Cost implications of differences in dentists' restorative treatment decisions.
OBJECTIVE
This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care.


METHODS
Each of 37 patients was examined individually by several practicing dentists (between 3-22, mean = 6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist


RESULTS
Considerable variation was found among dentists in each patients cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans.


CONCLUSIONS
These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on "outlier dentists" is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.
Department of Operative Dentistry, University of North Carolina, School of Dentistry, NC 27599-7450, USA. dshugars.dentce@mhs.unc.edu
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Shugars
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Bader
D003188:Composite Resins / Q000191:economics; D003363:Cost Control; D003442:Crowns / Q000191:economics; D003657:Decision Making; D003723:Dental Amalgam / Q000191:economics; D003793:Dental Restoration, Permanent / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D010347:Patient Care Planning; D019239:Practice Patterns, Dentists' / Q000191:economics*; D011787:Quality of Health Care; D014600:Utilization Review
D003188:Composite Resins; D003723:Dental Amalgam