Systematic Literature Review of Capitation and Fee-for-Service Payment Models for Oral Health Services: An Australian Perspective

Conquest, Jennifer Hanthorn; Gill, Nirjgot; Sivanujan, Praveena; Skinner, John; Kruger, Estie; Tennant, Marc

doi:10.3390/healthcare9091129

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…The 2021 systematic review by Conquest et al on bundled payments and fee-for-service payment models reported that clients favored bundled payments, although moving from fee-for-service to capitation could reduce services provided, including preventive interventions [ 58 ]. This review also suggested that adjusting the way dental practitioners are remunerated is unlikely to achieve all policy goals [ 58 ]; potentially elusive ones address oral health inequities and creating incentives for optimizing the dental workforce skill mix [ 58 ].…”

Section: Global Perspectives For the Value-based Healthcare Agendamentioning

confidence: 99%

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

Nguyen

Bridge

Hall

et al. 2023

J Public Health Pol

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The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.

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Section: Global Perspectives For the Value-based Healthcare Agendamentioning

confidence: 99%

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

Nguyen

Bridge

Hall

et al. 2023

J Public Health Pol

View full text Add to dashboard Cite

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Alternative Reimbursement Models for Health Providers in High-Performance Sport: Stakeholder Experiences and Perceptions

et al. 2023

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Background Value-based healthcare provider reimbursement models have been proposed as an alternative to traditional fee-for-service arrangements that can align financial reimbursement more closely to the outcomes of value to patients and society. This study aimed to investigate stakeholder perceptions and experiences of different reimbursement systems for healthcare providers in high-performance sport, with a focus on fee-for-service versus salaried provider models. Methods Three in-depth semi-structured focus group discussions and one individual interview were conducted with key stakeholders across the Australian high-performance sport system. Participants included healthcare providers, health managers, sports managers and executive personnel. An interview guide was developed using the Exploration, Preparation, Implementation, Sustainment framework, with key themes deductively mapped to the innovation, inner context and outer context domains. A total of 16 stakeholders participated in a focus group discussion or interview. Results Participants identified several key advantages of salaried provider models over fee-for-service arrangements, including: the potential for more proactive and preventive models of care; enhanced inter-disciplinary collaboration; and the ability for providers to have a deeper understanding of context and how their role aligns with a broader set of priorities for an athlete and the organisation. Noted challenges of salaried provider models included the potential for providers to revert to reactive care delivery when not afforded adequate capacity to provide services, and difficulties for providers in demonstrating and quantifying the value of their work. Conclusions Our findings suggest that high-performance sporting organisations seeking to improve primary prevention and multidisciplinary care should consider salaried provider arrangements. Further research to confirm these findings using prospective, experimental study designs remains a priority.

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Why Is Caries Prevention in Children So Difficult? A Narrative Opinion

Twetman

2024

IJERPH

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Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as “difficult”: i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

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Systematic Literature Review of Capitation and Fee-for-Service Payment Models for Oral Health Services: An Australian Perspective

Cited by 3 publications

References 20 publications

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

Alternative Reimbursement Models for Health Providers in High-Performance Sport: Stakeholder Experiences and Perceptions

Why Is Caries Prevention in Children So Difficult? A Narrative Opinion

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