Shipments by the combined medical equipment industries are expected to increase 8 percent in constant dollar value in 1993, following an 8.7 percent increase in 1992.

Medical and dental instruments and supplies comprise five specific industries: surgical and medical instruments (SIC 3841); surgical appliances and supplies (SIC 3842); dental equipment and supplies (SIC 3843); x-ray apparatus and tubes (SIC 3844); and electromedical equipment (SIC 3845).

These industries manufacture a wide range of health care products used to diagnose and treat patients, ranging from tongue depressors to highly sophisticated diagnostic devices that can provide clear images of internal organs. Medical items not covered in this chapter include in vitro and in vivo diagnostics, classified under SIC 2835, and surgical gloves, condoms, and similar latex-based products that fall under fabricated rubber products, not elsewhere classified (SIC 3069). For other topics related to this chapter, see chapters 42 (Health and Medical Services), and 43 (Drugs and Biotechnology).

Before reading this chapter, please see “How to Get the Most Out of This Book” on page 1. It will answer questions you may have concerning data collection procedures, factors affecting trade data, forecasting methodology, the use of constant dollars, the difference between industry and product data, contact points for sources of information, and the Standard Industrial Classification (SIC) system.

Medical and Dental Instruments and Supplies

Manufacturers of medical and dental instruments and supplies are forecast to increase their shipments by 7.3 percent in 1991 (in terms of 1987 dollars), compared with 9.1 percent in 1990. This total includes a gain of 8.6 percent for surgical and medical instruments (SIC 3841), 7.6 percent for surgical appliances and supplies (SIC 3842), 5.9 percent for dental equipment and supplies (SIC 3843), 4.9 percent for x-ray apparatus and tubes (SIC 3844), and 5.5 percent for electromedical equipment (SIC 3845).

The outlook for the medical and dental instruments and supplies industries remains mixed. U.S. health care expenditures, which increased 10.4 percent to a record $540 billion in 1988, have contributed to the strong growth of these industries. However, hospitals, the largest end-users, are facing extreme pressures by the U.S. Government and other third-party payers to curtail these rising health care expenditures. Hospitals account for 52 percent of the $25 billion medical equipment market (Figure 46-1 and Table 1). These cost containment efforts have affected the overall financial status of the hospital industry. Total hospital margins - the difference between total hospital revenue and total hospital costs - have declined from 7.6 percent in 1984, the first year the Government’s Prospective Payment System went into effect, to 3.8 percent in 1988. [Tabular Data Omitted]

Before reading this chapter, please see “How to Get the Most Out of This Book” on page 1. It will clarify questions you may have concerning data collection procedures, factors affecting trade data, forecasting methodology, the use of constant dollars, the difference between industry and product data, sources and references, and the Standard Industrial Classification system (SIC). For other topics related to this chapter, see chapters, 44 (Health and Medical Services), and 45 (Drugs).

Despite this financial hardship, hospitals have been increasing capital expenditures for construction to expand their outpatient facilities to generate new revenues from this strongly growing health care market segment. As these capital expenditures are completed in 1991, hospitals will need to increase their equipment spending to outfit newly expanded facilities.

Cost-containment and equitable access to health services have been longstanding concerns among health policymakers (Carr-Hill 1994; Davis 1991; Smith and Sheldon 2000). As the demand for health care continues to grow and the financial incentives that influence health professionals’ choice of practice location remain differentiated geographically (Johnston and Wilkinson 2001 ; Kobayashi and Takaki 1992), the significance of these issues is likely to extend into the foreseeable future. However, because of the rapid rise of health care cost in many countries since the 1970s, cost containment has dominated the agenda of health policy, often at the expense of commitment to ensuring equal access to health services.

Among the variety of cost containment mechanisms that have been experimented, global budgeting has assumed increased popularity and appeared to be effective in arresting the untamed growth of health care expenditures in many Organization for Economic Cooperation and Development (OECD) and Asian countries (Carr-Hill 1994; Chu 1992; Detsky et al. 1990; Detsky, Stacey, and Bombardier 1983; Henke, Munay, and Ade 1994; Lave, Jacobs, and Markel 1992; Redmon and Yakoboski 1995; Wiley 1992). A study by the U.S. General Accounting Office in 1991 estimated that global budgets in certain countries had lowered inflation-adjusted spending on health care services by 9 to 17 percent. Examining the trend of pharmaceutical expenditures in Germany, Ulrich and Wille (1996) found that compared with the reference price system for expenditure control, the introduction of global budgeting in 1993 had a more effective and lasting cost-containment impact. More recently, Leonard et al. (2003) compared the case-based approach in Austria with the global budgeting approach in Canada in terms of the impact on hospital care and found that Austrian inpatients stayed longer in hospitals than Canadian inpatients.

Silicosis is a debilitating, sometimes fatal, yet preventable occupational lung disease caused by inhaling respirable crystalline silica dust. Although crystalline silica exposure and silicosis have been associated historically with work in mining, quarrying, sandblasting, masonry, founding, and ceramics, certain materials and processes used in dental laboratories also place technicians at risk for silicosis (1-3). During 1994-2000, occupational disease surveillance programs in five states identified nine confirmed cases of silicosis among persons who worked in dental laboratories; four persons resided in Michigan, two in New Jersey, and one each in Massachusetts, New York, and Ohio. This report describes three of the cases and underscores the need for employers of dental laboratory technicians to ensure appropriate control of worker exposure to crystalline silica.

Silicosis cases in Michigan, New Jersey, and Ohio were identified through the Sentinel Event Notification Systems for Occupational Risks (SENSOR) surveillance program (4). The case in New York was identified through the state’s Occupational Lung Disease Registry, and the case in Massachusetts was identified through the state’s Occupational Disease and Injury Surveillance System; both use the SENSOR model. Although cases were identified during 1994-2000, diagnoses preceded state surveillance system identification. State surveillance programs identify suspected cases of silicosis through various sources, including hospital discharge data, death certificate data, workers’ compensation reports, and physician reports. Cases are confirmed on the basis of the silicosis surveillance case definition (Box 1) adopted by these state surveillance programs and information from interviews, medical record review, or chest radiograph classification by a National Institute for Occupational Safety and Health (NIOSH)–certified B-reader *.

We are offering seven new workbook courses, a CD-ROM and a new video introduction to dental assisting from the ADA. Please take a closer look at out new courses listed in this issue, and be sure to request a CE Catalog for 2004 if you don’t already have one. Call 312-541-1550 x211, e-mail srobles@adaa1.com or fax your request to 312-541-1496. We offer convenient, economical ways for you to keep up on what’s new in CE and in your profession.Revised Courses for 2004

* Dental Implants: A Second Chance at Dental Health

* Introduction to Basic Concepts in Dental Radiography

* Dental Radiographic Pitfalls and Errors

* Maintaining Proper Dental Records

* Basic Training I for New Dental Office Staff

Basic Training–A Video

Introduction to Dental Assisting

This video from the American Dental Association is a wonderful introduction to chairside dental assisting. It takes you through a typical day for a chairside assistant beginning with the morning meeting, cleaning and setting up the treatment room, ergonomics and motion economy, and responsibilities during procedures. The video addresses patient interaction, including greeting patients, taking blood pressure and reviewing medical and dental histories, hand-pieces and dental instruments. Types of X-rays and their machines and procedures, anesthetics, rubber dams, study models, and safety procedures and infection control are emphasized.

Ideas old and new are on display as Dental Assistants Recognition Week ends its competition for another year.

As always we are grateful to those who took the time to tell us what they did–and we’re sure there are many more out there who did things but were too busy to let us know. But we appreciate any efforts added to those of the ADAA and the ADA and our Canadian counterparts to help build well-deserved recognition for dental assisting professionals everywhere.

DENTAL ASSISTANTS ASSOCIATIONS

FIRST PLACE

CAPE ATLANTIC DENTAL ASSISTANTS ASSOCIATION GREEN CREEK, NJ

Presented by Kathleen Storz, CDA

This local association had bronzed gold DARW logo pins made up and their leadership including Kathleen Storz, CDA, Sandy Pickens, CDA, RDA, Patricia Hoffman, CDA, RDA, Brenda Amenhauser, RDA, Amie Fairman, CDA, delivered pins to 150 private practices in Cape May and Atlantic Counties … along with information on the local component and ADAA membership applications. The students of Cape May Technical School Dental Assisting Program and Delaware Valley Academy of Medical and Dental Assistants also were presented with pins. All told: approximately four hundred assistants and students received pins and learned about DARW and ADAA.

Midland Empire contributed generously to a food drive in their community during DARW and made sure that information about dental assisting and the ADAA was included. They also hosted a booth at an alumni meeting and distributed buttons, ADAA literature and goodwill. Also, during the observation a luncheon was hosted by local dentist Dr. Patricia Boise honoring DARW and dental assistants and photography from this event was the basis of later publicity in the local press.

Each year, a large number of students begin college with aspirations of entering a health profession. High school teachers and guidance counselors as well as college admission counselors and pre– health advisors can assist students by providing current information regarding general entrance requirements to health professions programs. This paper is designed to provide both counselors and teachers with information that will assist them in helping students plan programs of study in college and seek relevant health-related experiences. We offer suggestions on to how to seek information about health professions and obtain first-hand exposure to the work responsibilities of practitioners. We will describe the admission processes of medicine, dentistry, pharmacy, physical therapy, and physician assistant programs. To that end, we will review degrees available, required college course work, and application procedures and time frames. We will also discuss the importance of standardized tests, interviews, and letters of evaluation in the application process and in the admission decisions.

If considering a health career, students should begin investigating health professions programs as early as possible in their high school or collegiate education. To gather preliminary information about health careers and health professions education, students can write to health professions schools for publications or browse health professions web sites. To develop an understanding of the work responsibilities and lifestyle issues of various health care providers, students should speak with health professionals practicing in their field of interest. To test their motivation for a health career and their predisposition to work in a patient care environment, students may choose to participate in clinical observation experiences as volunteers or enroll in either clinical summer enrichment programs or service-based curricular experiences in health care settings.

With baby boomers fast approaching the age where chronic diseases like arthritis, diabetes and respiratory ailments set in, and with the number of seniors expected to grow to 70 million by 2030, according to the U.S. Administration on Aging, the medical supplies and equipment industry will continue to grow.

Though the Centers for Medicare & Medicaid Services (www.cms.hhs.gov) recently took action against abuses of the Medicare program by temporarily halting issuance of new supplier numbers, which vendors need to sell their products, they are expected to begin issuing numbers again early next year. New applications will be heavily scrutinized, making entree into this industry more difficult but not impossible. Most experts say the extra effort will pay off for entrepreneurs, as the size of this market continues to boom. “Families of senior citizens will rely on quality home health care more and more,” says Kay Cox, president and CEO of the American Association for Homecare, which represents the home medical equipment and supplies industry. “The entire home-care industry is growing consistently–no one particular segment has been left behind. And the number of patients is rising steadily.”

Samer Ariss, 29, and Farshad Firouznam, 30, started their home medical supplies business in 1998 after hearing about the opportunity from doctors they knew. Forgoing dental and medical school, the pair invested $16,000 of their own money and hours of building relationships with area doctors to grow Orange, California-based Global Care into a $6 million business. Ariss credits the success to the partners’ focus on a specific niche: respiratory and sleep apnea products. They’ve also expanded to include a mail order pharmacy. Says Ariss, “At the end of the day, you’re really helping older people live normal lives.”

Last September 1, the American Guild of Musical Artists enacted revisions to the coverage guaranteed by its Health Fund Plan A, which serves 750 union members. The co-pay for network physicians’ visits increased on Jan. 1 from $15 to $20, and the dental plan was eliminated. Beneficiaries of the plan previously had a co-pay of $10 to $30 for their prescriptions, but they now will pay 20 percent of the cost when buying them in pharmacies, or 15 percent for prescriptions filled by mail order. On Jan. 1, a $50 annual deductible for the prescription plan was added for individuals and $100 for families.

Because of the steep escalation of medical care costs, the AGMA trustees recognized the need to redesign the plan, which had not raised the cost of its coverage for 10 years. “The trustees were faced with several choices. They picked the choice that was least destructive,” said AGMA executive director Alan Gordon. One alternative considered was to impose an annual cap on prescription costs, so that after the plan had paid a fixed amount on an individual’s prescription costs, it wouldn’t pay anything more. Another rejected solution was to require stricter qualifications for the people actually covered. Gordon pointed out that the Actors’ Equity health plan has recently reduced the number of members receiving coverage by more than 25 percent. “We want to cover everybody who was previously covered without reducing benefits any more than we have to, while keeping the cost affordable,” said Gordon. (AGMA services concert dancers. Actors Equity serves dancers in musicals and industrials.)

For some members, the new plan presents a radical change. Lawrence Pech, ballet master for the San Francisco Opera and an AGMA member for 25 years, expressed his dismay at the revisions. Pech’s HIV medications cost over $3000 monthly, so the new plan requires him to pay over $500 monthly for drugs, as opposed to the original total co-pay of $40. “It’s made a huge impact for me. That’s more than a tenfold increase,” said Pech.

The versatility of our United States Army Dental Assistants was once again displayed during Operation Arctic Care 2005 held in the frozen tundra of the Alaskan peninsula from March 19th to April 1st. This major exercise is designed as a unique medical/dental training opportunity for members of the military while at the same time providing hard to get care to native Indians throughout the peninsula. Operation Arctic Care is an annual multiservice readiness exercise that offers training in moving Army, Navy, Air Force, Reserve, Guard, U.S. Public Health Service and native health personnel and their equipment/materials to remote locations in providing health care under realistic conditions. The locations served this year were the Kodiak Area Native Association and the Tanana Chiefs Conference villages of Ouzinkie, Port Lions, Larsen Bay, Karluk, Akhiok, Old Harbor Hughes, Huslia, Ruby Kaltag, and Nulato. These often remote and isolated villages provide a huge challenge logistically as many of the areas can only be approached by air or sea. Austere conditions such as high winds, heavy snow, rain and fog also added to the challenges of moving personnel and equipment to the villages for the rendering of medical/dental care. Through it all, seven soldier dental assistants from the Western Regional Dental Command based out of Fort Wainwright (Fairbanks, Alaska) and Fort Richardson (Anchorage, Alaska) weathered the storms and barriers in ultimately working side by side with dental officers from different services in performing dental care to a combined total of 1,477 native Indians. “I think it is worthwhile for other military people to do the exercise and get something good out of it: Helping others,” said Army Sergeant Victoria Haines. “You don’t have to go to another country to help other people. We can be in our own backyard and help others.” The Army dental assistant’s participation in this real world scenario and the experiences they each gained are irreplaceable.