Public Services Programme

Further Information: Project Posters

Updated Project Poster 2009

Below is a summary of this project’s provisional findings. It was originally presented as a dissemination poster, which is available here as a pdf document. All figures can be found at the bottom of this poster summary as thumbnails, which one should click to view full-size images. Alternatively, where figures are reffered to in the text, click the linked text for a full-size version.

 

HOW DO ATTITUDES AND INCENTIVES SHAPE DENTAL TREATMENT?

Background

For all professionals providing public services, the way formal incentives interact with individual attitudes and professional norms to shape behaviour is central to policy and institutional design. Dentists are a key example: would you rather your dentist was paid on a fee- per-item basis (meaning dentists are paid a fee for each treatment carried out, but there may be an incentive to over-treat), or paid a fixed monthly amount (meaning there may be an incentive to under-treat)? How best to pay dentists is central to NHS dentistry policy in the UK and indeed in 2006 England and Wales moved from a payment system like the first type to a payment system like the second.

Aims

We aimed to:

» put together, for the first time, data on treatment given by a cohort of dentists across the UK, who all graduated in the same year, with measures of those dentists’ attitudes and information about the various types of contracts those dentists worked under.

» Creating this unique database was intended both to help us to exploit the natural experiment resulting from the changeover in NHS dentist contracts and to explain the way dentists’ attitudes and contracts interact to influence the way they treat patients.

What We Did

» We had to put together a research team that combined expertise in dentistry with social science expertise (psychology and economics).

» We gathered  data on clinical treatment from routinely collected payment records (Figure 1) and data on dentist attitudes from questionnaire surveys. This involved a formidable obstacle course of negotiating approvals from national and local NHS R&D bodies across the UK (Figure 2).

» To test our predictions of how payment systems affect attitudes and treatment we use theoretical and empirical models, incorporating contract types, dentist attitudes and patient co-payments.

Provisional Findings

So far this project has revealed:

» the extent of the obstacles to clearing health research projects that go across the UK to make use of its potential as a site for a natural experiment;

» the extent of variation in dentists’ concern for patients’ ability to pay (Figure 3);

» the extent to which intensity of treatment depended on patients’ liability to pay part of the costs, known as co-payments, themselves (Figure 4).

» We are completing our analysis of the links between attitudes and treatment to determine the effect of attitudes within contracts, and how contracts affect attitudes and treatment.

Figures

Click on the figures to enlarge

                          

Project Publications

Discussion Paper DP0807, Initial Estimates of the Impact of the New NHS Dental Contract on England and Wales, is available in the Library section of our website.

Article in JPART Special Issue on Incentives Martin Chalkley, Colin Tilley, Linda Young, Debbie Bonetti, and Jan Clarkson ‘Incentives for Dentists in Public Service: Evidence from a Natural Experiment ’, July 2010.