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How are dentists paid? PowerPoint Presentation
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How are dentists paid?

How are dentists paid?

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How are dentists paid?

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

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

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

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

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

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

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

  8. Advantages Administratively simple Facilitates budgeting Reward linked to effort 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 Capitation Daly et al, 2002 PH & Epidemiology - October 2006

  9. Remuneration in the GDS (until 2006) • Target Annual Gross Income • Dentists & Doctors Review Body (DDRB) • 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 PH & Epidemiology - October 2006

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

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

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

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