title: Reimbursing dentists for smoking cessation treatment: views from dental insurers.
abstract: BACKGROUND
  Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers' role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers.
  
  
  METHODS
  Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identified using a targeted sampling method and represented viewpoints from a significant share of companies within the dental insurance industry.
  
  
  RESULTS
  All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage.
  
  
  CONCLUSIONS
  Dissemination of findings on efficacy and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings.
authors.affiliation: School of Medicine, New York University, 227 East 30th Street, Room 608, New York, NY 10016, USA. donna.shelley@nyumc.org
authors.forename: Donna
authors.initials: D
authors.lastname: Shelley
authors.forename: Shana
authors.initials: S
authors.lastname: Wright
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNeely
authors.forename: John
authors.initials: J
authors.lastname: Rotrosen
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Winitzer
authors.forename: Harold
authors.initials: H
authors.lastname: Pollack
authors.forename: Stephen
authors.initials: S
authors.lastname: Abel
authors.forename: Lisa
authors.initials: L
authors.lastname: Metsch
mesh_terms: D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D003815:Dentists / Q000191:economics; D055094:Evidence-Based Dentistry; D005792:General Practice, Dental / Q000191:economics; D019538:Health Care Surveys; D006284:Health Plan Implementation; D006301:Health Services Needs and Demand; D006801:Humans; D007343:Insurance Carriers / Q000706:statistics & numerical data*; D007347:Insurance, Dental / Q000191:economics / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D014029:Tobacco Use Disorder / Q000517:prevention & control*; D014481:United States