米国歯科医療市場のカテゴリーに投稿されている記事は、米国の歯科医療市場を網羅的に知るために私がビジネススクールにて書き上げてきたレポートをそのまま掲載したものです。いずれ時間があれば日本語に翻訳する可能性があります。

 

Ⅰ章 米国歯科医療市場

この章では、米国歯科医療市場のサイズや市場の成長率、米国歯科医師会などの組織、連邦政府と州政府によるレギュレーションなどについて記載しています。

 

1. The Dentist industry in 2013
– Market Revenue:   $118.8bn(2013) to $140.2bn(2018)
– Profit:   $20.6bn(17.3% of revenue)
– Annual Growth 2013-18:   3.4%
– Businesses   164,966(increasing 0.4%/year)

Exhibit: Dental Treatment Segmentation in 2013

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The Dentists industry held steadfast during the recession, benefiting from favorable demographic trends, technological advances and mounting awareness of the importance of oral hygiene. Furthermore, private dental clinics were one of the nation’s most profitable industries during the economic downturn. This profitability is partially attributed to industry operators being less dependent on reimbursement from healthcare insurers, as many patients pay for dental treatment out-of-pocket. However, better preventive care at home has somewhat suppressed revenue growth. Improved toothbrushes and formulas for toothpastes that keep teeth healthy have somewhat mitigated demand for traditional dental services.

Meanwhile, the cost of dental education has soared over the past five years. Weighed down with debt, dental graduates have been hindered from starting practices, which require significant capital investments. Rapid advancements in technology have also made it expensive to outfit a dental office. These factors have led to the growth of dental practice management companies (DPMCs), large companies that provide services for multiple dental offices. Because DPMCs also buy independent practices, their growing dominance has led to industry consolidation.

The number of dentists per 100,000 people is higher in large metropolitan cities than other areas, particularly rural areas. In fact, the top four regions with the largest number of industry establishments include the West, Southeast, Mid-Atlantic and Great Lakes, accounting for 21.4%, 21.2%, 17.1% and 14.7% of the total number of establishments, respectively. Although dentists are more concentrated in urban areas, 84.7% of the population that lives in the most rural counties has one or more private practice dentists, based on information from the American Dental Association (ADA). There are some areas where do not have any dentist. Dental practitioners are attracted to large cities such as Los Angeles and New York because they can receive higher prices for services in these areas. Personal lifestyle preferences also play a part in a dentist’s decision regarding where to locate.

In the US, most of the dental treatment is provided in the small clinics, so the number of clinics considerably depends on the number of dentists. The final authority on licensure requirements is the individual state. The state board of dentistry, known as board of dental examiners, is an agency of state government created by the state legislature. This agency governs the qualifications for and the practice of dentistry within the state. According to the interview with a student of USC School of Dentistry, each state control the number of new dentists who can work at the state after graduation because of its luck or surplus of dentists.

Now, the US is under implementation of the Patient Protection and Affordable Care Act (PPACA), and healthcare reform legislation increases the number of insured Americans. PPACA mandates that all Qualified Health Plans include oral care coverage for pediatric patients, boosting demand for dental services. Moreover, although the Act does not extend mandatory oral care coverage to adults, PPACA provides a boost to dental care providers by expanding Medicare and Medicaid and by setting up private health insurance exchanges, which had the effect of expanding medical coverage to millions of Americans, leaving them with more disposable income to spend on dental care and elective and cosmetic dental procedures. As a result, the effects of PPACA have boosted patients’ demand and ability to pay for pediatric and adult dentistry, rendering dental offices and laboratories more able to restock their clinical instrument supply. As a result, the industry revenue jumped 5.0% in 2014. However, there is a survey that illustrates two-thirds of dentist respondents revealed that they do not accept Medicaid payments. Though one in three dentists does take Medicaid, many were unimpressed. Through an interview, one dentist who runs his office at Los Angeles told that he do not welcome the expanding Medicare and Medicaid coverage.

In addition, as the job market improves, increased dental coverage from employers and rising disposable income will result in more patient visits. DMPCs will continue to penetrate the industry and grow in size as more dentists recognize the benefits of spreading costs across practices.

 

2. Organizations of the US Dental market
(1) American Dental Association (ADA)
Founded in 1859, the not-for-profit American Dental Association is the nation’s largest and oldest dental association, representing more than 157,000 dentist members. Since then, the ADA has grown to become the leading source of oral health related information for dentists and their patients. The ADA is committed to its members and to the improvement of oral health for the public. ADA also takes responsibility to define the education at School of dentistry, License Examination, and editing treatment guideline.

A specialty is an area of dentistry that has been formally recognized by the American Dental Association as meeting the specified Requirements for Recognition of Dental Specialties. The responsibilities of the different areas of specialization, the requirements and other information can be found here in Dental Specialties. Currently there are Nine Dental Specialties recognized by the ADA.

– Endodontics
– Periodontics
– Prosthodontics
– Orthodontics and Dentofacial Orthopedics
– Pediatric Dentistry
– Oral and Maxillofacial Surgery
– Oral and Maxillofacial Pathology
– Oral and Maxillofacial Radiology
– Dental Public Health

(2)  American Dental Hygienists Association (ADHA)
ADHA is the largest national United States organization representing the professional interests of more than 150,000 dental hygienists across the country.

(3) Organization for Dental Assistants
① American Dental Assistants Association (ADAA)
ADAA has issued a position statement on education and credentialing of dental assistants in the United States as a step toward preventing a recurrence of the unfortunate dental practice incidents recently experienced in various states.

② Dental Assisting National Board (DANB)
DANB is the nationally recognized, premier certification and credentialing agency for dental assistants. By providing high standards for testing and dental assistant certification, DANB ensures that the public receives quality dental care from qualified individuals.

③ The Commission on Dental Accreditation (CODA)
CODA belongs to ADA is responsible for accrediting dental assisting programs.

(4) The National Board for Certification in Dental Laboratory Technology (NBC)
NBC provides professional certification to both dental technicians and dental laboratories. NBC is dedicated to administering and promoting globally recognized certification programs to assess the knowledge and skills of dental technicians and to review facility and staff training criteria for dental laboratories.

 

3. Dental Regulation
Dentistry is typically practiced outside of an institutional setting and in private practice.
(1) Federal Regulation
The federal Anti-Kick Back Statute many things especially rerated to Medicare or other government health programs. There are also federal laws that prohibit health practitioners from referring patients to designated health services in which the practitioner has an ownership interest. Many states have also enacted laws similar in scope and purpose to the Anti-Kick Back Statute and the Stark laws to apply to state health programs.
Dentists must also comply with laws and regulations that are more wide ranging and apply to other professions.

(2) State regulation
Dentists define their own scope of practice. However, states regulate who can own and operate dental practices, which may employ dentists, and what level of control non-dentist owners and managers have over dental practices. State boards of dentistry issue licenses and seek to ensure that dental practitioners maintain their competence and practice in accordance with the law of the particular state. State laws also govern the ways that dentists advertise to the general public to solicit business. The laws vary from state to state but generally address ethical matters and the types of credentials a dentist may include in any advertisements.