Metamorphosis of dentistry. Update on alternative delivery systems.

In 1985, Americans spent $27.8 billion for dental care. Patients paid $18 billion out-of-pocket, while private health insurance paid about $9.2 billion. Public programs paid approximately $600 million primarily through Medicaid. Commercial insurance carriers have increased their market share to more than 80 million subscribers, or more than 70 per cent of the total market. Dental service corporations and Blue Cross/Blue Shield plans cover more than 30 million subscribers, while independent plans have policies with more than 6 million customers. Dentistry today is a big business, and Big Business wants to make it their business. What makes health care vastly different from the manufacture and sale of microwaves, furniture and clothing, or the production and serving of fast foods is that the provider is in a unique relationship with the consumer/patient and will always have a large measure of control for this reason. Receiving dental care is not the same as purchasing a new pair of tennis shoes, but good business practices from other business arenas can make it possible for greater numbers of people to have greater access to it. Over the past 25 years a metamorphosis of dentistry has been generated by a rather constant interplay between the various involved parties to obtain a position of least financial risk. Insurance carriers and/or administrative intermediaries want the risk placed on the dentist, employers want the administrators to take it, and dentists want employers, administrators, or patients to assume it. The future will see the gradual evolvement of equitable plans dividing the risk among the four principle parties. Plans are being put in place today that already reflect this. A viable alternative delivery system means: Dental care providers who have the knowledge and incentive to perform quality care; administrators willing to share some of the risk; and employers and consumers who are sophisticated and realistic in their demands in today's marketplace. All these factions are currently interacting to create the new dental picture we see today--and will see in the future.