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BMC Health Services Research

, 17:175

Organization, structure and delivery of healthcare


BackgroundIn 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.

MethodsWe 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.

ResultsNo 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.

ConclusionAlthough 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.

AbbreviationsBSOBusiness Services Organisation

DHSSPSThe Department of Health, Social Services and Public Safety


GDSGeneral Dental Services

HSCBHealth and Social Care Board

IMDIndex of multiple deprivation

OLSOrdinary Least Squares

RESETThe Ramsey Regression Equation Specification Error Test

UKUnited Kingdom

Electronic supplementary materialThe online version of this article doi:10.1186-s12913-017-2117-3 contains supplementary material, which is available to authorized users.

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Autor: Harry Hill - Stephen Birch - Martin Tickle - Ruth McDonald - Michael Donaldson - Donncha O’Carolan - Paul Brocklehurst


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