1. PH & Epidemiology - October 2006 How are dentists paid? Dr D White

2. PH & Epidemiology - October 2006 Funding oral health care Third party PublicDentist Daly et al, 2002 1 2 3

3. PH & Epidemiology - October 2006 Finance distribution Third party Patient Dentist Patient Third party Dentist Patient Third party Private servicesPublic funded services Co-payment model Daly et al, 2002

4. PH & Epidemiology - October 2006 Possible methods of remuneration Fee-per-item? Over-treatment Fee-per-item? Over-treatment Sessional Sessional Salaried Salaried Capitation? Under-treatment Capitation? Under-treatment

5. PH & Epidemiology - October 2006 Fee-per-item Advantages Good in areas of high need Good in areas of high need Reward for output Reward for output Treatment focus Treatment focus Easy to measure Easy to measure Disadvantages Potential for over- treatment Difficult to budget Little incentive for prevention Daly et al, 2002

6. PH & Epidemiology - October 2006 Sessional Advantages Regular income Regular income Reward for output Reward for output Minimise resource costs Minimise resource costs Option for special need groups Option for special need groups Disadvantages Adverse risk selection Under-treat patients Untried Daly et al, 2002

7. PH & Epidemiology - October 2006 Salaried Advantages Administratively simple Administratively simple Facilitates budgeting Facilitates budgeting Treatment not influenced by profit Treatment not influenced by profit Other benefits: sick pay & maternity leave Other benefits: sick pay & maternity leave Disadvantages Possible under- treatment Lack of financial incentives to work Requires extensive management structure Daly et al, 2002

8. PH & Epidemiology - October 2006 Capitation Advantages Administratively simple Administratively simple Facilitates budgeting Facilitates budgeting Reward linked to effort Reward linked to effort Treatment not influenced by profit Treatment not influenced by profit Disadvantages Adverse risk selection No knowledge of output Under-treatment of patients Payments ‘unfair’ in areas of high need compared to low need Daly et al, 2002

9. PH & Epidemiology - October 2006 Remuneration in the GDS (until 2006) Target Annual Gross Income Target Annual Gross Income Dentists & Doctors Review Body (DDRB) Dentists & Doctors Review Body (DDRB) Fee scale Fee scale  Fee-per-item basis  Patients pay 80% of cost up to ceiling of £348  Continuing care payments (54p per month)  Capitation payments for children Payments through Dental Practice Board Payments through Dental Practice Board

10. PH & Epidemiology - October 2006 Remuneration in the GDS (from April 2006) Units of Dental Activity (UDAs) Units of Dental Activity (UDAs) Contract agreed between Primary Care Trust (PCT) and dentist Contract agreed between Primary Care Trust (PCT) and dentist Contract value based on ‘test year’ Contract value based on ‘test year’ Guaranteed gross income for 3 years Guaranteed gross income for 3 years PCT administers payments PCT administers payments Patient charges collected by practice Patient charges collected by practice

11. PH & Epidemiology - October 2006 Patient charges (from April 2006) Banded system Banded system  1 = £15.50  2 = £42.40  3 = £189 Collected by dental practice Collected by dental practice Exemptions: under 18; pregnant; baby under 12 months; claiming benefits Exemptions: under 18; pregnant; baby under 12 months; claiming benefits

12. PH & Epidemiology - October 2006 Private Dental Care 24% patients receive private dental care (8% prior to 1990) 24% patients receive private dental care (8% prior to 1990) Self-pay Self-pay Capitation plans Capitation plans Dental Insurance arrangements Dental Insurance arrangements Dental Payment plans Dental Payment plans Corporate Bodies (27) Corporate Bodies (27)

13. PH & Epidemiology - October 2006 References Daly et al. Essential Dental Public Health Daly et al. Essential Dental Public Health chapter 19. www.dpb.nhs.uk www.dpb.nhs.uk www.dpb.nhs.uk