The role of payments systems in influencing oral health care provision

Abstract

Original citation Woods N. The role of payments systems in influencing oral health care provision. OA Dentistry. 2013 Aug 01;1(2) The role of payments systems in influencing oral health care provision. OA Dentistry 2013 Aug 01;1(1):2. Abstract Introduction The unique characteristics of dental disease, such as its predictability, non-communicability, ease of diagno-sis, and its extensive prevention pos-sibilities, should result in greater cost control and an expectation of a better operation of the market mechanism than in general health care. These dif-ferentiating features, however, also increase the likelihood that services are over-consumed and/or over-pro-vided. The most influential feature determining efficient resource use in health care provision is the type of payment system. A per capita system serves as a link between the dentist's future income and service provision, and provides equity in terms of cov-erage and access. The result is that patients may benefit from fewer un-necessary treatments, and encoun-ter more preventive activities. The system is limited by the potential for under-treatment and problems with patient selection. With fixed salary, the dentist's in-come is independent of service pro-vision, with incentives for low pro-duction, which leads to high costs per patient. Salaried dentists generally provide more prevention services, and allow the targeting of services to priority or 'special needs' groups. The patient benefits from the greater eq-uity of a service and the location of services can be determined by com-munity needs. Fee-per-item is the most common payment system in dental service provision for adults, where the dentist is rewarded ac-cording to the amount of work un-dertaken. Fee-per-item removes the incentive for supervised neglect or to cherry pick patients. It also solves the problems of patient selection and under-treatment, associated with capitation financing. Fee-per-item can encourage the use of services by patients on the advice of the den-tist with the result that costs can be inflated with little impact on oral health itself. In the absence of a sys-tem of probity, dentists can manipu-late demand and set fees, and pro-vided moral hazard can occur in the form of supplier inducement. This review discusses the role of payment systems in influencing oral health care provision Conclusion The optimal dental contract may be a 'blended' payment system whereby dentists receive a proportion of their income through capitation, a propor-tion from allowances and proportion from fee-per-item of service.