Dental care for the elderly through a Capped‐fee funding model: Optimising outcomes for primary government dental services

Conquest, Jennifer Hanthorn; Skinner, John; Kruger, Estie; Tennant, Marc

doi:10.1111/ger.12297

Cited by 4 publications

(6 citation statements)

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“…The pilot study identified that 60% of the case studies required further dental treatment following their full capitation course-of-care [ 22 ]. Due to the limitation of the pilot study design it could not be determined that the capitation model-of-care provided by the private sector could or could not be advantageous as an alternative public service delivery.…”

Section: Discussionmentioning

confidence: 99%

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Adult capped dental payment model applied within a university setting: an Australian reflective case study

et al. 2021

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Background Capitation models of care in dentistry started around 1973 with varying degrees of success in meeting the needs of the individuals and expectations of the participating private practitioners. These studies mostly identified that capitation payments resulted in under treatment whilst fee-for-service models often led to over treatment. The objective of this study was to develop a new way of doing business using an outsourcing capitation model of care to meet population health needs and activity-based funding requirements of rural Local Health Districts with a local university dental school. This payment model is an alternate referral pathway for public oral health practitioners from the existing New South Wales Oral Health Fee-for-Service Scheme that focuses on urgent treatment to one that offers an all-inclusive preventive approach that concentrates on sustaining good long-term oral health for the individual. Method The reflective study analysed various adult age cohorts (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75 + years) based on 950 participants randomly selected from the Greater Southern adult public dental waiting lists. The study’s capitation formula was derived from NSW government adult treatment items (n = 447,625). Dental care was provided through the local university’s dental clinics utilising only dental students under clinical supervision. All data were sourced from NSW Oral Health Data Warehouse during 1 January 2012–30 June 2018 and analysed by using SAS 9.3 and Version 13 Microsoft Excel. Results There were 10,305 dental care items and 1129 capitation courses of care totalling A$599,026. This resulted in an average of 11 dental care items being provided to each participant. The capitation payment formula utilising the most provided dental care items of 100 individual patients proved to be economical and preventive focused. Conclusion The systematic reflection showed that this unique methodology in developing an adult capitation payment formula associated to diagnostic pathways that resulted in: (i) more efficient usage of government expenditure on public dental services, (ii) provision of person-centred courses of dental care, and (iii) utilisation of university dental education programs to best practice treatment and holistic care.

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Section: Discussionmentioning

confidence: 99%

“…In 2012–2014 study that analysed the 20 case studies it was derived that the same capitation formula was not the most cost effective [ 22 ]. Nonetheless when the capitation formula (Table 1 ) was analysed in this larger cohort of 950 participants, the nuances of an individual’s dental status are reduced.…”

Section: Discussionmentioning

confidence: 99%

Adult capped dental payment model applied within a university setting: an Australian reflective case study

et al. 2021

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“…Having different interpretations of ABF in Australia is not exclusive to Western Australia-for example, general dental services provided by the New South Wales Government can include dentistry provided by salaried practitioners as a CF model as well as an FFS scheme through private practitioners with both modes of service existing to improve access to care. Conquest et al (2017) reviewed these arrangements: while the CF model performed less efficiently, the FFS model was more costly (Conquest et al, 2017). Despite the results of the study suggest advocating using FFS models in hospitals, a third model that reflects the unique characteristics of patients seen in a hospital environment may be more appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…While it is thought that in a public system where dentists are salaried this is less likely to be an issue, the introduction of incentives and targets can be the driving force to performing more services without having a positive impact on oral health quality (O'Reilly et al, 2012). While previous Australian studies have compared and contrasted the use of CF and FFS payment schemes, dental care in these schemes is always partly funded by the patient (Conquest et al, 2015(Conquest et al, , 2017(Conquest et al, , 2021. In contrast, dental treatment as part of the work-up for HNC management at FSH or OHCWA is not self-funded.…”

Section: Discussionmentioning

confidence: 99%

Inequalities in public funding: Are hospital‐based dental services funding models in Australia logical?

Sundaresan,

Kruger,

Mc Geachie

et al. 2024

World Med & Health Policy

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The availability of hospital‐based dental services across Australia varies with a number of hospitals disestablishing dental departments due to rising costs. However, the perceived costs are difficult to quantify as funding models used to capture activity are not uniform across health facilities. To investigate this the predicted funding generated using current models of activity‐based funding in the provision of specialist dentistry in Australian public hospitals was examined. Using data from Fiona Stanley Hospital regarding the dental treatment for head and neck cancer patients as part of their work‐up for cancer management, expected funding was estimated using the existing fee‐for‐service and capped‐fee models currently in use. Funding estimates were based on the Department of Veterans' Affairs Fee Schedule of Dental Services and the Independent Hospital Pricing Authority's Australian Non‐Admitted Care Classification. A total of 127 patients received dental treatment over 209 appointments including 17 patients who had all their remaining teeth removed. Analysis revealed the fee‐for‐service model generated more expected funding than the current capped‐fee model, or an average of AUD$458 (USD$356) per patient. Differences in how activity was recorded resulted in 81.7% uncaptured funding between the two models. This study shows that fee‐for‐service models capture activity more accurately. However, this model is not used in public hospitals despite it being standard practice in stand‐alone public dental clinics. As a result, hospital‐based dental clinics appear to be unproductive. Further research can include developing a model that better captures both the activity undertaken as well as patient complexity.

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“…The data for the participants' diagnostic pathways and dental treatment provided through the Capped- The Capped-fee MoC used was as described in a previous study (Conquest et al, 2017) and provided four diagnostic pathways of (i) no active caries and no pain, (ii) active caries and no pain, (iii) active caries and pain, (iv) periodontal [? ].…”

Section: Data Source and Analysismentioning

confidence: 99%

Oral Health Profiling for Young and Older Adults: A Descriptive Study

Conquest

Skinner

Kruger

et al. 2021

IJERPH

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The purpose of this study was to trial the suitability of an oral health promotion toolkit in a chair-side setting to determine: an individual’s knowledge; understanding of oral and general health behaviour and evaluate the commitment of dental practitioners to undertake an assessment of the individual’s attitude and aptitude to undertake a home care preventive plan. All participants were 18 years and over and came from low socio-economic backgrounds in rural New South Wales, Australia. The study evaluated 59 case studies regarding their knowledge of oral and general health. The study included an oral health profiling questionnaire, based on validated oral health promotion outcome measures, a full course of dental care provided by a private dental practitioner or a dental student. Out of the 59 participants, 47% of participants cleaned their teeth twice per day, 69% used fluoride toothpaste and 47% applied the toothpaste over all the bristles. The questionnaire, based on Watt et al. (2004) verified oral health prevention outcome measures was a sound approach to determine an individual’s knowledge, understanding of oral and general health behaviour. However, dental practitioners’ commitment to assessing the individual was low.

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Dental care for the elderly through a Capped‐fee funding model: Optimising outcomes for primary government dental services

Abstract: Policy makers in partnership with Government and private service providers should seek to develop partnerships with Government, private services and universities, scope opportunities in applying a Capped-fee funding model, and one that helps address the oral needs of the elderly.

Cited by 4 publications

References 6 publications

Adult capped dental payment model applied within a university setting: an Australian reflective case study

Adult capped dental payment model applied within a university setting: an Australian reflective case study

Inequalities in public funding: Are hospital‐based dental services funding models in Australia logical?

Oral Health Profiling for Young and Older Adults: A Descriptive Study

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