Per capita remuneration of dentists and the quality of dental services

Abstract

Objectives: The aim of this study was to examine the effects of a per capita based remuneration system on the quality of dental care.

Methods: The basis for the study was a natural experiment in the county of Østfold in Norway in which all public dental officers (n = 34) were given the opportunity to renegotiate their contract from a fixed salary to a combined per capita and fixed salary contract. Quality was assessed according to three criteria: number of preventive procedures, number of under-diagnosed carious lesions and number of untreated carious lesions. This information was selected from a random sample of patient records for 18-year-olds in the autumn of 1999 (base-line data) and at the end of 2006 (final data), altogether 20 records per dentist. At the end of the period of evaluation, 26 dentists were still eligible for inclusion in the study. The data were analysed both descriptively and using multilevel difference-in-difference regression models.

Results: The main finding was that the transition to a per capita remuneration system did not lead to under-diagnosis of carious lesions, under-treatment or less prevention.

Conclusions: A per capita remuneration scheme did not lead to a fall in the quality of dental care. This result must be assessed taking into account that the experiment was carried out within a publicly financed and managed dental service. Also, the incentive effect of the per capita contract was relatively weak.

Keywords: capitation; contracts; dental quality; fixed salary; incentives; payment systems; public dental officers.