Section for Translational Health Economics, Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany.
Centre for Health Economics, University of York, York, UK.
Eur J Health Econ. 2022 Feb;23(1):59-65. doi: 10.1007/s10198-021-01348-3. Epub 2021 Jul 13.
In many market settings individuals are encouraged to switch health care providers as a means of ensuring more competition. Switching may have a potentially undesirable side effect of increasing unnecessary treatment. Focusing on the most common source of medical radiation (dental X-rays), the purpose of this study was to assess whether, upon switching dentist, X-ray exposure increases depending on the type of provider payment.
The analysis used longitudinal data from 2005 to 2016 covering a 5% random sample of the Scottish adult population covered by the National Health Service (NHS). Multiple fixed-effects panel regression analyses were employed to determine the correlation of provider remuneration with patients' likelihood of receiving an X-ray upon switching to a new dentist other things equal. A broad set of covariates including a patient's copayment status was controlled for.
Upon switching to a dentist who was paid fee-for-service, patients had a by 9.6%-points (95% CI 7.4-11.8%) higher probability of receiving an X-ray, compared to switching to a salaried dentist. Results were robust when accounting for patient exemption status, as well as unobserved patient and dentist characteristics.
In comparison to staying with the same dentist, patients may be exposed to substantially more X-rays upon switching to a dentist who is paid fee-for-service. There may need to be better guidance and regulation to protect the health of those who have to switch provider due to moving and greater caution in advocating voluntary switching.
在许多市场环境中，鼓励个人更换医疗服务提供者，以确保更多的竞争。这种转换可能会产生一种潜在的不良副作用，即增加不必要的治疗。本研究聚焦于医疗辐射的最常见来源（牙科 X 光），旨在评估在更换牙医时，X 光照射是否会因提供者支付方式的不同而增加。
该分析使用了 2005 年至 2016 年期间覆盖苏格兰国民保健服务（NHS）覆盖的 5%随机抽样成年人的纵向数据。采用多项固定效应面板回归分析，以确定在其他条件相同的情况下，提供者报酬与患者在更换新牙医时接受 X 光照射的可能性之间的相关性。控制了患者共付额状况等广泛的协变量。
与更换为受薪牙医相比，患者在更换为按服务收费的牙医时，接受 X 光照射的可能性要高出 9.6%（95%CI7.4-11.8%）。当考虑到患者豁免状况以及未观察到的患者和牙医特征时，结果仍然稳健。
与继续由同一位牙医治疗相比，患者在更换按服务收费的牙医时，可能会接受更多的 X 光照射。可能需要更好的指导和监管，以保护那些因搬家而不得不更换提供者的人的健康，并在提倡自愿更换时更加谨慎。
