title: Controlling third-party expenditures and improving quality assurances: a plea for change.
abstract: Growing demands to contain health care's inflationary expenditures have particular relevance for elective (eg, orthodontic) services, because their progressively increasing provision will ultimately jeopardize the resources for others (eg, restorative dentistry). Some form of rationalization is therefore inevitable, especially in services eligible for payments from third-party benefits. These are central concerns of the ongoing debate on whether rationalization should be driven by service efficiency and cost efficiency and who should make such decisions. The adaptation of contemporary computer-based technology could resolve this dilemma, especially if real-time comprehensive assessments of 3-dimensional craniofacial forms before and after treatment are incorporated into local and national databases. Such a facility would then help to develop clinical guidelines to optimize the provision of specific orthodontic services for particular malocclusions. Referring individual cases to these databases would subsequently help to control service expenditures and maintain or even improve their outcomes to the ultimate benefit of both the profession and the public.
authors.affiliation: Department of Orthodontics, University of Manitoba, Winnipeg, Canada. blavell@ms.umanitoba.ca
authors.forename: Chris
authors.initials: C
authors.lastname: Lavelle
authors.forename: Robert
authors.initials: R
authors.lastname: Schroth
authors.forename: William A
authors.initials: WA
authors.lastname: Wiltshire
mesh_terms: D003363:Cost Control; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D018795:Device Approval / Q000592:standards*; D015276:Health Care Rationing; D005102:Health Expenditures; D006801:Humans; D007347:Insurance, Dental / Q000191:economics*; D008310:Malocclusion / Q000191:economics*; D009967:Orthodontic Appliances / Q000191:economics; D009971:Orthodontics, Corrective / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000592:standards; D011785:Quality Assurance, Health Care; D014481:United States