Dennis Heffley

Economic Impact of Regulating the Use of Amalgam Restorations

Objective. This article estimates the financial impact of a ban on amalgam restorations for selected population groups: the entire population, children, and children and women of childbearing age. Methods. Using claim and enrollment data from Delta Dental of Michigan, Ohio, and Indiana and the American Dental Association Survey of Dental Services Rendered, we estimated the per capita use and annual rate of change in amalgam restorations for each age, gender, and socioeconomic subgroup. We used population projections to obtain national estimates of amalgam use, and the dental component of the Consumer Price Index to estimate the annual rate of change in fees. We then calculated the number of dental amalgams affected by the regulation, and the fees for each of the years 2005 to 2020. Results. If amalgam restorations are banned for the entire population, the average price of restorations before 2005 and after the ban would increase

Utilization of Amniocentesis by Women Screening Positive for Down Syndrome on the Second-Trimester Triple Test

52 from

Dental care utilization over time

278 to

Spatial-equilibrium analysis of transferable development rights

330, and total expenditures for restorations would increase from

Zoning and Fiscal Interdependencies

46.2 billion to

Efficient spatial allocation in the quadratic assignment problem

49.7 billion. As the price of restorations increases, there would be 15,444,021 fewer restorations inserted per year. The estimated first-year impact of banning dental amalgams in the entire population is an increase in expenditures of

Landlords, tenants and the public sector in a spatial equilibrium model of rent control

8.2 billion. Conclusions. An amalgam ban would have a substantial short- and long-term impact on increasing expenditures for dental care, decreasing utilization, and increasing untreated disease. Based on the available evidence, we believe that state legislatures should seriously consider these effects when contemplating possible restrictions on the use of amalgam restorations.

Decomposition of the Koopmans-Beckmann Problem☆

Objective: Second-trimester maternal serum screening for Down syndrome has become widely accepted in the United States. However, many women with screen-positive results forgo definitive diagnostic testing that involves chromosomal analysis of amniotic fluid cells. We have reviewed 2,879 cases of women with screen-positive results in an effort to identify determining factors for the utilization of amniocentesis. Methods and Results: The lowest rate of utilization of amniocentesis was seen among very young women, with peak utilization among women of age 33. Although all women in the study had screen-positive results, amniocentesis was most likely to be performed when the patient-specific risk for an affected pregnancy was high. Black or Hispanic women were less likely to receive amniocentesis than white or Asian women. Amniocentesis utilization was also negatively associated with gestational age, maternal weight and an ultrasound examination prior to screening. A sharp decline in the utilization of amniocentesis was noted between 1993 and 1998. A logistic regression model was estimated to assess the independent effect of the variables. The model predicted 67% of the observed amniocenteses and had 66.6% concordance in the evaluation of paired cases with different response values. Conclusions: Our observations indicate that there are multiple medical, social and demographic factors that influence the utilization of amniocentesis by women with screen-positive results. Early screening and a prompt response to screen-positive results, together with accessible and appropriate genetic counseling, should assist women in making an informed choice.

A Spatial Equilibrium Analysis of Flexible Zoning and the Demand for Development Rights

Between 1950 and 1978, per capita real dental expenditures in the U.S. grew at an average annual rate of 3.33%. Between 1978 and 1989 there was virtually no net growth in this measure of dental care utilization. This sharp curtailment of utilization growth has promoted debate about the sources of this change. Possible explanations include, among others, a reduction in dental disease due to increased exposure to fluoridation, the substitution of noncaloric sweeteners for refined sugar, preventive dentistry, , improved oral health habits, an increase in the net price of dental services, and the cost-containment efforts of insurers and employers. Changes have occurred in all of these variables, but little has done to isolate and quantify the individual effects. This decomposition is difficult, in part, because of the lack of an established model for time-series analysis of dental care utilization. A model of dental care demand, incorporating economic factors (out-of-pocket or net dental prices, per capita income, and nondental prices) as well as dietary factors (refined sugar consumption, noncaloric sweeteners, and exposure to fluoridated water), is combined with a simple model of dental care supply within an equilibrium framework. A two-stage estimation procedure is applied, using U.S. aggregate time-series data for the period 1950-89. Results show that economic and dietary factors are significantly related to changes in utilization. Net price and income elasticities of demand exhibit the expected signs and are compatible with estimates from cross-sectional studies. Decreases in cane and beet sugar consumption, facilitated by the increase in the use of noncaloric sweeteners, are associated with reductions in utilization. Fluoridation appears to be weakly but positively related to utilization. There also appears to have been a significant structural shift in demand since 1978. Overall goodness-of-fit is strong and the model accurately tracks the 1978-89 flattening of per capita real dental expenditures. Analysis of the relative contribution of each independent variable suggests that economic, dietary, and structural shift factors have contributed to this curtailment of growth.

Tariff effects in a spatial oligopoly with land markets and mobile consumers

Abstract Transfer of development rights (TDR) programs combine low-density incentives with zoning flexibility to generate a market for development rights and to redirect land-use patterns. A differentiated spatial-equilibrium model is used to study the impacts of brokered and unbrokered TDR programs on rents, consumption/location patterns, household utility, and property-tax revenues. Properties of the TDR market, the relationship of TDR systems to uncontrolled and zoned economies, and questions regarding the optimal control of a TDR program are also examined.