Dollars vs. Dentist paper


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1 – STUDY THE DETAILS OF THE CASE: If you have all the details, note what circumstances distinguishes this case from similar ones.(hint… healthcare as a right or privilege). If you don’t have all the details, seek them out. If they’re unavailable consider what they might be.

Consider all significant consequences (direct and indirect; obvious and subtle; immediate and delayed; physical, emotional and intellectual; intended and unintended consequences), of the action on the individual performing the act as well as on others.

2- IDENTIFY THE RELEVANT CRITERIA: Consider any obligations that might exist among the individuals or groups involved (contractual, charity, altruism, business or professional obligations).

Consider relevant ideals, including prudence, justice, honesty, compassion, autonomy, veracity, fidelity, non-maleficence forgiveness, reparation, gratitude, or beneficence.

3- DETERMINE A POSSIBLE COURSE OF ACTION: Identify possible alternative responses to the situation. Note that this step might require you to use your imagination.

4- DECIDE WHICH ACTION IS MOST ETHICAL: In light of your consideration of the criteria, (see item 2), decide which response is ETHICALLY preferable. If two responses result in a good or two produce harm, choose the one that produces the greater good or the lesser harm. 

This assignment requires you to not only reflect on the video, but also think critically and identify the moral and/or ethical dilemmas presented in the video. Providing superficial responses will not serve you well in the grading of this paper.

There are 5 key players identified in the video.  Each has a role in the “troubled system” the players include:

  • The patient
  • The health care provider
  • The ADA professional organization
  • The insurance industry (Medicaid, Medicare, &       private insurance, to a lesser degree)
  • Corporate business models – equity backed firms

What are the key issues presented in this video? (2 paragraphs per issue minimum)

How have the issues related to our dental care system been expressed?

Describe the behavior of the players on each side of the issue and identify any ethical dilemmas related to their situation.

What seems to be motivating this behavior?

Think in terms of the 5 perspectives:  

1. What responsibility do patients have? Should they assume responsibility for maintaining their oral health? Should they keep appointments? Should they have the ability to pay for these services? Should they commit to a payment plan if they can’t afford it? Should they read and understand payment agreements before signing them? What ethical principles are in play here?

2. What about dental providers? If they’re in private practice should they expect to make a comfortable living? Should they expect to be paid or give their services away for free (what’s reasonable)? Should they accept Medicaid insurance and be paid 20 cents on the dollar? How do they maintain their business if they do this? What about doing unnecessary work or providing more expensive options when less expensive options exist? If they work for a publically held company should they be incentivized to place quantity over quality? How much risk is reasonable for a private practice to depend on patients to pay their bills for the services rendered? What are the ethics in play here?

3. The American Dental Association- professional organization – What is the primary concern about equity backed business leaders operating dental offices? Are these concerns self-serving or are they genuine? It was suggested that highly trained therapists can perform many of the common procedures at considerably less cost than most fully trained dentists. Why might that be a concern? Is there any conflict of interests here? Whose best interest do they have in mind, professionally and patient wise? What ethics relate to these questions?

4. The insurance providers – (Medicaid, Medicare, & private insurance, to a lesser degree), paying a fraction of what the services actually cost. Is this ethical to the providers who provide these services? Is it ethical for taxpayers to fund these services? If reimbursement rates are too low for providers to offer their services, what could be done to fix the problem? Describe the ethical dilemmas.

5. Equity backed organizations – Kool Smiles, Aspen Dental, Sarrell, and others, are in business to make money. They’re also providing a service that’s desperately needed. What are they doing wrong, if anything? What behaviors might cause their ethics to be called into question? Do you believe the way they run their business is any different than how private practice dentists run theirs? Should they be concerned about offering patients high interest credit cards, or is the arrangement they have with the credit card company just good business practice? What are the ethical implications?

Hopefully by now, you’ve gained enough feedback to better understand what I look for in these assignments. If you need a refresher on what to keep in mind I encourage you to revisit pages 194-204 of the textbook. 

When I say USE DATA I’m asking you to use primary data. In a previous assignment (Pro-Con website) you were given citations to the primary sources to help present each side of the issue. Some of you used those sources and some cited the pro-con website. For this assignment any citations you use MUST be from the original source and correctly cited. Additionally, you are most likely going to have to do your own research to find facts to support your position.  DO NOT QUOTE “FRONTLINE or DOLLARS AND DENTISTS” unless this is the primary source for specific pieces of information. Finally, when writing your paper I encourage you to look over the issues presented in the discussion Is Health Care a Right or a Privilege. As many of the same issues exist here in dentistry.

Good Luck!

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