has been more gradual, in part because the accounts tend to be set aside for discretionary restorative services that are already influenced by cost considerations; a consumer who has to pay half the cost of an implant or bridge, for example, decides between the two based on personal preferences and means.
But few, if any, savings-account models tamper with the true source of dental cost stability: preventive care. In some cases, preventive-care costs are paid from funds outside the savings account. Employees use funds in their savings accounts to pay for services such as fillings and crowns. They might shop around and choose less expensive options, such as amalgam rather than composite for fillings.
Weighing the cost of discretionary dental services is something consumers have been doing for years. Such experience likely leaves them better prepared to accept more responsibility as the trend toward consumer-driven care continues - though the goal of dental insurers is and has been to prevent disease - and the subsequent need to decide on treatment options in the first place.
|
