A Markov model assessing the impact on primary care practice revenues and patient's health when using mid‐level providers, lesson learned from the United Kingdom

Abstract

In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.

Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon‐Kuskokwim Delta

“…One example is cost effectiveness. A recent simulation study from the United Kingdom found that mid‐level dental providers working in a public dental care delivery system can be a dominant strategy over dentists (i.e., improved outcomes at a lower cost) . These findings may be applicable to the YK communities.…”

Mid-level health providers (MLHPs) in delivering and improving access to primary health care services – a narrative review

“…Studies that have measured patient satisfaction with the provision of primary care have found that patients who received care from NPHWs were equally or more satisfied than those who received care from physicians [ [23] , [24] , [25] , [26] ]. In Chhattisgarh India, patients of Medical Officers and NPHWs reported similar levels of satisfaction, trust, and perceived quality, with scores of 84% for Medical Officers, 80% for AYUSH Medical Officers, and 85% for RMAs [ 27 ].…”

A systematic review of decision analytic modeling techniques for the economic evaluation of dental caries interventions

“…Most studies were conducted in Germany [22,27,29–31,34–37,40,42], followed by studies that were performed in the USA [18,20,25,28,32,41], in Australia [23,24,26,33,38], in the UK [19,39] and in Sweden [21]. The target populations were mainly school age children [18,21,22,28,34,35,37,41], pre-school aged children [20,25,33] and other specific populations [19,23,24,27–33,36,39,40,42]. Investigated strategies included preventive intervention [25,26,32,33,41,42], screening strategy [35,36], and invasive/non-invasive treatment [18–24,27–31,34,37,40].…”

“…The perspectives included mixed public-private payer [27,29–31,34–36,40], private dental practitioner [21,23,24,38,39], public payer [18,20,26,37,41] and societal perspectives [33]. The most common modeling techniques were the Markov model [18–20,24,26,28,31,33,38,39,41,42], followed by the Markov/microsimulation mixed model [27,29,30,34,35,37,40], systematic dynamic model [22,25,32], microsimulation model [23,36] and decision tree [21]. Time horizons ranged between 3.5 to 63.5 years when a life time horizon was not deployed.…”

“…Quality assessment of data was not performed in any of the included studies. Over half of the included studies [18,21,23,24,27,29–31,35,37–39,41] analyzed the data using a justifiable epidemiological technique in the pre-model analysis. Calculation of transition probabilities were not justified in six studies [18,20–22,25,38].…”