Does the way dentists are paid affect the quantity or quality of care?

24 June 2020

Does changing the way dentists are paid affect access to dental care in the population and the volume of care received by patients?

Professor Stephen Birch and colleagues have published new research in the international journal Community Dentistry and Oral Epidemiology that seeks to answer this question. In this study of primary dental care in the NHS in Northern Ireland, a group of dental practices were switched from contracts that paid dentists according to the volume of services provided to contracts in which dentists were paid according to the number of patients on the practice’s list.

performing dentistry in a private practiceDifferences in the number of patients, quantity of services and patient satisfaction before and after the change were measured and compared with differences observed over the same time period in dental practices that did not change to the new payment contract.

There was no difference in changes to patient numbers between the two groups of dentists but the dentists working under the new payment methods had large reductions in the volume of care provided compared to the comparator dentists. Because patients incurred co-payments for the care received, the change in dentist payment also resulted in large reductions in revenue from co-payments. Patients noticed little change in the service they received.

This revenue effect represents a potential risk to the financial sustainability of primary care practices under traditional models of independent provider practices.

Read the journal article