From Volume to Value: Comparative value, quality, and cost between three treatment modalities for early childhood caries

ContextIn recent decades there has been a shift from a reimbursement system based upon treatment "volume" to "value." AimsTo compare value, quality, and cost of three treatment modalities for early childhood caries: surgical care with and without general anesthesia, and non-surgical care with disease management. Settings and DesignThrough an analytical, observational, cross-sectional design, data was collected from 487 pediatric subjects treated at health centers in seven states. Nearly 95% of the subjects were beneficiaries of the United States government Medicaid health insurance program, which supports families with low socioeconomic status. Methods and MaterialQuality was measured with a Parental-Reported Symptom and Service Quality questionnaire, adapted from the validated Early Child Oral Health Impact Scale, Child-Oral Impacts on Daily Performance, and Dental Consumer Assessments of Healthcare Providers and Systems surveys. Cost was measured by the labor cost for clinicians and adjusted by total relative value units for all treatment procedures. Value was calculated as the quotient of the weighted quality score and the adjusted cost, multiplied by a coefficient. Statistical AnalysisValue comparisons were analyzed using chi-square, ANOVA, and likelihood ratio tests. ResultsChildren treated with non-surgical, disease management had significantly higher parental-perceived quality, lower cost, and higher value when compared to the two surgical treatment modalities. ConclusionsDentists should consider that non-surgical treatment yields higher "value" than surgical treatments for the management of early childhood caries. Payers and consumers would benefit by comparing treatment "value" when choosing institutions and providers for the management of early childhood caries.