Research Proposal 2



With this research, my project hopes to meet at least one of the three critical objectives in the Institute for Healthcare Improvement’s Triple Aim framework.  It is the project’s hope to at least meet the 3rd  objective of reducing the per capita cost of dental care who seek out such treatment.  This will be addressed by data collection of the different pricing in the respective markets.  Achieving Triple Aim’s other two objectives might also be achieved as a consequence of the meeting the 3rd objective.  If members of the population are able to receive dental care that they might not otherwise have had due to the cost savings, this would improve the health of such members, ie. the 1st objective of Triple Aim.  Triple Aim’s 2nd objective might be more difficult in its achievement as comparing the patient care experience between my studied populations might show less variation.

How is this project hoping to achieve the above; some background first.  With U.S. healthcare costs reaching $3.2 trillion dollars (in 2015), one component of this figure includes the sector of dental health care.  Researching the price discrepancies of such dental care in the U.S. versus Sonora, Mexico market might be of some interest for the local Tucson population.  This research would focus on the service prices in the three distinct regions of Tucson, Nogales and Hermosillo.  Dental care prices are figured to be lower in Nogales, MX than in Tucson, US; and maybe even lower in Hermosillo, MX, 4 hours south of Nogales.  The further distance and perceived unknown of interior Mexico may provide a barrier for many in Tucson to attempt dental care services. 

The has already begun to collect primary data of pricing for various dental services in each of the above three-mentioned markets.  That summary descriptive data will be analyzed for broad  differences/similarities.  Inferential statistics will then be performed to test for differences, including two-way ANOVA tests.  A survey will also be created.  The response data will help in performing an analysis of local U.S. views on having dental work done in U.S vs. Sonora, MX.  Also, exploring what price points might be attractive enough to have a patient make a trip to either Nogales or Hermosillo.  I would also attempt to frame the survey questions with certain wording similar to how the health care advertising industry frames its arguments in order to manipulate consumer purchasing of health care.  Would different wording of the survey questions make local resident less likely to have dental work in Mexico compared to controlled survey wording?  Would it change their price point (make it lower) before considering such a trip?  Both uninsured and insured dental care patients would be considered for this survey and would be appropriately screened.  Overall, does the further distance and being in Mexico provide a barrier to attempt such dental care services? 

 Dental services achieved the highest acceleration (almost double) of spending from 2014, versus any other health care sector, with an increase of 4.2% from the previous year’s 2.4% growth.1 This translates to $117.5 billion, or 4% of the health care market.1 With an astronomical 40% of these services paid for out-of-pocket1, exorbitant pricing has an immediate direct impact on the patient.  Where many people might have a perception of dental care as a teeth cleaning or something aesthetic, untreated dental care can result in a great deal of pain and even death.  Untreated dental care can also lead to health problems not just contained in the human mouth.  Research has linked treating periodontal disease with lower medical costs for diabetes and heart disease, among other conditions.2   One of the populations most greatly affected by poor dental is that of senior population, with more than a third of such incomes below 200 percent of the federal poverty level (about $23,000 annually) and suffering from untreated tooth decay.3

Traditional Medicare generally does not cover dental care services unless it is related to services received in a hospital. Medicare managed care plans provide some general dental care, but the coverage can vary, and often is minimal with the plans often being a loss leader.3   It gets “people in the door”, but the coverage is extremely limited.3    Trying to purchase private dental insurance may not even provide a good value for the consumer.  "When you add up the premiums and copays, for the vast majority of adults it's not worthwhile to have dental insurance".3

Other fundamental concerns for funding of dental services come from many states’ dental health system not being able to provide proper appropriations for their state’s fund leading to a deficiency of services for their state’s poorest.2    Overall, this has led many U.S. citizens to consider other alternatives for their dental care.  An estimated 1.3 million Americans left the US for medical care in 2016; about 50 percent went to Mexico for dental procedures.  The total value of the global medical tourism market is expected to climb to over $32 billion by 2019.5   

Literature has indicated that healthcare information can be framed in such a way as to influence how individuals process advertising information6 and how they respond with their purchase decisions.7 One specific study divided health-care customers into two groups, prevention-focused individuals and promotion-focused individuals.8 The study found that how an advertiser frames its advertisement about health-care significantly affects how a group decides to purchase a health-care service.  In turns out that applying a negatively framed healthcare advertising strategy to prevention-focused individuals will enhance the advertising effectiveness.8  Specifically, for the target market consisting of prevention-focused individuals, advertisers should highlight that those who refuse to follow the advocacy in the negatively-framed healthcare advertising messages may not maintain their health and may suffer from health losses.8 To persuade promotion-focused individuals, on the contrary, advertisers are advised to frame their healthcare advertising messages positively, which emphasize that the positively framed advocacy benefits to make them healthier.8  

It would be interesting to conduct a similar statistical study and show how manipulation of the wording of questions in a survey will impact how a person views dental care in the foreign country of Mexico and how much it could potentially limit them to seek such care even at a significantly lower price.  Difficulties might present themselves in obtaining very similar representative samples across all of the different survey groups, both control and uncontrolled.  Predetermination of a person’s attribute of prevention-focused vs promotion-focused may be impossible to determine before grouping them according to certain group variables.  It may also be difficult to obtain pricing for certain dental services in Tucson.







6 Kiviniemi, M. T., & Rothman, A. J. (2006). Selective Memory Biases in Individuals’ Memory for Health-Related Information and Behavior Recommendations. Psychology and Health, 21(2), 247-272.

7 Kolodinsky, J. M., & Narsana, R. T. (2003). Factors Influencing the Search for Information about Genetically Modified Food Products. International Journal of Consumer Studies, 27(3), 218-251.

8 www.scholink.org/ojs/index.php/jbtp    Journal of Business Theory and Practice     Vol. 1, No. 1; March 2013, 104.  Published by SCHOLINK CO., LTD

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