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Effects of provider incentives on dental X-raying in NHS Scotland: what happens if patients switch providers?

Author

Listed:
  • Olivier Kalmus

    (University Hospital Heidelberg)

  • Martin Chalkley

    (University of York)

  • Stefan Listl

    (University Hospital Heidelberg
    Radboudumc - Radboud Institute of Health Sciences)

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Suggested Citation

  • Olivier Kalmus & Martin Chalkley & Stefan Listl, 2022. "Effects of provider incentives on dental X-raying in NHS Scotland: what happens if patients switch providers?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(1), pages 59-65, February.
    • Handle: RePEc:spr:eujhec:v:23:y:2022:i:1:d:10.1007_s10198-021-01348-3
    DOI: 10.1007/s10198-021-01348-3
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    References listed on IDEAS

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    1. Martin Chalkley & Colin Tilley, 2006. "Treatment intensity and provider remuneration: dentists in the British National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 933-946, September.
    2. Listl, Stefan & Chalkley, Martin, 2014. "Provider payment bares teeth: Dentist reimbursement and the use of check-up examinations," Social Science & Medicine, Elsevier, vol. 111(C), pages 110-116.
    3. Anna-Lena Trescher & Stefan Listl & Onno Galien & Frank Gabel & Olivier Kalmus, 2020. "Once bitten, twice shy? Lessons learned from an experiment to liberalize price regulations for dental care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 425-436, April.
    4. Chalkley, Martin & Listl, Stefan, 2018. "First do no harm – The impact of financial incentives on dental X-rays," Journal of Health Economics, Elsevier, vol. 58(C), pages 1-9.
    5. Jostein Grytten & Dorthe Holst & Irene Skau, 2009. "Incentives and remuneration systems in dental services," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 259-278, September.
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