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

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 providers’ 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 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 have profound economic effect on dental practices. CLINICAL SIGNIFIANCE: Policy makers will want to consider our findings 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.