4 ms·

My Wife is a Dentist with a specialty in prosthodontics. One of the more complicated cases you can do in Dentistry is a full mouth reconstruction where you ba

by harshaw 15y ago

My Wife is a Dentist with a specialty in prosthodontics. One of the more complicated cases you can do in Dentistry is a full mouth reconstruction where you basically are fixing all the teeth and likely fixing the bite. These treatment plans can easily cost $30K or greater. Sure, you can go overseas and get this kind of treatment. However, if they are doing implants the only way to do it in a timely basis is immediate placement (stick the implant in the bone and put a crown on) instead of installing the implant and waiting for the bone to heal. Additionally, good luck in getting a stateside dentist to support foreign dental work. The statement that dentistry has been around since Roman times is laughable; certainly not modern dentistry and definitely not implant dentistry. Here's a brief overview of the economics: 230K student loans, 6K / month business loan for office, 2K / month rent (fairly cheap IMO), salaries for staff, malpractice, lab fees, etc. So there is clearly a lot of shit to pay for. We aren't driving a Bentley yet. One of the big issues driving cost is the same thing as medical costs: fee for service payment. The nature of the beast forces Dentist to optimize specific procedures or more of the expensive procedures. Additonally, armies of consultants out there train dentists (and their staff) to optimize "coding" against Dental insurance rules to optimize the payouts from the insurance companies.

Retric 15y ago
There are basically 4 things driving up medical costs in this country. (Education, Malpractice, R&D, and Insurance) Unfortunately, I don't see any fundamental change happening in any of those areas any time soon. Just think what it would mean if you banned say, advertising the name of any prescription drug to private citizens. I mean I can understand advertising that there are prescription treatments for ED which hey people might not know about. But, when these things have significant side effects and can't be sold over the counter you need actual medical advice not just people dancing around with smiles on their faces. Not that I think there is a chance in hell of this actually changing, but many country's actually do something like this.
- a3camero 15y ago
  Your neighbour to the north does this. It leads to vague advertising that tells you about some problem and encourages you to ask your doctor about it. Doesn't seem to have been the end of the world.
- dalke 15y ago
  Malpractice insurance is something like 2% of the overall medical costs in the US, and at least some states have caps on liability lawsuits. Looking now, it seems malpractice insurance premiums have stayed pretty constant over the last couple of years. Are you sure that malpractice is one of the major factors "driving up medical costs in this country", and if so, do you have a pointer to something which reinforces that statement? Personally I thought the big increases in liability insurance coverage 5 or so years ago were because the insurance companies were so invested in the market, that after the market crash they needed to hike rates to build back their reserves. Those hikes were then used as justification in advocating liability caps.
  - Retric 15y ago
    It's not a major direct cost, however due to inefficiencies in the system your paying for that 2% in several additional ways. Doctors do a lot of tests to cover their ass. People without insurance tack their get their costs shifted to other people. Then Insurance company's tack on their profit margin above that 2% that's already been compounded a few times. And many of those unnecessary tests can cause further complications down the road due to things like false positives.
    - dalke 15y ago
      I believe that 2% includes defensive medicine. Ahh, here's one of the relevant papers: http://content.healthaffairs.org/content/29/9/1569.abstract http://content.healthaffairs.org/content/29/9/1569.abstract "Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending." I really don't see 2.4% as one of the major things "driving up medical costs in this country." Here's another from http://www.factcheck.org/2009/10/malpractice-savings-reconsidered/ http://www.factcheck.org/2009/10/malpractice-savings-reconsi... "In an Oct. 9 letter to Republican Sen. Orrin Hatch of Utah, CBO Director Douglas Elmendorf said that a package of changes including limits on malpractice awards 'would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009).'" "That figure includes a 0.2 percent reduction just from lower premiums for malpractice insurance paid by medical professionals. And it includes an additional 0.3 percent in reduced costs of medical tests, imaging and other medical services. " This would imply that the malpractice overhead isn't more than a couple percent. Personally, I think the major perception regarding malpractice is based on propaganda by people who want to put caps on all lawsuits. See, of all things, a Cracked article on the major examples of 'outrageous' judgements where the actual facts are at odds with the perceptions: http://www.cracked.com/article_19150_6-famous-frivolous-lawsuit-stories-that-are-total-b.s..html http://www.cracked.com/article_19150_6-famous-frivolous-laws... . Civil lawsuits are one of the few ways that individuals can take on large companies with bad business practices. Caps mean those companies are more free to make decisions in favor of cost-cutting over quality. Of course it's hard to justify it that way. It's much easier to say "idiotic medical lawsuits are one of the major reasons for increases in medical costs, so lets cap all lawsuits." Where do you get your idea that medical malpractice costs are a major contributor to increasing medical costs, either direct or indirect?
paul_mctaggart 15y ago
Harshaw: we actually see roughly 30% of our patient base receive dental implants. The vast majority (95%) of our patients do not receive immediate load dental implants. They receive their implant and then travel back for treatment 4-6 months later (after the bone has fused to the implant). The great part is they still save money even with the second visit and this includes the cost of their travel. I appreciate your costs to become a dentist...I've felt the burden of student loans and it is tough to dig yourself out. Dental Departures is globalization plain and simple: dentistry & medical services are no longer immune. The labor, overhead & cost of materials are less expensive overseas than in the United States (for the same quality of care). Full disclosure: I work @ Dental Departures
drew55 15y ago
FYI, there are Mayan human skull remains that have shell, bone, and wood implanted into the jawbone. Not really the point though; are you suggesting that a US dentist would disregard their Hippocratic Oath and refuse to treat a patient who has been treated abroad in the past?
- harshaw 15y ago
  My point was more that the Dentist will treat the patient according to their standard of care. That could mean for example that they won't patch the current crappy work and instead treatment plan a correct solution. Keep in mind that I am a lowly hacker who has some insight into Dentistry via pillow talk :)

by harshaw 15y ago

Retric 15y ago

There are basically 4 things driving up medical costs in this country. (Education, Malpractice, R&D, and Insurance) Unfortunately, I don't see any fundamental change happening in any of those areas any time soon. Just think what it would mean if you banned say, advertising the name of any prescription drug to private citizens. I mean I can understand advertising that there are prescription treatments for ED which hey people might not know about. But, when these things have significant side effects and can't be sold over the counter you need actual medical advice not just people dancing around with smiles on their faces. Not that I think there is a chance in hell of this actually changing, but many country's actually do something like this.

a3camero 15y ago
Your neighbour to the north does this. It leads to vague advertising that tells you about some problem and encourages you to ask your doctor about it. Doesn't seem to have been the end of the world.
dalke 15y ago
Malpractice insurance is something like 2% of the overall medical costs in the US, and at least some states have caps on liability lawsuits. Looking now, it seems malpractice insurance premiums have stayed pretty constant over the last couple of years. Are you sure that malpractice is one of the major factors "driving up medical costs in this country", and if so, do you have a pointer to something which reinforces that statement? Personally I thought the big increases in liability insurance coverage 5 or so years ago were because the insurance companies were so invested in the market, that after the market crash they needed to hike rates to build back their reserves. Those hikes were then used as justification in advocating liability caps.
- Retric 15y ago
  It's not a major direct cost, however due to inefficiencies in the system your paying for that 2% in several additional ways. Doctors do a lot of tests to cover their ass. People without insurance tack their get their costs shifted to other people. Then Insurance company's tack on their profit margin above that 2% that's already been compounded a few times. And many of those unnecessary tests can cause further complications down the road due to things like false positives.
  - dalke 15y ago
    I believe that 2% includes defensive medicine. Ahh, here's one of the relevant papers: http://content.healthaffairs.org/content/29/9/1569.abstract http://content.healthaffairs.org/content/29/9/1569.abstract "Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending." I really don't see 2.4% as one of the major things "driving up medical costs in this country." Here's another from http://www.factcheck.org/2009/10/malpractice-savings-reconsidered/ http://www.factcheck.org/2009/10/malpractice-savings-reconsi... "In an Oct. 9 letter to Republican Sen. Orrin Hatch of Utah, CBO Director Douglas Elmendorf said that a package of changes including limits on malpractice awards 'would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009).'" "That figure includes a 0.2 percent reduction just from lower premiums for malpractice insurance paid by medical professionals. And it includes an additional 0.3 percent in reduced costs of medical tests, imaging and other medical services. " This would imply that the malpractice overhead isn't more than a couple percent. Personally, I think the major perception regarding malpractice is based on propaganda by people who want to put caps on all lawsuits. See, of all things, a Cracked article on the major examples of 'outrageous' judgements where the actual facts are at odds with the perceptions: http://www.cracked.com/article_19150_6-famous-frivolous-lawsuit-stories-that-are-total-b.s..html http://www.cracked.com/article_19150_6-famous-frivolous-laws... . Civil lawsuits are one of the few ways that individuals can take on large companies with bad business practices. Caps mean those companies are more free to make decisions in favor of cost-cutting over quality. Of course it's hard to justify it that way. It's much easier to say "idiotic medical lawsuits are one of the major reasons for increases in medical costs, so lets cap all lawsuits." Where do you get your idea that medical malpractice costs are a major contributor to increasing medical costs, either direct or indirect?

paul_mctaggart 15y ago

Harshaw: we actually see roughly 30% of our patient base receive dental implants. The vast majority (95%) of our patients do not receive immediate load dental implants. They receive their implant and then travel back for treatment 4-6 months later (after the bone has fused to the implant). The great part is they still save money even with the second visit and this includes the cost of their travel. I appreciate your costs to become a dentist...I've felt the burden of student loans and it is tough to dig yourself out. Dental Departures is globalization plain and simple: dentistry & medical services are no longer immune. The labor, overhead & cost of materials are less expensive overseas than in the United States (for the same quality of care). Full disclosure: I work @ Dental Departures

drew55 15y ago

FYI, there are Mayan human skull remains that have shell, bone, and wood implanted into the jawbone. Not really the point though; are you suggesting that a US dentist would disregard their Hippocratic Oath and refuse to treat a patient who has been treated abroad in the past?

harshaw 15y ago
My point was more that the Dentist will treat the patient according to their standard of care. That could mean for example that they won't patch the current crappy work and instead treatment plan a correct solution. Keep in mind that I am a lowly hacker who has some insight into Dentistry via pillow talk :)