Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis

Schwendicke, Falk; Krois, Joachim; Gomez, Jesus

Abstract Objectives To combat SARS-CoV2 (Covid-19), policy makers worldwide have adopted different policy alternatives, often including mitigation/suppression policies. We assessed the economic impact of such policies on dental practices in Germany using a modelling approach. Methods A provider’s perspective within German healthcare was taken, with two provider scenarios (low/high volume practice, low/high proportion of non-statutory insurance revenue, low/high staff pool and costs; S1 and S2 scenarios) being modelled. Providers’ costs were estimated in different blocks (staff, material, laboratory, others). A telephone-based survey was conducted on 24th March to 2nd April 2020 on a random sample of 300 German dentists (response: n = 146) to determine the experienced dental services utilization changes in these service blocks. A Markov chain model was constructed, following 100 practices in each scenario for a total of 365 days. Different Covid-19 mitigation/suppression periods (90 days: base-case, 45, 135 days: sensitivity analyses) were modelled. Monte-Carlo micro-simulation was performed and uncertainty introduced via probabilistic and univariate sensitivity analyses. Results Mitigation/suppression reduced utilization of all services, the most severe for prevention (-80% in mean), periodontics (-76%) and prosthetics (-70%). Within the base-case, mean revenue reductions were 18.7%/15.7% from the public insurance, 18.7/18.6% from private insurers and 19%/19% for out-of-pocket expenses in S1/S2, respectively. If the mitigation/suppression was upheld for 135 days, overall revenue decreased by 31%/30% in S1/S2, respectively. In this case, 29%/12% S1/S2 would have a negative net profit over the course of one year. Conclusions Covid-19 and associated policies will have profound economic effect on dental practices. Clinical signifiance Policy makers will want to consider this when designing governmental subsidy and safety nets with immediate and midterm economic relieve effects. Dentists may consider practice re-organization to reduce costs and maintain minimum profitability.