Treatment intensity and provider remuneration: dentists in the British National Health Service

Abstract

Dental service providers in the British National Health Service (NHS) operate under a number of remuneration arrangements that give rise to different incentives. Using data derived from the Scottish dental system, we examine the relationships between remuneration, patient exemption status and treatment intensity. After controlling for differences in patient need and dentist-specific preferences, we find that self-employed dentists treat patients who are exempt from payment more intensively than their salaried counterparts. The results imply that changes in remuneration can have a large effect on the distribution of treatments. More generally, our results provide support for economic models that view financial incentives as important determinants of physician behaviour.

Direct access: lessons learnt from the Netherlands

“…Fee-per-item systems can create incentives to overtreat, while the direction of the incentives in a per-capita remuneration systems is to provide the same service at less cost or to undertreat. [18][19][20] The preliminary evidence from the pilots of the new dental contract suggest that the potential benefit of using DCPs in an integrated model is being recognised. 21 Direct access in an integrated model does offer some advantages within a prospective payment system.…”

An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies

“…In contrast, Chalkley and Tilley show that dentists' treatment decisions respond to financial incentives. 17 These results suggest that subsidies for cost-effective treatments may be better targeted towards providers than patients.…”

Translation of remuneration arrangements into incentives to delegate to English dental therapists

“…There has been much debate regarding the relative merits of different remuneration systems on the delivery of dental (and medical) care, with most attention being paid to whether systems based on capitation schemes incorporate more incentives for higher quality care than do FFI systems [1][2][3][4]. This study however illustrates that for the incentives embedded within the remuneration system to be fully understood, an appreciation of dental (and medical) practices as organisations is needed.…”

“…The impact of changing how dentists are remunerated has been the focus of much previous research [1][2][3][4]. Most of this research describes how incentive-based contracts (such as fee-for-item [FFI] arrangements) are associated with a higher supply of services (or numbers of outputs e.g.…”