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How are dentists paid?

How are dentists paid?. Dr D White. Funding oral health care. Third party. 3. 1. Public. Dentist. 2. Daly et al, 2002. Finance distribution. Public funded services. Private services. Third party. Third party. Third party. Patient. Patient. Patient. Dentist. Dentist. Dentist.

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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

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