It is interesting that Dr. James Bader and his colleagues conclude "A Pilot Study of Risk-Based Prevention in Private Practice" (September JADA) by advancing the idea that risk-based data provided by clinicians would provide the information that insurers would need to administer benefit plans tailored to patients’ risk levels.
While such information could be utilized in such a fashion, such information also could be used by insurers to limit or deny insurance coverage based on a patient’s reported risk factors.
Dental insurance companies, including the one that supported this study, are for-profit businesses. How long would it take for them to realize that, with such a pool of valuable data, they could attach a monetary cost to each risk level and thus increase their profit margins by raising "moderate-risk" patient premiums, or denying insurance to "high-risk" dental patients?
Such is the case when insurance companies underwrite medical or life insurance benefits. People are denied insurance, or simply cannot afford insurance, because of the risk they pose to the profits of the insurance company.
I am not averse to risk assessment, nor am I averse to the reality that a business entity such as an insurance company is entitled to make a profit. However, I do believe it is prudent to recognize that there are other potential uses for risk assessment data, and other potential outcomes in utilizing risk assessment data, than those championed by the authors in their study. There is no guarantee that insurance companies would not use such data to restrict or deny insurance based on risk factor information to which they currently do not have access.
I believe that risk assessment is a valuable tool and an effective management strategy, but it ultimately is most beneficial to the patient if it is used only within the dentist’s own office to tailor treatment plans.
By tailoring treatment plans in the dental office, rather than tailoring benefit plans in the boardroom, we eliminate the idea that risk management data would ever be utilized by an insurance company for financial gain. It is possible that such risk assessment data provided to insurance companies could have the effect of excluding the very type of patient who is in need of treatment in the first place.
