Comment by rgersten | Hacker News Reader

Comment by rgersten | Hacker News Reader

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This. I come from a family of dentists and they are very hesitant to drill unless absolutely necessary. Their rationale as I understand it is that all fillings, crowns, bridges, etc fail eventually. That anytime you attach something to a tooth you add a failure point and potential for infection.

The problem is their businesses can’t compete with the ones that play the insurance game. Insurance reimbursement rates haven’t kept up with overhead and so conservative dentistry is losing marketshare to ones willing to push treatment. We know multiple dentists that have filed bankruptcy in the last couple years.

Keep in mind that many people are very reluctant to pay out of pocket for dentistry. Until insurance reimbursement rates favor conservative dentistry, nothing will change. More responsible dentists will lose their practices or turn to over treatment.

Maybe the HN crowd wisdom has some ideas on how we can improve this situation.

> Maybe the HN crowd wisdom has some ideas on how we can improve this situation.

HMO / Capitation dentistry is the obvious answer here, where your dentist gets paid X per patient per year, to focus on preventive instead of pushing unnecessary care.

It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.

>It’s really hard to implement in the US though because people push for a lot of unnecessary stuff.

"Unnecessary" is in the eye of the beholder to a certain degree. Extracting a molar is pretty cheap. Root canals, implants, and crowns much less so. But, depending upon the circumstances, more expensive procedures may make sense.

Well sure, but in the universe where capitation rules the world, we have people clamoring for services that they say they need, but professionals refuse to provide.

And there are probably HN threads there explaining why we need to go to a fee-for-service model.

There’s a dentist near where I live in a wealthy neighborhood that I went to once and was great. Problem is, she’s expensive and doesn’t take insurance. She doesn’t need to push anything extra because everything is already priced where she needs it to be. Obviously that won’t work generally, but something to think about.

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