An analysis of onsite versus offsite dental care for an institutionalized population

The Job Corps is a program for disadvantaged youths between the ages of 16 and 22 in need of general education and vocational training. During fiscal 1978, 61 residential centers had a total enrollment of 33,732. Despite differences in size, location, and organizational structure of the centers, uniform requirements for health services have been established. The administration at each center must ensure emergency dental care, arrange for examination of all corps members, and make routine treatment available on a priority basis. Because of uniqueness of local situations, various mechanisms are used to accomplish these goals. The most fundamental difference is the provision of care by means of onsite clinics with salaried dentists as opposed to offsite arrangements with fee-for-service in private dental offices. An analysis of cost and utilization data for the 1978 FY indicated that onsite care ($96.19/CMY) was significantly more expensive than offsite care ($72.24/CMY). The difference in the mean number of visits, however, was also statistically significant. Onsite care resulted in 4.78 visits/CMY; corps members made 2.24 visits/CMY when offsite care was provided. Furthermore, even taking into consideration the initial expenses involved in establishing clinical facilities, the cost of an onsite visit, $22.30, was less than an offsite visit, $33.62. The cost and utilization patterns were the same at small centers as large centers.