Dental News - CED publishes resolution regarding third-party payers in dentistry

Dental Tribune International

Tue. 26. June 2018

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BRUSSELS, Belgium: The growth of third-party payers in the provision of dental care, as well as its implications for oral health policy, has become a concern for the Council of European Dentists (CED). Consequently, the CED has recently released a resolution that sets out some important principles and policies that prioritise the welfare of patients and respect the ethical and professional responsibilities and rights of the dental profession.

The CED describes a third-party payer as any organisation, public or private, that pays or contributes towards or intermediates regarding health care expenses on behalf of beneficiaries, such as employers, insurance companies and public health funding mechanisms. These third-party payments are distinguished by the separation between the individual receiving the service (the first party), the dentist providing the service (the second party) and the organisation paying or intermediating for it (the third party). A third party is thus an outside body that can influence the relationship between the dentist and the patient.

The CED’s concern is that third-party payers may be having more of a significant influence on the relationship between the dentist and the patient than is appropriate. This can materialise in the form of things such as inappropriate pressures from third-party payers that are driven by financial or budgetary interests, possibly resulting in the loss of the health perspective and overall care of the patient.

According to the CED, the financial involvement of third-party payers should support appropriate oral health care for the patient and must rely on evidence-based treatment decisions taken by the dentist with the consent of the patient, rather than by any type of benefit protocol. Additionally, the CED states that, to reduce or eliminate patients’ out-of-pocket expenses, third-party payers should compensate fairly and promptly for treatment provided by dentists.

Other areas of concern raised in the CED resolution are transparency and engagement with dentists. Here, the CED has called for all third-party payers to take responsibility for ensuring patients are provided with full disclosure regarding the scope of their coverage and that complaint resolution mechanisms are fair and transparent. Additionally, the CED noted that all dentists must be treated equally and that they cannot be prevented from fulfilling their ethical obligations by third-party payers.

Despite the tone of the resolution, the CED did also note that third-party payers do have a role to play in health care funding. It said that they may be involved where they can provide a solid foundation for a safe and quality-oriented health care system; however, it highlighted that this must happen without interfering with the dentist’s professional treatment decisions or the patient–dentist relationship.

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