The Macy Study: A Framework for Consensus

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153738/1/jddj0022033720056911tb04018x.pd

The Macy Study: A Framework for Consensus

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153659/1/jddj002203372008722suppltb04486x.pd

U.S. State‐Supported Dental Schools: Financial Projections and Implications

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153620/1/jddj002203372006703tb04080x.pd

U.S. State‐Supported Dental Schools: Financial Projections and Implications

This article examines the impact of financial trends in state‐supported dental schools on full‐time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full‐time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full‐time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH‐funded research programs. If current trends continue, the term “crisis” will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153587/1/jddj002203372008722suppltb04487x.pd

Dental care utilization over time

Between 1950 and 1978, per capita real dental expenfitures in the U.S. grew at an average annual rate of 3.33%. Between 1978 and 1989 there was virtually no net growth in this measure of dental care utilization. This sharp curtailment of utilization growth has prompted debate about the sources of this change. Possible explanations include, among others, a reduction in dental disease due to increased exposure to flouridation, the substitution of noncaloric sweeteners for refined sugar, preventive dentistry, improved oral health habits, an increase in the net price of dental services, and the cost-containment efforts of insurers and employers. Changes have occured in all of these variables, but little has been done to isolate and quantify the individual effects. This decomposition is difficult, in part, because of the lack of an established model for time-series analysis of dental care utilization. A model of dental care demand, incorporating economic factors (out-of-pocket or net dental prices, per capita income, and nondental prices) as well as dietary factors (refined sugar consumption, noncaloric sweeteners, and exposure to flouridated water), is combined with a simple model of dental care supply within an equilibrium framework. A two-stage estimation procedure is applied, using U.S. aggregate time-series data for the period 1950-1989. Results show that economic and dietary factors are significantly related to changes in utilization. Net price and income elasticities of demand exhibit the expected signs and are compatible with estimates from cross-sectional studies. Decreases in cane and beet sugar consumption, facilitated by the increase in the use of noncaloric sweeteners, are associated with reductions in utilization. Flouridation appears to be weakly but positively related to utilization. There also appears to have been a significant structural shift in demand since 1978. Overall goodness-of-fit is strong and the model accurately tracks the 1978-1989 flattening of per capita real dental expenditures. Analysis of the relative contribution of each independent variable suggests that economic, dietary, and structural shift factors have contributed to this curtailment of growth.demand for dental care dental utilization dental economics