Comparison of Procedures Performed and Costs between an Outsourced Dental Health Plan with Fee-For-Service Payment and an Evidence-Based, In-House Dental Health Service with Salaried Professionals

Aim: Evaluate the change in terms of levels and mixes of services rendered and costs resulting from the change from an outsourced dental health plan with fee-for-service payment to an in-house health service provided by salaried dentists.

Method: We evaluated dental care services provided to almost 4,000 users (employees and their families) of a big company (Moinhos de Vento Hospital, Brazil). The analysis was divided into two periods of time: from January 2000 to December 2002, during which time the dental care provided to employees (and families) was outsourced to a dental plan which operates with an accredited network, and from March 2003 to June 2005, when the dental care was provided by an in-house dental care service with preventive and evidence-based dentistry guidelines. Economic data were collected, as well as the type and number of procedures performed.

Results: There was a significant increase in the number of preventive and oral environment adequacy procedures performed by the in-house service in relation to the outsourced dental plan. There also was a significant decrease in the number of restorative procedures with the implementation of the in-house service. Expenses were reduced by 36%, while the number of procedures increased by 30% and customer satisfaction did not decrease with the adoption of the in-house service.

Conclusion: An in-house service with evidence-based clinical protocols, as compared with an accredited network, decreased costs and also increased the number of procedures done, changed the profile of care for a less invasive dentistry and one more geared toward the causes of diseases, while still preserving the customers’ satisfaction.