Dental capitation insurance provider compensation: a fair deal?

OBJECTIVE

To investigate the fairness of dental capitation insurance provider compensation amounts being paid by one of the nation's largest capitation insurance companies.

STUDY DESIGN

Analysis of insurance company documents.

METHODS

The article first reports and then analyzes the capitation amounts paid by one of the nation's largest capitation plans over the past 13 years as retrieved directly from the insurance company documents. The annual rates of change in the capitation amounts are then compared with the annual rates of change in the mean dental office overhead expenses across the United States, as well as with the rates of change in income and expenses of the average US worker.

RESULTS

The compensation (capitation amount) paid to participating providers decreased dramatically every year over the past 13 years, while the mean office overhead costs of participating providers increased every year.

CONCLUSIONS

Solo general dentists with office overhead costs greater than or equal to the national mean likely find that the capitation amounts paid by insurance companies are an unfair compensation or are incompatible with their income objectives. Participation by solo general practitioners in capitation plans with such compensation levels would be problematic or unlikely.