Design of an innovative paediatric capitation payment approach for public sector dentistry: an Australian experience

Conquest, Jennifer Hanthorn; Jacobi, Michael; Skinner, John; Tennant, Marc

doi:10.1111/idj.12131

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Atchison and Schoen’s (1990) study shows that fee-for-service payment is the preferred option by the private practitioner, rather than capitation payments [ 23 ]. The consumer’s perspective as presented by Andås and Hakeberg (2014), stated that their preference is the capped prepayment fee [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…It may be argued that capitation had an advantage, as the payment price was discounted by 65% and there was not a payment increase during the study. The reason for the discount was based on a previous paediatric capitation study that also utilised oral health therapy students to provide the care and that they cost less than dentists [ 23 ].…”

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%

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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“…patient expectations, and perceptions around the professional role of dentists) affecting the delivery of caries prevention in general ( Templeton et al, 2016 ). Business pressure means the cost-effectiveness of different remuneration models for FV application is likely to be of continued interest ( Birch, 2015 ) because this affects aspects of the model such as time, space and staff resources ( Brocklehurst et al, 2013b , Conquest et al, 2015 ). We have reported that, in terms of evidence-based practice, practitioner beliefs about effectiveness ( Elouafkaoui et al, 2015 ), clinical judgement relating to need, and patient preferences, seem to be somewhat stronger drivers than the available research evidence on its own ( Vander Schaaf et al ) How to best extend duties across the dental team is known to be a somewhat intractable problem ( Brocklehurst et al, 2013a ), but interesting research is seeking to understand how best to utilise the team to increase efficiency and lower costs ( Brocklehurst et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice

et al. 2018

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BackgroundAll children attending General Dental Practice in Scotland are recommended to receive twice-yearly applications of sodium fluoride varnish to prevent childhood caries, yet application is variable. Development of complex interventions requires theorizing and modelling to understand context. This study applies the Functional Resonance Analysis Method (FRAM) to produce a sociotechnical systems model and identify opportunities for intervention to support application.MethodsThe FRAM was used to synthesise data which were: routine monitoring of fluoride varnish application in 2015/16; a longitudinal survey with practitioners (n = 1090); in-depth practitioner and key informant interviews (n = 43); and a ‘world café’ workshop (n = 56).ResultsWe describe a detailed model of functions linked to application, and use this to make recommendations for system-wide intervention.ConclusionsRigorous research is required to produce accessible models of complex systems in healthcare. This novel paper shows how careful articulation of the functions associated with fluoride varnish application can support future improvement efforts.

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“…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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Design of an innovative paediatric capitation payment approach for public sector dentistry: an Australian experience

Abstract: This model offered an early entry point for paediatric patients to access dental care that addressed their needs, whilst being flexible enough to be fiscally attractive.

Cited by 5 publications

References 7 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

A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice

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

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