Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA.
Am J Orthod Dentofacial Orthop. 2010 Mar;137(3):334-9. doi: 10.1016/j.ajodo.2008.08.024.
Access to orthodontic services for children enrolled in Medicaid is limited nationwide. Orthodontists cite low fee reimbursement as a significant barrier to Medicaid participation. The purpose of this study was to examine, under a specific set of practice assumptions, the simulated effect on profitability of treating patients covered by Medicaid in orthodontic practices in North Carolina by using a break-even analysis for the 2005 fiscal year.
Questionnaires were mailed to 154 orthodontists in active practice in North Carolina. The response rate was 58%. Seventy respondents met the eligibility criteria. Respondents were categorized into 4 groups based on the number of 2005 Medicaid case starts (I, 0; II, 1-5; III, 6-12; IV, 13 or more). By using the aggregated responses for treatment fees, treatment times, and overhead percentages for each group, average per-patient costs were calculated for each group and used in a break-even analysis.
Group I accounted for 60% of respondents; group II, 20%; group III, 9%; and group IV, 11%. Assuming that the break-even point had not been reached, the group I practice would have an average estimated loss of $164 per patient whereas groups II, III, and IV would realize average profits from $98 to $256. The break-even point increased slightly in groups I, II, and III after the total number of patients in the patient pool was increased by 5%, assuming that additional patients were enrolled in Medicaid: group I, 203 to 210; group II, 220 to 226; group III, 158 to 160. The break-even point for group IV was 234 patients. Assuming that the break-even point had been reached, all groups were estimated to realize average per-patient profits of $1483 to $1897.
Break-even analysis is a basic economic concept applicable to orthodontic practices. Under the specific conditions of this study, the inclusion of 5% of patients enrolled in Medicaid in the active patient pool had minimal effect on the financial break-even point and, assuming that the break-even point had been reached, was unlikely to have a negative financial impact on the practice.
全国范围内，参加医疗补助计划（Medicaid）的儿童获得正畸服务的机会有限。正畸医生表示，较低的费用报销是他们参与医疗补助计划的一个重大障碍。本研究的目的是通过盈亏平衡分析，在特定的实践假设下，考察北卡罗来纳州正畸实践中治疗医疗补助计划覆盖患者对盈利能力的模拟影响，分析时间为 2005 财年。
向北卡罗来纳州 154 名活跃执业的正畸医生邮寄问卷。回复率为 58%。符合条件的有 70 名受访者。根据 2005 年医疗补助计划新案开始数（I，0；II，1-5；III，6-12；IV，13 或更多），受访者被分为 4 组。通过对每组的治疗费用、治疗时间和间接费用百分比的综合回复，计算出每组的平均每位患者的费用，并用于盈亏平衡分析。
第 I 组占受访者的 60%；第 II 组占 20%；第 III 组占 9%；第 IV 组占 11%。假设尚未达到盈亏平衡点，第 I 组的业务将平均预计每位患者损失 164 美元，而第 II、III 和 IV 组的平均利润将从 98 美元到 256 美元不等。在假设患者总数增加 5%，即更多的患者被纳入医疗补助计划后，I、II 和 III 组的盈亏平衡点略有上升：第 I 组，203 至 210；第 II 组，220 至 226；第 III 组，158 至 160。第 IV 组的盈亏平衡点为 234 名患者。假设已经达到盈亏平衡点，所有组预计平均每位患者的利润为 1483 美元至 1897 美元。
盈亏平衡分析是一种适用于正畸实践的基本经济概念。在本研究的具体条件下，将 5%的参加医疗补助计划的患者纳入活跃患者群体对财务收支平衡点的影响很小，并且假设已经达到收支平衡点，不太可能对实践产生负面影响。
