Conrad Douglas, Lee Rosanna, Milgrom Peter, Huebner Colleen
Department of Health Services, University of Washington, Seattle, WA 98195-7660, USA.
Community Dent Oral Epidemiol. 2009 Jun;37(3):189-98. doi: 10.1111/j.1600-0528.2008.00454.x.
Shifts in payment options for dental care over several decades have resulted in more dental expenditures being paid through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation arrangements. Patients' and employers' choices to participate in these arrangements is determined in part by dentists' willingness to participate in plans, and plan choices may be influenced by patient satisfaction, self-reported oral health, and/or quality or cost of care.
This study examined determinants of dentists' decisions to accept capitation payment for services.
Cross-sectional mail survey in December 2006.
1605 general dentists in Oregon.
Questions addressed dentists' perceptions of the importance of control over various practice parameters, willingness to accept capitation payment, employment or ownership status within the practice, and practice characteristics.
Capitation was accepted by 22.6% of the respondent dentists (n = 729). Reported average fees (2007 dollars) ranged from $60 (initial oral examination) to approximately $800 (porcelain crowns). The likelihood of accepting capitation payment was related to the number of dentists in the practice, but surprisingly owner-dentists were no less likely than employee-dentists (associates) to accept capitation. As expected, dentists' usual and customary fees were negatively associated with accepting capitation. In contrast, measures of dentists' importance of control were not related to decisions about capitation. Longer average appointment delays were related to acceptance of capitation, but the effects were small.
Dentists' behavior regarding payment acceptance is generally consistent with microeconomic theory of provider behavior. Study findings should inform practitioners, plan managers, and researchers in examining dentist payment decisions.
几十年来牙科护理支付方式的转变导致更多的牙科支出通过健康维护组织（HMO）、优选提供者组织（PPO）和按人头付费安排来支付。患者和雇主参与这些安排的选择部分取决于牙医参与计划的意愿，而计划选择可能会受到患者满意度、自我报告的口腔健康状况和/或护理质量或成本的影响。
本研究调查了牙医决定接受服务按人头付费的影响因素。
2006年12月进行的横断面邮件调查。
俄勒冈州的1605名普通牙医。
问题涉及牙医对控制各种执业参数的重要性的看法、接受按人头付费的意愿、执业中的就业或所有权状况以及执业特征。
22.6%的受访牙医（n = 729）接受按人头付费。报告的平均费用（2007年美元）从60美元（初次口腔检查）到约800美元（烤瓷冠）不等。接受按人头付费的可能性与执业中的牙医数量有关，但令人惊讶的是，个体牙医接受按人头付费的可能性并不低于雇员牙医（助理）。正如预期的那样，牙医的惯常费用与接受按人头付费呈负相关。相比之下，牙医对控制权的重视程度指标与按人头付费的决策无关。较长的平均预约延迟与接受按人头付费有关，但影响较小。
牙医在支付接受方面的行为总体上与提供者行为的微观经济理论一致。研究结果应为从业者、计划管理者和研究人员审视牙医支付决策提供参考。
