Authors' objectives: The results of a comprehensive review of the literature, led by the research team, found that dentists are influenced by how they are paid. If dentists are paid for the number of items that they provide (fee-for-service or FFS) e.g. fillings or dentures, they tend to over-treat and do more fillings and dentures. However, if dentists are paid a set amount of money for each patient (known as capitation), which isn t linked to any clinical activity, they tend to under-treat or see patients less frequently. However, the quality of the studies in the review was poor and further research was recommended, particularly during times when policy makers are changing the way that dentists were paid. The review also recommended that attention should be paid to the impact that paying dentists had on factors that the patient thought were important. This problem of dentists responding to the incentives within a payment system is evident in the National Health Service in England and Wales and the new contract introduced in 2006 has received growing criticism for not delivering appropriate levels of care for patients. As a result, the Department of Health in England has been piloting a new NHS dental contract since 2010, with an emphasis on prevention while meeting patients treatment needs more effectively . Concurrently, concerns have been raised in Northern Ireland (NI) due to dentists over-claiming for treatment and causing the budget for dentistry to become over-spent. As a result, the Health and Social Care Board decided to pilot a new way of paying dentists, based on capitation i.e. paying for the number of patients registered, rather than paying for individual items of treatment (FFS). Two phases are planned, the first will involve a small number of pilot practices over a six month period, which will be followed by a second phase with 15 practices over a period of 12 months. Practices would then return back to a FFS payment system. This presents a unique opportunity to undertake a rigorous evaluation of this change in NI and so address the recommendations of the comprehensive review. This will also build on an existing research project being undertaken by the research team and enable the methods used in this study to inform the assessment process. The aim of the proposed research is to evaluate the impact of a change in the way that dentists are paid in NI on the productivity of the dental team and the quality of care provided. The objectives will be to measure changes in clinical activity as dentists move from being paid for what they do (FFS), to a capitation system and then back again to FFS. In addition, the research team will use interviews and questionnaires to assess dentists and patients views about these changes and how they affect the quality of care received. This will help support policy makers across Europe who are grappling with the problems involved in redesigning dental services. It will also contribute valuable information to the health and social care system more broadly. Recent reports argue that patients will need to contribute to health and social care in the future. Co-payments by patients have been a fundamental component of the NHS dental contract since 1950 and studying the impact of changes to the co-payment system is an important part of the proposed programme. It will also explore the unintended consequences of changes to the remuneration system on health inequalities, including access to services.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/141912

Year Published: 2015

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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