Coventry P, Holloway P J, Lennon M A, Mellor A C, Worthington H V
Community Dent Health. 1989 Dec;6 Suppl 1:1-63.
A 3-year clinical trial comparing capitation and fee-for-service remuneration systems for general dental practitioners for the treatment of children has been successfully completed. Capitation dentists restored carious teeth at a later stage in the disease process than fee-for-service controls, and carried out more preventive treatment and advice. However, the disease experience of their patients was little different from that of patients treated under fee-for-service. Capitation dentists saw their patients less frequently and took fewer radiographs than their fee-for-service colleagues. The prevalence of both fissue sealants and arrested caries was low in both groups, as was the prevalence of teeth extracted as a result of caries. Levels of oral cleanliness were similar under both systems. Private treatment was rarely prescribed for children, but was more prevalent for patients of fee-for-service dentists. The profession felt that capitation offered greater clinical freedom and more financial stability to dentists, but a greater temptation to under-prescribe treatment. The profession lacked commitment to capitation as a method of remuneration for the treatment of children in the General Dental Service. Fee-for-service dentists appeared to be more innovative, expressed a greater allegiance to their patients and felt a greater temptation to over-prescribe than capitation dentists. The parents had a high opinion of the service for children, irrespective of the remuneration system, and the children found the service very acceptable. Parents had a stronger allegiance to the fee-for-service than the capitation dentists. The study revealed several short-comings in the capitation model tested, but solutions to all of these became apparent. A capitation agreement of more than 12 months would simplify administration and reduce costs, as would a reduction in the number of forms. The need to notify parents when a dentist was replaced in a practice created considerable difficulties and increased expense. The treatment of trauma and extractions for orthodontic purposes should have been items excluded from the capitation fee. The need for information on dentists' activity in capitation was accepted but should be kept simple and relevant. Monitoring quality of care under capitation can be carried out from the routine data collected for administrative purposes. Capitation does not appear to increase participation. Costs of administering capitation are little different from those for fee-for-service. More resources were spent per dentist and per patient under capitation than fee-for-service. In the clinical trial fee-for-service was more cost-effective than capitation.(ABSTRACT TRUNCATED AT 400 WORDS)
一项为期3年的临床试验已成功完成，该试验比较了全科牙医治疗儿童时的按人头付费和按服务收费薪酬制度。按人头付费的牙医在疾病进程的较后期才修复龋齿，并且开展了更多的预防性治疗和建议。然而，他们患者的疾病情况与按服务收费模式下治疗的患者相比几乎没有差异。按人头付费的牙医看诊患者的频率低于按服务收费的同行，且拍摄的X光片也更少。两组中窝沟封闭剂和静止性龋齿的患病率都很低，因龋齿拔牙的患病率也是如此。两种制度下的口腔清洁水平相似。很少为儿童开私人治疗的处方，但在按服务收费牙医的患者中更为普遍。业内人士认为，按人头付费为牙医提供了更大的临床自由度和更高的财务稳定性，但也更有可能导致治疗处方不足。业内人士对按人头付费作为国民医疗服务体系中儿童治疗薪酬支付方式缺乏信心。按服务收费的牙医似乎更具创新性，对患者表现出更强的忠诚感，并且比按人头付费的牙医更有过度开处方的倾向。无论薪酬制度如何，家长们对儿童服务评价很高，孩子们也觉得该服务非常可以接受。家长们对按服务收费的牙医比对按人头付费的牙医忠诚度更高。该研究揭示了所测试的按人头付费模式中的几个缺点，但所有这些问题的解决方案都已明晰。超过12个月的按人头付费协议将简化管理并降低成本，减少表格数量也会如此。在诊所更换牙医时需要通知家长，这带来了相当大的困难并增加了费用。创伤治疗和正畸拔牙本应被排除在按人头付费之外。接受获取牙医按人头付费活动信息的必要性，但信息应保持简单且相关。可以从为行政目的收集的常规数据中对按人头付费下的护理质量进行监测。按人头付费似乎不会增加参与度。按人头付费的管理成本与按服务收费的成本相差不大。与按服务收费相比，按人头付费时每位牙医和每位患者花费的资源更多。在临床试验中，按服务收费比按人头付费更具成本效益。（摘要截选至400字）
