Abstract: The financial sustainability of dental practices in the United States is shaped less by clinical skill than by the reimbursement architecture surrounding it: a fragmented, largely fee-for-service payment system spanning commercial dental plans, state Medicaid programs, and near-total exclusion from traditional Medicare. This narrative review examines how dental insurance design and provider payment methodology, fee-for-service, capitation, and emerging value-based payment (VBP) models, shape practice-level financial sustainability and patient access. Fee-for-service remuneration, the dominant model in American dentistry, is associated with higher treatment volume......
Key Word: dental insurance; fee-for-service; value-based payment; practice financial sustainability; Medicaid reimbursement; United States
[1]. Vujicic, M., Buchmueller, T., & Klein, R. (2016). Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Affairs, 35(12), 2176-2182.
[2]. Oliveira, J. A. P., Apolinário, V. C., Loiola, S. F., Souza, P. M., Abadessa, S. N., Dalbone, A. F., Lima, P. A. D., Mello, F. F., Castro Júnior, U. A., Arume, G. S. C. A., Bastos, P. V. O., & Dalla, E. F. (2026). Advancing dental practice management in the United States: Strategic leadership, economic sustainability, and healthcare innovation. Revista DCS, 23(90), 1-6.
[3]. Nasseh, K., LoSasso, A. T., & Vujicic, M. (2024). Percentage of dentists and dental practices affiliated with private equity nearly doubled, 2015-21. Health Affairs, 43(8), 1082-1089.
[4]. Semprini, J., & Samuelson, R. (2023). Synthesizing 30-years of adult Medicaid dental policy research: A scoping review to identify gaps and opportunities. Heliyon, 9(2), e13703