ethical and moral issues ( Dollars & Dentists )

While the Dollars and Dentists video was filled with non-stop ethical and moral dilemmas ranging from personal hygiene to governmental insurance, I am going to focus on the oral health providers (Dentists). The video described two perspective that present two different sets of issues; private practice dentists and corporate backed dentists.

For individuals who own their own dental practice they are faced with massive amounts of debt which averages $261,000 (ASDA, 2016), overhead (350,000 annually) (Able, 2006), start-up costs which can range between $350,000-550,000 (Amos, 2017), and trying to make a comfortable living for their families. They work autonomously and have a lot of freedom to work as long or short of a day as they wish. They can also set prices and decide what insurance they will accept and what insurance they won’t accept.

While there were a number of issues facing private practice dentists, there are two issues I consider key concerns for this group. First is the low reimbursement rate provided by the governmental programs Medicaid and Medicare? It was stated that Medicaid reimburses at a rate of only 20% of what would be reimbursed by private insurance. Hence, dentists who make the decision to see Medicaid patients are, in essence, agreeing to accept .20 cents on the dollar to treat these individuals. The ethical dilemma facing these dentists is whether to see patients who desperately need their services and accept this low reimbursement, or turn these patients away. If they do decide to see them how much welfare should be extended? If they see patients as part of a charity program, what’s reasonable? Given the expenses associated with maintaining an office this is a concern that each private practice dentist must decide.

The second group of dentists are those who work in dental offices that are owned by equity based companies. These offices are becoming popular in many parts of the country as more and more private practice dentist are turning away patients who rely on Medicaid and/or Medicare insurance. There is an appeal to dentists to join these types of practices. While they lose autonomy, they are not saddled with the expenses of starting a new practice, they have a business office to bill patients and insurance companies. They also pretty much are able to work a 9-5 job without the responsibilities of owning and running a private practice.