1. Patients Mired in Costly Credit From Doctors JESSICA SILVER-GREENBERG NY Times October 14, 2013 http://www.nytimes.com/2013/10/14/business/economy/patients-mired-in-costly-credit-from-doctors.html?hp&_r=0

2. Dental Costs The dentist set to work, tapping and probing, then put down his tools and delivered the news. His patient, Patricia Gannon, needed a partial denture. The cost: more than $5,700. Ms. Gannon, 78, was staggered. She said she could not afford it. And her insurance would pay only a small portion. But she was barely out of the chair, her mouth still sore, when her dentists office held out a solution: a special line of credit to help cover her bill. Before she knew it, Ms. Gannon recalled, the office manager was taking down her financial details.

3. 23% ??? But what seemed like the perfect answer seemed, in fact, like just what the doctor ordered has turned into a quagmire. Her new loan ensured that the dentist, Dr. Dan A. Knellinger, would be paid in full upfront. But for Ms. Gannon, the price was steep: an annual interest rate of about 23%, with a 33% penalty rate kicking in if she missed a payment. She said that Dr. Knellingers office subsequently suggested another form of financing, a medical credit card, to pay for more work. Now, her minimum monthly dental bill, roughly $214 all told, is eating up a third of her Social Security check. If she is late, she faces a penalty of about $50.

4. No Formal Policy The AMA and the ADA have no formal policy, but some practitioners refuse to use them, saying they threaten to exploit the traditional relationship between provider and patient. Doctors, dentists and others have a financial incentive to recommend the financing because it encourages patients to opt for procedures and products that they might otherwise forgo because they are not covered by insurance. It also ensures that providers are paid upfront a fact that financial services companies promote in marketing material to providers.

5. One of the financing companies One of the financing companies, iCare Financial of Atlanta, which offers financing plans through providers offices, asks providers on its Web site: How much money are you losing everyday by not offering iCare to your patients? Over the last three years, the companys enrollment has grown 320%. Another company posted a video online that shows patients suddenly vanishing outside a medical office because they cannot afford treatment. The company offers a financing plan as a remedy.posted a video

6. The Economics This is an instant loan. It is like a credit card. No checking of collateral. Definitely a high risk loan. Alternatives? –Borrow money elsewhere. –Delay treatment. –Dont get treatment.

7. Other Countries UK The cost of dentures on the NHS Having dentures fitted is a band 3 treatment. This means that (from April 2013) dentures and other necessary dental treatment will cost £214 on the NHS. Find out who is entitled to free dental care.who is entitled to free dental care http://www.nhs.uk/Conditions/dentures/Pages/introduction.aspx

8. Other Countries Canada Canada provides a very low level of public subsidies to access dental care. Currently, 95% of all dental services are funded privately, a level that is similar to the United States, Spain and Portugal, the only other wealthy countries with such high levels of private finance for dental services http://www.euro.who.int/__data/assets/pdf_ file/0011/181955/e96759.pdf

9. Other Countries Japan Medical treatment for between 10 and 30% of the original cost Preschool infants ·(20%) School-age children through adults up to 69 years ·(30%) Adults aged from 70 to 74 (The copayment percentage that is written on the Certificate for Elderly Recipient of Health Insurance.)