No. An insurance ‘agency’ (i.e. company) has a primary mission to make a profit. They make that profit by charging the consumers more than the procedures actually cost. (And also by investing the money you pay them)
UHC is simply paid for by taxes. No one is making a profit on medical procedures except the doctors and other medical professionals who do the work.
There is incentive in both systems to inflate costs. But when you are talking about individuals vs corporations, guess who does inflation better?
I was talking about individual doctors and dentists. Can a doctor under UHC overbill the system or get their patients to undergo expensive dental work even though they dont need it? How does a UHC system ensure all the dentists in a given community are good ones?
I trust my current dentist and appreciate that she, and the previous dentist that owned that practice, don’t push any products at all.
But that was not always the case. Starting as a small child and up until I was in my early 40s, I saw a dentist routinely and never, ever had a cavity. Except for a wisdom tooth extraction at 17, routine cleaning and x-rays were all I ever had done. Then I moved to another area too far away from my previous dentist(s) and started with a new one. For the next 15 years, at every visit, I had a new crack or cavity that needed to be addressed. Every. Single. Visit. I thought that perhaps my teeth were developing problems since I was in my 40s. You know, natural consequence of aging and all that.
Then I moved again and started with my current dental office. Been with them for over seven years. In all that time, I’ve had one old filing replaced and a crown put on because I broke a tooth on a hard candy. That tooth had had a ginormous filling in it, put in by the previous repair-happy dentist. My current dentist said my tooth probably cracked and ultimately broke because that filling was so large.
Ah I see. Yes overbilling occurs everywhere (where a doctor can profit from it) I would guess. If you get caught though, for example billing for a consultation on a patient who didn’t actually come in, it would be a pretty serious offence and might even have an impact of the doctor’s license to practise. Billing is monitored much like at the IRS but it’s impossible to monitor everything. So if a doctor wants to overbill the safest way would be to do unnecesary procedures because if its a grey area thay can fall back on their professional opnion that it was necessary. I guess.
Right, and the same can happen with American doctors under normal insurance. Insurance companies also look at dentists their plan cover and see who might be billing more expensive work.
Again I have to ask, do you trust your dentist and all other dentists in your country who work under UHC?
The UK dental system is fundamentally flawed, and is not a good advert for UHC at all.
To answer Urbanredneck’s question, some procedures earn more money for the dentist than others (and, indeed, some actually cost more to perform to modern standards than they get back), so there will be good dentists who are trying to do their best to serve their patients, and others who will attempt to ‘game’ the system to a greater or lesser extent. There is nothing inherent in the system to say that any particular dentist will be ‘good’, beyond the training requirements to actually practice.
There are also private dentists in the UK, who will either charge directly or be part of an insurance scheme such as “Denplan”.
I do trust my dentist, and also my hygenist. I’ve been with him for upwards of a decade, and she’s been taking care of me for almost 8 years after my last one retired. Sometimes they try to “upsell” me fancy floss, but they’ve never pushed anything firmly or ridiculously. Their work is good.
They’re also in the weird space where they are neither a family practice nor a “corporation” – they’re a small practice. I think there were 3-4 dentists there when I started, and they’re up to around 8 now, with most of the new ones handling cosmetic stuff.
When I was young, we switched from the old-school crusty dentist, to the young guy in his big group of assistants who had all the fancy equipment. Over the next decade it turned out my teeth were a train wreck, and my mouth is now full of crowns and fillings of the highest quality, optically identified by one of the first laser cavity detection systems in the states of Texas.
Then I moved to Massachusetts, and for some reason don’t go to the dentist for more than 20 years. Each year I become more and more aware of how bad my teeth must be, but finally I get my courage up and go to the dentist.
After a lengthy exam, he concludes, “yeah, your teeth are fine.“ Then, after a long pause, he says, “did your previous dentist explain why he had to do all these procedures? Because I’m not sure all of them makes sense to me.“
So do I trust my dentist? Yeah, I like my current dentist OK, he’s OK if I go in every year, year and a half. My prior dentist, I’d love to fucking punch him in the nose.
I have an old-fashioned independent auto mechanic. He charges a good deal more than $19.95 for an oil change, and a good deal more than $2 for the set of wiper blades he insists I need once a year. But more than once I have called him with a problem and he’s said “bring the car (or have it towed) right now.” And when my head gasket blew, he said, “You have a blown head gasket, and I don’t do those. Take it to the dealer.”
I’ve been using this guy for 20 years or so, and I trust him completely. If he charges me twice as much for an oil change twice a year, that’s the price I pay for his service. The same thing with my dentist. If she says I need to get my teeth cleaned twice a year, and X-rays once a year, when I could get by with half that, I also know that if I call her on Christmas morning, if she’s in town, she’ll get me in.
Basically, you can split UK dental practices into three different types:
Community Dental: the emergency dental units, generally attached to hospitals, where you go if you an emergency dental issue and you don’t have a dentist (or your dentist can’t fit you in). You do not pay for these services, but they don’t do the regular checkups and stuff, they just do emergencies.
Independent practice: A dentist sets up (possibly with other dentists in the same practice) and works for himself. Can be purely NHS, but many also do private work since that’s basically the only way to actually make money. Some do purely private work. In these practices, the principal dentist owns the business and pays the staff salaries.
Corporate dentists: In these, dentists work as self-employed contractors to a corporation that owns the actual practice, generally under a practice manager (and then area manager above them, and so on up). The general staff here earn a salary from the business, but the dentists take a cut of the money generated by their work. Again, many of them take private work.
Hygienists are a separate issue - many of them might work for different practices on different days, although some larger practices retain their own. It can be hard for a small practice to generate enough work to support a full-time hygienist though.
Having said all this, my own dentist is a corporate dentist, and I trust her. Not because of her work situation, but because she’s shown herself to be trustworthy whilst I’ve been with her.
I just wanted to add to this here in the USA a dental hygienist, or sometimes called a dental assistant, is a person (almost always a woman but thats another story) who actually cleans teeth, does x rays, and does preliminary dental work. Only after they are done will the actual dentist see you (normally).
A dental hygienist will normally go college to get this for 2 years and it can be a great part time job for say a woman with kids because they can work just a few hours.HERE is such a local program.
Now the good thing is many times the hygienist know the score and will rat out the bad dentists if they feel they are overcharging the patients.
I trust my dentist and have gone to the same practice ever since I had teeth (I am 50). When the father retired, I started seeing the son. Other than a couple of small fillings when I was in my teens and impacted wisdom tooth removal, for which I was referred to an oral surgeon, I have never needed anything but cleanings. The one time they had a hygienist who was a little bit rough, they asked me about it, and she was gone by my next cleaning.
Apparently they are on the expensive side, and I pay out of pocket because the dental coverage I can get through work is so useless that I don’t bother, but it’s worth it to me for no hassles.
YMMV, but in my experience, the assistant and the hygienist are two different people. A dental assistant is the person who assists the dentist- lays out the tools and materials and hands them to the dentist, moves the suction hose *and * also does some administrative tasks such as making appointments. Dental assistants are never doing any actual dental work without the dentist in the room… Dental hygienists work more independently - although they may have to work under the general supervision of a dentist, I typically have a separate appointment with the hygienist during which the dentist might pop his head in to say " Hi", but that’s it. And the hygienist often has worked in this dentist’s office on Monday and a different one on Tuesday.
I love my dentist who I’ve been going to for about 15 years, maybe more. I trust her completely and have no reason to doubt her recommendations. The staff dental hygienists are very nice and do a great job and I get to spend sufficient time with the dentist herself on each visit to discuss any concerns or recommendations. What few larger procedures that I’ve had done were all warranted in her medical opinion and I agreed with her assessments.
For a brief period I did try a different dentist who was located closer to my home. I hated the entire experience. I felt like I was in an assembly line shop meant to maximize their insurance billings and profitability. I was a number and was constantly marketed to with incentives (Visa gift cards) to recommend them to friends and family. I repeatedly asked to be removed from their marketing emails but they would not stop sending them via postal mail and email. Even after I told them I was moving back to my former dentist and the reasons I still continually get emails from them which now are automatically routed to a spam folder.
Dental HMO. I chose my dentist from a list of area dentists. I do not know him well enough to trust him. I mean, he seems OK. But then all con men seem OK at first.
Not anymore… looking for a new one. My dentist just really screwed up my crown for a broken tooth. I had no doubt the tooth was broken; I could see that. But she did a shitty job prepping it for a crown which lead to a month of severe dental pain ending in a root canal.