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Payment systems and incentives in dentistry.

Jostein Grytten1

  • 1Department of Community Dentistry, University of Oslo, Oslo, Norway.

Community Dentistry and Oral Epidemiology
|November 4, 2016
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Summary

This commentary examines dental payment systems like fee-for-service and per capita, highlighting their pros and cons. It suggests that mixed systems or fixed salaries may balance quality, cost, and dentist motivation.

Keywords:
fee-for-service remunerationincentivespay-for-performanceper capita remunerationsupplier-induced demand

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Area of Science:

  • Dental Economics
  • Healthcare Management
  • Health Policy

Background:

  • Incentive-based remuneration systems are increasingly discussed in dentistry.
  • Understanding the impact of different payment models on quality, cost, and provider behavior is crucial.

Purpose of the Study:

  • To analyze the advantages and disadvantages of various incentive-based remuneration systems in dentistry.
  • To evaluate fee-for-service, per capita, mixed payment, and pay-for-performance models.
  • To explore potential solutions for mitigating negative impacts on dentist motivation and healthcare costs.

Main Methods:

  • Commentary and discussion of existing literature and theoretical frameworks.
  • Comparative analysis of different remuneration schemes based on their potential outcomes.
  • Exploration of economic principles such as supplier-induced demand and crowding-out effect.

Main Results:

  • Fee-for-service (FFS) can ensure high quality but may increase costs due to supplier-induced demand.
  • Per capita (capitation) payments can enhance efficiency but risk under-treatment and patient selection.
  • Mixed systems offer a balance, while pay-for-performance faces design and acceptance challenges.
  • All incentive systems risk undermining dentists' intrinsic motivation (crowding-out effect).

Conclusions:

  • Mixed payment systems or incorporating fixed salary components may optimize dental care delivery.
  • Neutral fee structures can help contain costs and limit supplier-induced demand.
  • Careful design and implementation are essential for any remuneration system to be effective and accepted.