This document discusses healthcare systems and dental payment mechanisms in India and the United States. It provides details on:
1) The public and private healthcare sectors in India, including government insurance schemes like CGHS and ESIS.
2) Types of dental payment plans in the US, including private fee-for-service, insurance plans (HMOs, PPOs), and public programs like Medicaid and Medicare.
3) Reimbursement methods for dentists in the US, including UCR fees, fee schedules, and capitation. Major dental insurance plans like Delta Dental are also summarized.
Taboos in dentistry (public health dentistry)Shazlana Raheem
there are many taboos made by community among themselves regarding the dentistry and the dental problems. Here's the slide regarding the things to know before creating or assuming the taboos regarding dentistry.
A very important aspect in determining and studying disease is the knowledge of surveys. Its designs, methods etc. This elaborative presentation gives a detailed insight to the survey procedures used in dentistry. Special section on the WHO oral assessment proforma.
Taboos in dentistry (public health dentistry)Shazlana Raheem
there are many taboos made by community among themselves regarding the dentistry and the dental problems. Here's the slide regarding the things to know before creating or assuming the taboos regarding dentistry.
A very important aspect in determining and studying disease is the knowledge of surveys. Its designs, methods etc. This elaborative presentation gives a detailed insight to the survey procedures used in dentistry. Special section on the WHO oral assessment proforma.
https://userupload.net/yk8shpcpwk19
Dentistry can do so much these days to improve a person’s health, appearance and self-confidence. From barely noticeable braces that straighten crooked smiles to dental implants that replace missing teeth, there is a state-of-the-art solution to virtually any dental problem. Of course, like anything that involves the time and resources of skilled professionals, highly technical and sophisticated dental treatment doesn’t come inexpensively; indeed, the phrase “you get what you pay for” probably applies doubly to dentistry. Also, the types of treatment mentioned above, as well as many others, are often considered elective and therefore may not be covered (or only partially covered) by dental insurance. This can be the case even when a given procedure offers proven health benefits.
In this lecture I explain in step-by-step fashion the basics of Endodontic Diagnosis: Pulp Vitality Tests. a photo guide is attached to the guide to aid in better understanding of the topic
MECHANISMS OF PAYMENT
1. Private fee - for services
2. Post payment plans
3. Private third party prepayment plans
-Commercial insurance companies
-Non-profit health service corporations
-Prepaid group practice
-Capitation plans
4. Salary
5. Public programs
1. Private fee - for service
• The two party arrangement, traditional form of reimbursement for dental services.
• Integral part of private practice as a delivery method.
Advantages:
1) Culturally acceptable
2) Flexibility
3) Administratively simple
4) Can be used in expensive situations
Disadvantages:
1. Major percent of the population cannot afford dental care.
Post Payment Plans or Budget Plans
• First started in Late 1930's - local dental societies in Pennsylvania & Michigan
• Mechanisms for the individual purchase of service
Advantages:
1. Helpful for middle income people
2. Primarily used to finance prosthetic and other costly treatment
Disadvantages:
1. Lower income people cannot use to the full
2. Problem of defaulted loans
Private Third Party Prepayment Plans
Defined as payment for service by some agency rather than directly by the beneficiary of those services.
1st Party-Dentist; 2nd Party-Patient; 3rd Party-Administrator of Finances
Third Party/ Carrier/ Insurer/ Underwriter/ Administrative Agent.
• Defined as The party to a dental prepayment contract that may collect premiums, assume financial risk, pay claims and provide administrative services
Reimbursement of Dentist in Third Party Plans
The major forms of third-party reimbursement currently in use are:
Usual fee: The fee that an individual dentist most frequently charges for a given dental service.
Customary Fee: The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.
Reasonable Fee: the fee charged by the dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications may differ from the dentists usual fee or the benefit administrators customary fee.
A table of allowances: A list of covered services with an assigned amount that represents the total obligation of the plan with respect to payment for such service but that does not necessarily represent the dentists full fee for that service”.
Fee schedule: A list of charges established or agreed to by a dentist for specific dental services. A fee schedule is usually taken to represent payment in full, whereas a table of allowances may not.
Capitation: A capitation fee is usually a fixed monthly payment paid by a carrier to a dentist based on the number of patients assigned to the dentist for treatment.
SALARY
Dentists in some group practices, those in the armed forces and those employed by public agencies are salaried.
PUBLIC PROGRAMS
Medicare
Medicaid
NHI
https://userupload.net/yk8shpcpwk19
Dentistry can do so much these days to improve a person’s health, appearance and self-confidence. From barely noticeable braces that straighten crooked smiles to dental implants that replace missing teeth, there is a state-of-the-art solution to virtually any dental problem. Of course, like anything that involves the time and resources of skilled professionals, highly technical and sophisticated dental treatment doesn’t come inexpensively; indeed, the phrase “you get what you pay for” probably applies doubly to dentistry. Also, the types of treatment mentioned above, as well as many others, are often considered elective and therefore may not be covered (or only partially covered) by dental insurance. This can be the case even when a given procedure offers proven health benefits.
In this lecture I explain in step-by-step fashion the basics of Endodontic Diagnosis: Pulp Vitality Tests. a photo guide is attached to the guide to aid in better understanding of the topic
MECHANISMS OF PAYMENT
1. Private fee - for services
2. Post payment plans
3. Private third party prepayment plans
-Commercial insurance companies
-Non-profit health service corporations
-Prepaid group practice
-Capitation plans
4. Salary
5. Public programs
1. Private fee - for service
• The two party arrangement, traditional form of reimbursement for dental services.
• Integral part of private practice as a delivery method.
Advantages:
1) Culturally acceptable
2) Flexibility
3) Administratively simple
4) Can be used in expensive situations
Disadvantages:
1. Major percent of the population cannot afford dental care.
Post Payment Plans or Budget Plans
• First started in Late 1930's - local dental societies in Pennsylvania & Michigan
• Mechanisms for the individual purchase of service
Advantages:
1. Helpful for middle income people
2. Primarily used to finance prosthetic and other costly treatment
Disadvantages:
1. Lower income people cannot use to the full
2. Problem of defaulted loans
Private Third Party Prepayment Plans
Defined as payment for service by some agency rather than directly by the beneficiary of those services.
1st Party-Dentist; 2nd Party-Patient; 3rd Party-Administrator of Finances
Third Party/ Carrier/ Insurer/ Underwriter/ Administrative Agent.
• Defined as The party to a dental prepayment contract that may collect premiums, assume financial risk, pay claims and provide administrative services
Reimbursement of Dentist in Third Party Plans
The major forms of third-party reimbursement currently in use are:
Usual fee: The fee that an individual dentist most frequently charges for a given dental service.
Customary Fee: The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.
Reasonable Fee: the fee charged by the dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications may differ from the dentists usual fee or the benefit administrators customary fee.
A table of allowances: A list of covered services with an assigned amount that represents the total obligation of the plan with respect to payment for such service but that does not necessarily represent the dentists full fee for that service”.
Fee schedule: A list of charges established or agreed to by a dentist for specific dental services. A fee schedule is usually taken to represent payment in full, whereas a table of allowances may not.
Capitation: A capitation fee is usually a fixed monthly payment paid by a carrier to a dentist based on the number of patients assigned to the dentist for treatment.
SALARY
Dentists in some group practices, those in the armed forces and those employed by public agencies are salaried.
PUBLIC PROGRAMS
Medicare
Medicaid
NHI
The acceleration in the rate of increase of healthcare costs have been attributed to a number of factors, principally
The public’s increasing demand for health services. The ever-growing technology of health care.
The probably higher quality of care now being delivered.
General inflation.
The lack of incentives in medical care to keep costs down.
The increasing practice of “defensive medicine” in which diagnostic tests and prescribed treatment are aimed at avoiding lawsuits rather than at meeting the patients real needs.
Private Fee for Service the two party arrangement is the traditional form of reimbursement for dental services in most countries
Post payment Plans first introduced in the late 1930’s by local dental societies in Pennsylvania and Michigan.
It is also known as budget payment plans.
. Private Third Party Prepayment for dental services is defined as “payment for services by some agency rather than directly by the beneficiary of those services”
A capitation fee is defined as a fixed monthly or yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment.
The money is paid regardless of whether the patients participate in the plan, receive no care, a little care or great deal of care
finance in dentistry is based on soben peter article said about the varies methods of financing in the world for dentistry and which i included some indian methods in financing as well as kerala.
This challenge presents an opportunity for dental practices to increase their patient base and boost revenue by billing qualifying dental procedures to medical policies instead. Doing so not only helps patients access care to resolve complex oral health issues but also does so cost-effectively while preserving what dental benefits they might have.
This challenge presents an opportunity for dental practices to increase their patient base and boost revenue by billing qualifying dental procedures to medical policies instead. Doing so not only helps patients access care to resolve complex oral health issues but also does so cost-effectively while preserving what dental benefits they might have.
The healthcare needs of the people have changed over time with the emergence of new ailments, and so has the healthcare industry. Following the steep rise in the cost of medical treatments, the necessity for some sort of cover to provide protection during a medical emergency has increased. Considering the changing lifestyle and needs of the people, the medical schemes in South Africa have also evolved over time.
Current System Issues and Their ImpactsIntroductionBefore we .docxalanrgibson41217
Current System Issues and Their Impacts
Introduction
Before we can discuss change and innovation in our health care delivery system, a strong understanding of the current system is necessary, including how it functions, what types of incentives are at work, and how the different entities inside it work with and impact each other.
What Elements Drive Our Current System?
There are several key drivers of the existing system, and among these are the money, providers, payers, and consumers. When examining the behavior of any system, it is useful to look at the series of rewards and consequences that drive behavior. In health care, this means that much can be learned about the system's behavior by following the money trail. What things are reimbursed, under what circumstances, and with what outcomes? Under what circumstances are consequences, such as not getting paid, applied? In the current system, payments are highest for procedures, and proceduralists such as surgeons, gastroenterologists, and interventional cardiologists are all paid much higher fees than are family practice physicians, pediatricians, or hospitalists, all of whom manage medical care. Hospitals function under the same premise. Approximately 75% of the revenue for the average community hospital comes from surgeries, and another 12% comes from diagnostic imaging procedures. Additional amounts come from cardiac diagnostic and interventional procedures. So, approximately 90% to 95% of revenue comes from performing procedures on patients rather than providing management of diseases through medications or other noninvasive treatments. Thus, the system is focused on rewarding procedures that lead to "curing" and focused away from medical management of chronic diseases or prevention of disease and illness.
Financial Elements
Without doubt, money is one of, if not the, most powerful drivers of system functioning. For a classic example, we can look at the old fee-for-service payment methodology prevalent in the 1960s and 1970s, and contrast it with Medicare's implementation of diagnosis-related groups (DRGs) as a payment mechanism in 1983. Under fee-for-service health care, providers used whatever procedures, equipment, and supplies they felt were needed for care, and they submitted a bill that charged for each item. The payors received the bill, corrected any errors, and then issued a check for the corrected amount to the providers. If a provider wished to make a larger profit, they could provide more services or billable items to increase the payment. It comes as no great surprise to note that utilization of services and cost both rose rapidly under this methodology, since there was no incentive to be frugal. When Medicare changed its reimbursement to DRGs, the system began to experience the impact of being paid one flat fee, set by DRG, for the entire admission, regardless of how much care was rendered. For example, if a hospital provided care at a cost below the DRG payment, it was ab.
1. Health Policy,
2. Features of health policy,
3. Types of health insurance,
4. Ayushman Bharat,
5. Mediclaim Policy,
6. Types of Mediclain policy,
7. What mediclaim policy cover,
8. Types of Mediclaim policy,
9. What Mediclaim policy not covered,
10. Difference between Health Policy and Mediclaim policy
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Health care systems of India
1.Public health sector
a) Primary health care
- Primary health centers
- Sub-centers
b) Hospitals/ & health centers
- Community health centers
- Rural hospitals
- District hospital/ health center
- Specialist hospitals
- Teaching hospitals
3. Health care systems of India
c) Health insurance schemes
- Employees state insurance
- Central govt. health schemes
d) Other agencies
- Defense services
- Railways
2.Private sector
a) private hospitals, poly clinics, nursing
homes and dispensaries
b) General practitioners and clinics
4. Health care systems of India
3. Indigenous system of medicine
- Ayurveda and siddha
- Unani and Tibbi
- Homeopathy
- Unregistered practioners
4. Voluntary health agencies
5. National health programmes
5. Mechanism of payment for dental care in US
1. Private fee-for-service
2. Post payment plans
3. Private third party prepayment plans
a. Commercial insurance companies
b. Non profit health service corporations (delta dental
plans & blue cross/blue shield).
c. Prepaid group practice, including health
maintenance organizations and independent
practice associations
4. Salary
5. Public programmes
6. Private fee-for-service
Two party arrangement
Traditional form of reimbursement
1970, nearly 90% of payments was in this manner.
But by 1988, dropped to 55% of all payment
because growth in the various forms of prepayment.
Patient Dentist
7. Private fee-for-service
Advantages
Simple and Culturally acceptable
Flexibility for dentist – price discrimination – robin
hood approach
Only system under which some expensive form of
treatment will be provided
8. Post payment plans
Budget-payment plans
Not true third party financing plans
Dentist allow payments for dental care to be made
at intervals over a period of time
9. Under budget payment plan, The patient borrows
money from the bank or financing company to pay
the dentist at the time he receive care
The patient then repays the loan to the bank
Disadvantages of post payments
Mostly used by middle class people as low income
patients were not considered as credit worthy by
lending institutions
Post payment plans
10. Private Third party pre-payment plans
Defined as
Payment for services by some agency rather than
directly by the beneficiary of those services
As the party to a dental prepayment contract that may
collect premiums, assume financial risks, pay the
claims and provide administrative services
Dentist – first party ; patient – second party; the
administrator of the finances – third party.
11. Private Third party pre-payment plans
also called as carrier, insurer, underwriter, or
administrative agent
The purchaser of the plan can be
an organized private group such as a union, or an
employer, a union-employer welfare fund, or a
governmental agency
the term third party, refers to a
private carrier such as an insurance company;
public financing of care when the government acts as
the third party
12. Private Third party pre-payment plans
In private third-party plans, periodic premiums are
collected to meet the costs of providing care as well
as the administrative costs of the third party.
Prepayment
plans
Dental
insurance
×
13. Private Third party pre-payment plans
Insurance
involves a group of people making small payments in
order to cover the risk of a few suffering
catastrophic loss, such as the loss of a home through
fire.
Dental prepayment
is a mechanism to spread the financial load of dental
care over a group and over time
14. Principles of Insurance
To be insurable, a risk must
Be precisely definable.
Be of sufficient magnitude that if it occurs, it
constitutes a major loss.
Be infrequent.
Be of an unwanted nature, such as destruction of a
home through fire.
Be beyond the control of the individual.
Not constitute a "moral hazard," which means that
the presence of insurance it self should not lead to
additional claims.
15. Principles of Insurance
All health insurance violates some of these
principles. For example,
benefits paid – small amounts of money, and
people with insurance are more likely to use care
than those who don't have it
16. To get around these problems Insurance carriers
came up with
Deductible .
Coinsurance .
Range of health care services .
Health insurance only to groups .
Using preauthorization and annual expenditure
limits
17. Deductible
is a set amount of money that the patient must pay
toward the cost of treatment before benefits of the
program go into effect .
• Eg - "front-end" payment for auto-mobile insurance.
Coinsurance
means that the patient pays a percentage of the total
cost of treatment .
Eg -if a patient is to pay 20% of the daily cost of
hospital care, the amount the patient must pay will
vary depending on the actual hospital charges, but in
any case will be 20% of those charges
18. Range of health care services
some are available and some not, according to the
plan.
This range is termed coverage, covered charges, or
schedule of benefits.
Preauthorization,
means that treatment plans for more than a specified
sum must be reviewed by the carrier's dental
consultants to ensure that the proposed treatment is
reasonable and that the same quality of care could
not be achieved at less expense
19. Health insurance only to groups
because illness experience is reasonably predictable
for a group, though not for an individual.
The risk of adverse selection, was reduced because
insuring only large groups "averaged out“ the risks
The probability of adverse selection was further
reduced by the use of waiting periods after
enrollment before any benefits became available.
20. REIMBURSEMENT OF DENTISTS IN
THIRD-PARTY PLANS
The major forms of third-party reimbursement
currently in use are
Usual, customary, and reasonable (UCR) fee.
Table of allowances.
Fee schedules.
Capitation.
21. Usual, customary, and reasonable (UCR)fee.
The ADA defines-
Usual Fee.
The fee that an individual dentist most frequently charges for a
given dental service.
Customary Fee.
The fee level determined by the administrator of a dental
benefit plan from actual submitted fees for a specific dental
procedure to establish the maximum benefit payable under a
given plan for that specific procedure.
22. Reasonable Fee.
The fee charged by a dentist for a specific
dental procedure that has been modified by the
nature and severity of the condition being treated
and by medical or dental complications or unusual
circumstances, and therefore may differ from the
dentist's "usual" fee or the benefit administrator's
"customary" fee
23. Table of allowances.
is defined as a list of covered services with an
assigned dollar amount that represents the total
obligation of the plan with respect to payment for
such service, but that does not necessarily
represent the dentist's full fee for that service
24. For example,
if a dentist's usual fee - $20
the plan lists for that service a fee of - $15,
the dentist will provide the service, collect $15 from
the carrier, and may charge the patient $5 to make
up the difference.
25. Fee schedules
is also called a service plan
is defined as a list of the charges established or
agreed to by a dentist for specific dental services
A program in which the payment is meant to
represent full payment, with no additional charge to
the patient
26. Dentistry's opposition to fee schedules is based on
(a) Their potential inflexibility, meaning that the fees
listed can fall below customary fees, particularly in
times of rapid inflation;
(b) The implicit assumption that all dentists' treatment
is of the same quality and therefore worth the same
fee; and
(c) The fear that autonomy is threatened, especially if
the fee schedule is not controlled by the dentists
27. Capitation
became more common during the 1980s
Is defined as a fixed monthly or yearly payment
paid by the carrier to the dentist in a closed panel,
based on the number of patients assigned to the
dentist for treatment.
Dentist fear of
High utilization
Demand of expensive treatment
28. Delta dental plans
A dental service corporation is a legally constituted
not-for-profit organization that negotiates and
administers contracts for dental care, incorporated
on a state-by-state basis
National Association of dental service plans
(NADSP) was formed in June 1966, with the help
of ADA
29. NADSP changed its name to delta dental plans
association in April 1969 and the member
corporations became known as delta plan for the
particular state
So delta plan and dental service are synonymous
Most blue cross and blue shield dental plans are
now also organized as dental service corporation
30. Reimbursement of dentists in delta
plans
Exclusively by UCR concept
Reimbursing depends on whether the dentist is
participating or nonparticipating (par or nonpar) in
the delta plan
Participating dentist – any duly licensed dentist with
whom a delta plan has a contractual agreement to
render care to covered subscribers
31. Rules of delta dental plan
By participating in delta plans the dentist agree the
following –
Prefiling of their usual and customary fees
Acceptance of payment for their services at the 90th
percentile
Fee audits by auditors from delta, who may check
their office records from time to time
Post treatment inspection of randomly chosen
patients
With holding of a small amount of each fee, usually
less than 5%, to go into delta capital reserve fund.
32. Nonparticipating dentist can also treat the patients
covered under delta plans, but they are reimbursed
at a considerably lower percentile – median or 50th
percentile
34. Health maintenance organization (HMO)
Was defined in the act 1973 as “ a legal entity
which provides a prescribed range of health services
to each individual who has enrolled in the
organization in return for a prepaid, fixed and
uniform payment
35. Independent practice association (IPA)
Is a association of dentist (or physician) that
develops its own management and fiscal structure
for the treatment of patients enrolled in an HMO
Dentist remain in their own office and continue to
treat their fee for service and other patients
The IPA receives its capitation premium from the
HMO and in turn reimburse the individual dentist
on either a modified fee-for service or capitation
basis
36. Preferred provider organisation (PPO)
PPOs typically involve contracts between insurers
and a number of practitioners who agree to provide
specific service for fees that are lower than average
in that area
37. Direct Reimbursement
Involves an agreement between an employer and a
group of employees in which the employer agrees to
reimburse the employees for some part of their
expenses for dental care.
The patient is responsible for paying the dentist
from whom they get the service ,
38. All treatment decisions are thus negotiated between
the patient and the dentist in a traditional two-party
manner.
After treatment has been provided and the patient
takes the receipt to her employer and is reimbursed
for her expenses according to the rules of the
agreement
Reimbursement is usually on a percentage basis, and
there is usually an annual limit
39. Medicare
Title XVIII of the Social Security amendments of
1965 is the program known as Medicare.
Medicare had two parts:
Part A, hospital insurance, and
Part B, voluntary supplemental medical insurance.
The dental segment of Medicare is limited to those
services requiring hospitalization for their treatment,
usually surgical treatment for fractures and cancer
40. Medicaid
Title XIX of the Social Security amendments of 1965
is a joint federal-state program, with the federal
government and state governments sharing the costs
The federal government provides 50% to 83% of the
funds used by each state, according to a formula that
is based on the ratio of per capita income in the state
to the national per capita income.
41. In order to qualify for the federal government's share
of Medicaid financing,
every state cover a set of basic services for everyone
receiving federally supported financial assistance.
States offer early and periodic screening, diagnosis,
and treatment (the so-called EPSDT program) to
needy children at least up to age 18. Dental care is
mandatory under the EPSDT program.
42. Third parties in India
Government
General Insurance
Corporation
(GIC)
Life Insurance
Corporation
(LIC)
Employees’
State
Insurance
Scheme
(ESIS)
Central
Government
Health
Scheme
(CGHS)
National
Insurance
Corporation
(NIC)
United Indian
Insurance
Corporation
(UIIC),
New India
Assurance
(NIA)
Oriental
Insurance
Company
(OIC).
43. Central government health scheme (CGHS)
Introduced in 1954 in New Delhi to provide
comprehensive medical care to central government
employees and their families
320 Separate dispensaries for the employees
covered by the scheme
45. Facilities under the scheme
a. Out patient care thro network of dispensaries
b. Supply of necessary drugs
c. Laboratory and x-ray investigations
d. Domiciliary visits
e. Hospitalization facilities at Govt and private
hospitals
46. f. specialist consultation
g. Pediatric consultation including immunization
h. Antenatal, natal and postnatal care
i. Emergency treatment
j. Supply of optical and dental aids at reasonable
rates
k. Family welfare service
47. Employees state insurance scheme (ESIS)
Established in 1948, ESIS is an insurance system
which provides both the cash and medical benefits
Managed by employees state insurance corporation
(ESIC) – a wholly Govt owned enterprises
The scheme cover
Non-power using factories employing 20 or more
members
Power using factories employing 10 or more persons
Road transport establishments
News paper establishments
Cinema theatre, hotels and shops
48. Only employees earning basic salaries of less than
3000 Rs (recently enhanced to 6500) are eligible
Premiums are paid thro pay roll tax of 4.75% by
employer and 1.75% by employee
49. Mediclaim policy of the GIC
General Insurance Corporation was set by Govt in
1973 as a public sector organization to market a
range of insurance services
It introduced mediclaim insurance scheme in 1986,
and became active in 1987
Policy was modified in 1996 to allow for differentials
in premium for six age groups – 5-45; 46-55; 56-65;
66-70; 71-75 and 76 plus
Policy was framed for both groups and individuals
50. Mediclaim provides only reimbursement insurance –
i.e..,enrollees are reimbursed for their medical claim
only after the payments have been made out of the
pocket to the provider
sum insured ranging from Rs. 15.000 to Rs. 5,00,000
51. Salient Features
Provides cover, which takes care of medical
expenses following hospitalization from sudden
illness or accident
Cover extends to pre-hospitalization and post-
hospitalization for periods of 30 days and 60 days
respectively
Domiciliary hospitalization is also covered
52. Major weaknesses of mediclaim –
It covers only hospitalization leaving out out-patient
care
The coverage is subjected various exclusions, limits
and restrictions on eligibility
Premiums are high in relation to claim payments –
claim payments are only 58% of the premiums
53. Bibliography
Dentistry, Dental practice & the Community
– burt /eklund 4th edition
Dentistry, Dental practice & the Community
– Striffler, Young & Burt
TB of Preventive & Social medicine
–K.park 17th edition
Essentials of community dentistry
– Soben peter
TB of preventive & social medicine
– Mahajan
Various websites on third party payments