How are dentists paid?

1
How are dentists paid?

• Dr D White

2
Funding oral health care
Third party
3
1
Public
Dentist
2
Daly et al, 2002
3
Finance distribution
Private services
Public funded services
Third party
Third party
Third party
Patient
Patient
Patient
Dentist
Dentist
Dentist
Co-payment model
Daly et al, 2002
4
Possible methods of remuneration

• Fee-per-item ? Over-treatment
• Sessional
• Salaried
• Capitation ? Under-treatment

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Fee-per-item

• 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

Daly et al, 2002
6
Sessional

• Advantages
• Regular income
• Reward for output
• Minimise resource costs
• Option for special need groups

• Disadvantages
• Adverse risk selection
• Under-treat patients
• Untried

Daly et al, 2002
7
Salaried

• 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

Daly et al, 2002
8
Capitation

• 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

Daly et al, 2002
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

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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

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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

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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)

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References

• Daly et al. Essential Dental Public Health
• chapter 19.
• www.dpb.nhs.uk