 Hello, everyone. Welcome back to a new session on dentistry and more. Today's topic is finance in dentistry or payment in dental care. So, this is the most toughest chapter in public health dentistry I feel. So, even when I was a student, I find it very difficult to understand the concept. And as a teacher, it's quite difficult to express the concept or make the students to understand the concept of finance in dentistry. The main problem lies with the chapter is the whole concept is, all the concept of finance in dentistry is not from our country. This very few concept that is just a payment for service for a private people services based on our country and rest all the plans are about United States. So, American system of finance is what we are trying to understand because we have never seen these programs in our life. Most of us have not seen or heard of it. So, only thing we have witnessed or we have come across in life will understand in a better way. So, this is just a imaginary scenario we have to mark up all the concept. So, on this video, I will try to explain you with a chalk and board type presentation. So, hope you can understand it in a better way, the various concept. So, let's get started. So, what are the mechanisms of payment in dentistry? So, the first one is private fee for service, then we have post payment plans, private third party prepayment plans. This is also a third party plan. Okay, then we have salary and public programs. So, with respect to India or as far as Indian scenario concerned, we have only private fee for service. That is just like we are going to a dentist to treatment done and we are paying for the service. That is one option. We have next one is a salary. So, dentist is appointed by an employer and he is paying salary every month. That is the second option. So, these two options is what our country has. These two are very simple administratively and there is not much complications involved. So, the complicated ones are third party private plans and post payment plans. Few public programs are also existing in various countries. So, let's see what is private fee for service. That is what our country has. The first one is private fee for service. That is a two party arrangement only dentist and the patient is existing in the system. It is a very traditional form of payment. So, we go to dentist treatment on paying their dentist. So, it is culturally very much acceptable. It is very flexible and administratively simple one. There is not much complication or paperwork. But the disadvantage is even though we have flexibility and discrimination, there are still some patients who cannot afford this dental care because we know dentistry is a very expensive part of treatment. So, a few patients might not be able to afford this. So, that was the biggest problem of private fee for service. So, that is what our country is having around 90 to 95 percentage. So, the next one is post payment plans. So, before post payment plan, we need to understand the concept. So, you might be airing the third party everywhere in this chapter that is third party involvement. So, in private fee for service, we have just two parties that is patient and dentist, first party, second party. So, you can interchange it. There is no problem. So, third party is what the American system is completely based on third party arrangement. There is no direct payment of fee to the dentist. It is all done by third party and how the third party is doing is the rest of the chapter is talking about. So, this is post payment plan or the budget plan. So, post payment we know the post payment system in our mobile building. So, we have prepayment that is we pay first and get the treatment then or get the data usage or get the mobile monthly plan we take up. Sometimes we use the data or we use the service and at the end of the month we pay for it that is post payment plan. So, that concept is applied here. Treatment first then payment but payment via a third party and then post payment plan which is by bank or a funding agency. So, it started in 1930s by some local dental society in Pennsylvania and Michigan. So, under this plan what happens is the patient borrows money from the bank for some financial company for paying dentist. So, once the process the paperwork is done the bank pays entire fee to the dentist. So, we are just taking loan process. We go to a bank we take education loan and the bank pays to the college or bank gives demand draft and goes to the college. So, after the application approved bank pays the entire fee to the dentist the patient then repays the loan to the bank in a chitted amount. So, the treatment will be done once the loan is approved we can go to a dentist with the papers and get the treatment done then on a frequency manner we can repay to the bank. But the problem with this post payment plan was at the time they had been developed it was to hope that this would benefit large segment of population. But what happened actually was it was used primarily by the middle income group and the lower group it was meant to used by the lower income group but actually it was used by middle income group. So, its purpose was not served and it was no using any system of finance and dental care. So, that was a failure post payment plan or budget plan was a failure. So, keep this in mind at the first party and the second party and third party because this keeps on changing since this is a post payment plan bank or funding agency comes. So, in our prepayment plan we will face so many third parties. So, that's about private fee for service and post payment plan. So, next we have private prepayment plans okay. So, prepayment plan is nothing like just the opposite of post payment we first pay the third party and sign the paper or we have the papers paper works done just like a car insurance to get the next year policy we pay at the beginning of the year and get the policy or the get the car insured for the next one year. So, it's like an African interval maybe six months or maybe one year we keep paying at the beginning of the period then that entire period will be covered or treatment will be covered. So, we don't know what problems we may have in future. So, we keep on paying the premium every year to get the treatment done. So, sometimes it might go to loss because we know how car insurance is working every year we paying the premium but sometimes there won't be any claim for that year. So, that year policy actually is not giving us any protection or that money is going waste but this is how it is working because insurance policies are like that we have to pay beginning of the year or beginning of our financial year and we get our car or our vehicle covered for next one year. So, similar way we cover our teeth one year or a certain period of time by paying the premium at the beginning of the period. So, what is the definition of private pre-payment plans that is payment for service by some agency rather than directly with patient it is same as post payment plan there is a third party involvement only difference is we are paying at the beginning not the after the treatment before the treatment goes into action or before the treatment we are receiving we should pay the premium the dentist and the patient are the first and second party and the administrator is the third party. So, it is a it is a dental payment contract that may collect premium assumes financial risk can play games play games and provides administrative services. So, the third party is also known as carrier insurer underwriter or administrative agent. So, third party is called under all these names. So, that is a pre-payment system and post payment system. So, we will see what is exactly each plan is about in detail in future slides. So, now let us see another sub topic that is insurable risk. So, insurable risk is frequently asked question. So, when a risk can be ensured on what condition risk can be ensured. So, that is the question. So, to be insurable a risk must be precisely definable. So, we need to define what is going to be the risk and it should have a sufficient magnitude if it occurs it constitute a major loss. So, we are ensuring a vehicle and vehicles damage should be sufficient that there should be a major loss then only they will give insurance and should be very infrequent it is the most important thing in insurance. If something happens for like 9 out of 10 times the insurance companies won't give you insurance because if they are giving insurance for 9 out of 10 times the company will be a loss. So, the company will be a failure on profit basis they can't make any profit and they will stock the company by 1 year. So, what their mind is like if you are giving 10 policies only 1 or 2 will come for a claiming. So, they have 8 members policies as a deposit. So, they need to pay for only 1 or 2. So, always insurance will be given for a very infrequent thing. So, every vehicle should be insured every vehicle should be insured and only 1 or 2 cause out of 10 or we can say 10 or 20 cause out of 100 is having an accident and going for a claiming. So, that is a concept it should be always infrequent and it should be of unwanted nature. So, risk is never will be given for a wanted nature like health. So, health is a wanted nature everybody is very much concerned about health. So, only thing which are not very much important to our life the insurance will be given or otherwise there will be so much conditions we have to apply. So, it should be of unwanted nature and it should be beyond the control of individual because health is something which we can control to an extent. So, conditions which are under our control the insurance will not be given if they are giving there will be a lot of conditions to be applied. So, these are insurable risk that is a risk can be insured under these criteria. So, like I said the health is a wanted nature and it can be controlled by individuals. So, generally the insurance companies are not much favoring the health insurance but there are companies giving health insurance but the thing is they have so much conditions to be applied. So, let us see how insurance companies overcome these problems while coming to the health insurance. Okay, this is a general thing it coming to the health insurance what they are doing is having patient pay a share of cost. So, it is like they will not give you exactly everything but a percentage of total cost the remaining post has to be paid by the patient. So, why they are keeping this concept means the patient will not utilize this. So, that is the first one having patient pay a share of cost and limited the service like they will not give insurance or coverage for every treatment they will give only a limited service they will not give for all the treatment because we know that health problems or dental problems are very prevalent. So, all the people are going and claiming for insurance means the company will be a big failure on profit basis. So, they limit the services they won't give for everything only few conditions few problems they will not give for pre-existing if you have a pre-existing condition. So, many things are there so that is limiting the range of services and cosmetic frustrations are not covered because everyone can go for a cosmetic frustration it is simply a subjective mind. So, if insurance is covered for something people will misutilize this and the next one is offering coverage only to groups. So, to avoid adverse selection adverse selection means if insurance is covered for all the groups people who is not actually needing a treatment or needing a coverage will utilize this just to avail that insurance. So, to remove that group of people who will misutilize this insurance the companies what they do is they restrict the coverage only to few groups to avoid adverse selection. So, that is one us adverse selection and always they keep waiting period it is like we are taking a health insurance today they will not be activated tomorrow they keep some three months or six months waiting period to ensure that we are healthy people and most of the insurance companies will not give insurance for a people with already existing some existing diseases if we have some pre-existing diseases they won't give insurance because they would know that if we have disease we would definitely claim so always they give to healthy people. So, to make sure that we are not misutilizing the insurance and also to make sure that we are healthy they keep a waiting period for three months or six months. So, during that period if we are claiming we won't get insurance so healthy people they keep three months or six months waiting period to make sure that you don't have any disease and the next one is using pre-authorization and annual expenditure limit. So, always we need to get the insurance only from few points not from few hospitals or few firms we cannot just go to any places or any hospitals it is already authorized people will be there or authorized hospitals or authorized clinics will be there so we can avail treatment or covering done only on those authorized people or authorized hospitals and there will be always a upper limit for our treatment expenditure so we need many illustrations many implant therapy might cause some five times ten times of our expenditure limit it is not possible they always keep to avoid over utilization of our insurance they keep expenditure limit so that's about insurance risk what is the insurance risk when a risk insured what conditions and what insurance companies are doing for giving health insurance so these are the conditions for a general insurance since health is unwanted nature and it is under control of individual and it is very frequent and all these principles are violated in coming to condition because it cannot be properly defined we can't say that it is a major loss sometimes it is a major loss but most of the conditions are not a major loss and it is very frequent it is wanted nature and it is under the control of individual so these modifications they have made just to apply into health insurance okay so that is a just a different part when insurance we insured and what is health insurance scenario so now let's get back to our three-party arrangement so we have seen post payment plan next we have uh prepayment plan so post payment plan we are not seeing anymore because we are into prepayment third party plan okay so we have payment mechanism in prepayment third party mechanism that is deductible co-insurance and group insurance so this is the payment mechanism so first understand the first party second party and third party arrangement first party is the patient second party is the dentist third party is the insurance carrier or administrator so the payment mechanism is how the patient pays to the third party or insurance company and the reimbursement mechanism is how the third party is reimbursing to the second party that is dentist so the payment mechanism this is a prepayment mechanism system so the first First method is deductible, second is co-insurance, third is group insurance. In deductible we have a fixed amount that is front end payment for particular coverage. So if it is 10,000 premium and we have a 1 lakh average. So if the cost is around 60,000 or 70,000, 80,000 let it be any amount up to 1 lakh we have to pay only 10,000. The co-insurance is like co-payment or sharing scenario. So we have to share 30% of the total cost. If it is 1 lakh we have to share 30,000 and we will be getting only 70,000. If it is 50,000 we have to wear the 30,000, sorry 30% that will be 15,000 and the insurance will be for 35,000 it will be 30 to 70. So it is just an example it can be in any sequence. Only thing is co-insurance the patient has to bear a fixed amount of percentage of total cost. Group insurance as I discussed it is for the groups for like students in a particular class or any institute or any rehabilitation center or such things. So this is a payment mechanism next is a reimbursement mechanism. The second mechanism is how the third party is giving to dentists or reimbursing the dentist. The first concept is UCR concept that will be dealt in detail, usual, customary and reasonable. Second one is table of allowances third one is fee schedules. Table of allowances is nothing like sometimes there is a problem dentist fee greater than the allowances they receive. So patient has to pay extra amount to match up with the dentist fee. So that is a problem. Fee schedules like the schedules will be there for each service but the mean payment will be taken as a reimbursement. Since it is inflexible and there is no autonomy it is not very accepted by the dentist. So this is table of allowances fee schedule and UCR. The only thing we need to understand is this is a payment mechanism. This is a reimbursement mechanism. This is a payment mechanism. This is reimbursement mechanism. So if you have this idea of first party, second party, third party, this will be pretty much easier to understand. See what is deductible it is known as rent and payment. So it is a fixed amount that patient pays towards the cost of treatment for the benefit of program going to effect like for automobile insurance deductible 10,000 means if the damage occurred the owner pays only 10,000 where the total cost may reach up to one like this is just an example. So you have a one lakh covered for that vehicle. So you are paying 10,000 rupees. So if you are damaged and you require one lakh you will get one lakh just for paying 10,000 premium that is deductible or friend and payment whereas coinsurance is called as co-payment. It means that patient pays a percentage of total cost of treatment. So during it is done in defined as a coinsurance is arrangement under which the buyer and the beneficiary are liable to share the cost. And group insurance is covered to groups because illness experience is reasonably predict in a group just like a school, children or inmates of an institution. So the group entirely will be covered and there will be proper criteria is how many of them will get treatment on what regular basis. So that type of insurance as group insurance we are paying for a group. So the next segment is reimbursement mechanism. This is third party is giving to dentist or for the services provided the third party system or third party giving the money back to dentist but the payment mechanism is what the patient is paying to third party this is like a triangle. Patient pays the third party by payment mechanism and the third party is reimbursing for the services rendered to the dentist. So payment mechanism is deductible coinsurance and group insurance that is only a few that is what they mentioned in the chapter there are many other mechanisms. Under the reimbursement mechanisms common owner you see our concept table of allowances and fee schedules. Don't think that these are the only system existing in that country there are many other mechanisms but since it is mentioned in the textbooks we are studying this. You see our concept is little bit tricky and the table of allowances and fee schedule. So if you have a graphical or diagrammatic way it is easy to understand. So the UCR concept is commonly applied in delta dental plan. So it is a one of the reimbursement mechanism. So let's see what is exactly UCR concept. So let's take the example Mr. X, Mr. Y and Mr. Z is practicing at location ABC all are having same qualification that is BDS and they are charging for scaling or order profile access $100 Mr. Y 150 and Mr. Z $200. So UCR concept is like the usual fee of these three people will be taken up by the third party and calculate a customary fee which is customer friendly. So even if you charge $250, $300 there is no point there will be a customary fee calculation by the third party. So they decide how much you can ask from the patient. So this UCR concept is the best method of payment because it prevents the exploitation of patients. Some dentist might charge very high and some might get very low payment. So this ensures a uniform payment mechanism. So this is a usual fee. What is there? Fee for a particular service but the location and the qualification should be same. If it is MDS it can be different. So for MDS qualification the customary fee also will be different. So it will be calculated among the MDS people. This will be calculated among the BDS people at a particular location and mostly this will be calculated by taking percentile. So percentile we have already seen previously. So just an example the customary fee calculated by the third party is $150 for an order profile access. So each treatment will have different usual fee. So that is customary fee which is customer friendly. So you can see that Mr. Y's usual fee and customary fee is matching. So this is matching for Mr. Y. So Mr. Y's fee is reasonable when usual and customary fee is matching that is known as reasonable fee. So that is just a hypothetical scenario. Usually it will be reasonable for every patient and for also dentist working in that particular area. So this is the UCR concept. This should be adopted everywhere because it is both beneficial for the patient, those who cannot afford very much treatment charges and also for dentist because those are paying or asking less money because of their facilities and some might ask very high fee. So all dentists will get a reasonable amount from the patient. So this is UCR concept. So UCR concept I explained you in detail. So the next one is table of allowances that is like a list of covered services that are sent for each service. So each treatment services there will be a particular allowances will be given to the dentist by the third party. But the problem is that represents a total charge for the services but which will not necessarily fulfill the dentist fee for services. So dentist might be charging $200 for a oral profile access or his mind is usual fee or his mind the fee will be $200 but the allowances he will be getting only $150. So what happens is if the dentist fee becomes more than the assigned to the service by the third party the remaining $50 will be collected by the dentist from the patient. So the patient has to pay that $50 extra. So that is why this is a failure because the patient might not be knowing this extra amount he has to pay to the dentist because he already taken the insurance from the third party. So that patient might oppose this table of allowances. Only when the treatment charges is more than that of covered services. Peace schedule is like another mechanism where the list of charges by the dentist. So every dentist will give their list of charges and there will be a mean payment will be taken. So it will affect those who are charging more and it will be beneficial those who are charging less. So the dentist oppose this due to its inflexibility and lack of autonomy. So the prepayment plans we can subdivided into four types one is commercial insurance plans second one is non-profit organization. So commercial insurance plans is totally based on the profit. So non-profit organization which is only think of the welfare of dentists and patients. So that is delta dental plan and blue cross blue shield plans then the group practices like prepaid group practices and capitation plans. So let's see what is commercial insurance plans. So we have seen when insurance company is giving insurance the risk must follow certain criteria. We have already seen because they will be more selective about groups to choose to offer dental insurance and they claim no obligation towards the dental health of community because their priority is only business and profit. So they do not conduct fee on its post treatment dental examination because they have no obligations how the treatment went was it beneficial to the dentist or the patient's treatment patient who received the treatment and since they operate only for profit they always charge higher premiums. So that is about commercial insurance plans. So next we learn about non-profit organization because commercial insurance plans is just for profit. So people thought of a non-profit organization then this dental plan came into existence. It is synonymous with the name dental service corporation. It is nothing but it is a legal body constituted to run by a non-profit organization a state by state basis and sponsored by dental society to negotiate the third party for the dental care. So always there will be control of the cost because there is no plan of making profit out of it. But they are subjected to the insurance law of the state because this is the most commonly in the US state so each state will be having different different insurance law. So they have to oblige the insurance law of that particular state. So it was started like National Association of Dental Service Plan or NADSV in June 1966 with the help of American Dental Association. Then it changed its name to Delta Dental Plan in 1969 April. So the philosophy is that the practitioners can adapt their traditional practice to meet the demand of group purchase because a patient is registering to Delta Dental Plan will be allocated to the dentist who are registered in Delta Dental Plan. So it is like a group practice if one treatment option is not available one dentist it can be referred to the next dentist who can offer that particular treatment but under the closed panel. So basically there are two types of dentists I will explain you more by having a diagrammatic representation about participating and non-participating dentist. So it explains you about 90th percentile and 50th percentile how the calculation all about. So let's see what is Delta Dental Plan. So in Delta Dental Plan we know that it was started as NADSV in 1969 later its name changed to Delta Plan in 1969. So it follows use your mechanism of percentile calculation we have already seen how to calculate percentiles and there is no profit. This is a non-profit association with along with Blue Cross and Blue Shield. So in Delta Dental Plan there are two types of dentists. So dentists can register in Delta Dental Plan as a participating dentist or non-participating dentist. So the criteria are different and the reimbursement mechanism is different. So let's see what are the basic difference between the participating dentist and non-participating dentist. The first and foremost difference is the reimbursement amount. So the participating dentist will be getting at a 90th percentile reimbursement for the same treatment the non-participating will get only the 50th percentile. So that is a huge difference of reimbursement. But the participating dentist has to pre-file his usual fee. So we have seen what is usual what is customary and what is reasonable fee. So he has to file the usual fee but he doesn't need to file usual fee. For participating dentist there will be auditing of his accounts by the Delta Dental Plan auditors but he is having no auditing of his accounts. Then there will be post quality check evaluation by the inspectors from the Delta Dental Plan in case of participating dentist. But there is no quality check in non-participating dentist. So the participating dentist can take up patients only from the Delta Dental Plan patients. From the patients those who have registered in Delta Dental Plan he can't take up any other plan patients. There are other plans like cavitation plan, blue close, blue shield plans. So such plans patients participating dentist cannot take up but non-participating dentist can give treatment to any patients from any scheme. So he can include any patients and participating dentist is obliged to give a fixed amount to the Delta Dental Plan's reserve fund. But this non-participating dentist non-need to give such funds. So non-participating dentist has so much benefits. This we cannot say it is benefits but benefit for the dentist not for the patient but he gets only 15th percentile payment whereas the participating dentist get at a 19th percentile payment. So that is Delta Dental Plan. The next we have Blue Cross Blue Shield Program. It is also a non-profit organization. It is actually association of Federation of 38 separate health insurance organization and companies in the United States. It started in 1960. Blue Cross started in 1960 and Blue Shield in 1948 and both merged in 1982. So it is just as I said it is a non-profit health service corporation like Delta Plan. It follows 15th percentile mechanism. Now let's move on to prepaid group or group practices. So it is a term given to a group practice that provides dental services on a prepaid basis. Such groups are now generally regarded as open panel so this has not always been so. Open panel means all patients can approach to this group of dentists and a dentist also having flexibility to work. So these definitions are very much complicated in finance and dental care. ADA defined as the type of dental practice in which dentists sometimes in association with members of other health professions agree formally themselves on a certain central arrangement designed to provide efficient dental health services. It is just like a hospital where the dentists along with other doctors can work together with a central arrangement just how we see in a hospital. So we have few types of group practices that is general practice, single speciality and multi-speciality. General practices groups composed of entirely general practitioners if a hospital of like a big dental clinic or with many dentists but all are doing general practitioners. There is no specialist, there is no special divisions so patients can all do all the treatment that is general practice. More speciality is a single speciality members will be working like a endodontist like a root canal center so all the endodontists work there, no other treatments will be done there in general. More specialities are working at the same center just like a hospital where endodontists will be there, pedodontist, prostodontist all the specialities will be working at the same place. These are the group practices. So HMO is a type of group practice, it is known as health maintenance organization. So it has four components, so let's see what are the components of HMO. So the health maintenance organization or HMO is a different group practice. So it has basically four components or principles. There is a system of health care that is provided as where the patients can avail treatment that is system of health care. The second one the treatment services offered by these providers then there will be a enthralled group that is the people who enthralled in this health maintenance organization just like any other models like delta dental plan or a blue cross or blue shield and the last mechanism is reimbursement. So how the providers were paid. So these are the models or how the dental personnel are being reimbursed by the HMO. So the first staff model the HMO repays every person in the staff model. So all staffs of that staff model HMO pays individually. But in group model the HMO pays a bulk amount and the group model will distribute the amount with themselves but HMO pays a single bulk amount to the group model. The third one is independent practice association. So these two are group model. This is an independent practice like individually they are practicing at different places but they are agreed with the HMO plans. So they also get individually the reimbursement. So these are different why because this is not a group model these two are group model and this is again an independent practice association type but it works under capitation plan that is why the primary care capitated network. They also receives individually the amount. So this is how HMO reimburses the dental personnel. So we have four groups that is staff model group model independent practice association and primary care capitated network. This is capitation plan and these are the components or principles of HMO. So HMO is nothing but a group model or a prepaid groups. So the capitation plan is a different reimbursement mechanism where the third party reimburs the health maintenance organization or a group practice or independent practice association or a individual dentist established some on a monthly or yearly basis but based on the number of patients. So with the third party if the dentist is with agreement on capitation plan basis he receives yearly or monthly a fixed some based on the number of patients not particularly based on the number of services he provided but anyway he has to perform a certain procedures in each patients even if he does the treatment or not doing the treatment he will receive the sum that is the advantage. The money is paid regardless of whether the patient utilizes a care or not and return the patient is entitled to receive a certain sets of services for a specified period of time. So it is totally based on the number of patients not based on the particular treatment services. So in areas where there is a real or perceived oversupply of dentists these capitation plans could be attractive to both purchaser and provider because it is beneficial for dentists. Dentist is not getting enough of treatment at least he gets few patients he will receives a fixed amount of sum. So when we have a lot of dentists a play this type of mechanism would be beneficial but those who are having a good practice this might not be a good plan. So this is another way of reimbursement mechanism but it is a different one just like our user piece caduce table of allowances and capitation plan. So the salary is what the Indian system is currently following dentists in practice group or in armed forces or any by the public agencies it allows the dentists to be largely free of the business concern of a running practice they were allowing the dentists to concentrate on clinical matters fringe benefits are also attractive but the problem is there could be lack of financial incentives and it those who are need to be very highly productive. So you will be get only fixed amount monthly so he will not explore his potential. So we have some public programs usually like not all the insurance companies or the all the private firms will not able to meet up the people's needs so the government is always keeping some programs for the public's help. So such programs in United States is Medicare and Medicaid and national health insurance is in United Kingdom. Medicare is the 18th social security amendment in 1965 known as Medicare this programs remove all financial barriers for hospitals and physician services for people 65 or above. So by 1970 test two parts one is hospital insurance and the part B is supplemental insurance. So both is having a complex series of services benefits for patients Medicare was brought into being because the voluntary health insurance system was unable to provide educated persons for 65 because most of the insurance companies will not provide insurance for aged people. So that is the importance of Medicare and the dental segment is very limited in this sector because it requires hospitalization. Medicaid is the 19th amendment of the Social Security Act of 1965 so the original intent of the program was to provide funds to meet the health care need of all the indigent and medically indigent persons. So it has inpatient care, outpatient care and laboratory and x-ray so this is mainly for indigenous people of United States they have nursing facilities, family planning services and physical physician services. So national health insurance scheme is of Germany, England it is funded by public health program. We have in Indian scenario we have very very negligible amount of insurance the common plans are fee for service that is most common then dental insurance is negligible and even if it is there it requires hospitalized scenario and free or discounted rate in public sector is obtained from defense and railways and ESIS that is Employment State Insurance Schemes and Central Government Employee Scheme and also from State Government Hospital also we can get a discounted rate dental treatment. So that is all about the dental payment or the payment in dental care. So it is the most toughest chapter but the concept once you are clear with you can easily study this chapter. So mostly the questions asked are UCR Mechanism, Delta Dental Plan, Capitation Plan, Fee Schedules, most of the short notes are insurable risk is another short note. Most commonly Delta Dental Plan is asked for 8 marks or 5 marks question and sometimes it might ask the private third party or post payment or budget payment plan. Okay I will come up with a new session on dentistry and more. Thank you.