Hill Harry, Birch Stephen, Tickle Martin, McDonald Ruth, Donaldson Michael, O'Carolan Donncha, Brocklehurst Paul
School of Dentistry, University of Manchester, Manchester, M13 9PL, UK.
Manchester Centre for Health Economics, University of Manchester, Manchester, M13 9PL, UK.
BMC Health Serv Res. 2017 Mar 6;17(1):175. doi: 10.1186/s12913-017-2117-3.
In May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services.
We analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system.
No evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups.
Although remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients.
2009年5月，北爱尔兰政府在一家企业牙科服务提供商新设立的牙科诊所引入了基于人头费的一般牙科服务（GDS）合同，以促进此前难以获得牙科服务的人群获得牙科护理。牙科服务是人群总体健康服务的重要组成部分，但卫生系统融资对所提供护理的影响以及服务的财务成本在研究文献中受到的关注相对较少。本研究的目的是评估最近开业的企业诊所中人头费支付政策对北爱尔兰初级口腔保健服务提供和服务可及性的影响。
我们将北爱尔兰的这项政策举措作为一项自然实验进行分析，以找出新设立的采用前瞻性人头费系统支付初级保健牙医薪酬的企业诊所对医疗服务提供的影响。数据收集自2011年4月至2014年10月期间提交给商业服务组织（BSO）的GDS索赔表。在人头费系统下运营的卫生和社会保健委员会（HSCB）诊所与一个对照组进行匹配，对照组采用回顾性按服务收费系统支付薪酬。
在由企业提供商设立并在人头费制度下运营的HSCB诊所中，未发现患者选择的证据。然而，与对照组患者相比，这些诊所的患者看牙医的可能性较小，就诊时接受的治疗也较少（P < 0.05）。两个诊所组在提供的预防活动程度和患者支付费用收入方面没有差异。
尽管在新设立的企业诊所中采用前瞻性人头费系统支付国民保健制度初级保健牙医薪酬可控制医疗保健成本，但有证据表明该政策可能减少了注册患者获得护理的机会。
