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Am J Public Health. 2014 May;104(5):881-7. doi: 10.2105/AJPH.2013.301825. Epub 2014 Mar 13.

Insurer views on reimbursement of preventive services in the dental setting: results from a qualitative study.

Author information

1
Rebecca T. Feinstein-Winitzer and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Carrigan L. Parish, Margaret R. Pereyra, and Lisa R. Metsch are with the Mailman School of Public Health, Columbia University, New York, NY. Stephen N. Abel is with the School of Dental Medicine, University of Buffalo, NY.

Abstract

OBJECTIVES:

We explored insurers' perceptions regarding barriers to reimbursement for oral rapid HIV testing and other preventive screenings during dental care.

METHODS:

We conducted semistructured interviews between April and October 2010 with a targeted sample of 13 dental insurance company executives and consultants, whose firms' cumulative market share exceeded 50% of US employer-based dental insurance markets. Participants represented viewpoints from a significant share of the dental insurance industry.

RESULTS:

Some preventive screenings, such as for oral cancer, received widespread insurer support and reimbursement. Others, such as population-based HIV screening, appeared to face many barriers to insurance reimbursement. The principal barriers were minimal employer demand, limited evidence of effectiveness and return on investment specific to dental settings, implementation and organizational constraints, lack of provider training, and perceived lack of patient acceptance.

CONCLUSIONS:

The dental setting is a promising venue for preventive screenings, and addressing barriers to insurance reimbursement for such services is a key challenge for public health policy.

PMID:
24625150
PMCID:
PMC3987575
DOI:
10.2105/AJPH.2013.301825
[Indexed for MEDLINE]
Free PMC Article
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