Private dentists assess treatment required as more extensive, demanding and costly, than public sector dentists
Article first published online: 14 MAR 2012
© 2012 John Wiley & Sons A/S
Community Dentistry and Oral Epidemiology
Volume 40, Issue 4, pages 362–368, August 2012
How to Cite
- Issue published online: 17 JUL 2012
- Article first published online: 14 MAR 2012
- Manuscript Accepted: 20 JAN 2012
- Manuscript Received: 16 JUN 2011
- Hospital District of Southwest Finland and the City of Turku
- Private sector;
- Public sector;
- Dental services
The aim was to evaluate whether contracted private practitioners assess required treatment more extensive, demanding and economically more rewarding than mainly salaried public sector dentists and to estimate the cost consequences of using these alternative providers.
All dental services included in comprehensive treatments funded by the city of Turku and provided to adult patients during the year 2009 were recorded. Patients were distributed randomly without any determination of treatment needs before appointing them to different dentists. Treatment courses for 7432 patients in public clinics included 63 906 procedures and for 2932 patients assigned to treatment by contracted private practitioners included 21 194 procedures. Public sector dentists were mainly salaried with production incentives, and private practitioners worked purely on a fee-for-service basis. The cost estimates were based on the distributions of competence classifications recorded by the providers, which also formed the basis for reimbursement.
For each studied treatment category with more than one competence classification, private contractors were less likely than their public sector counterparts to give an assessment of simple or less demanding: 8% versus 29% of examinations, 46% versus 69% of periodontal treatments, 63% versus 85% of extractions, 31% versus 46% of fillings, 18% versus 35% of root canals. The excess cost to society varied from 7.0% for root canal treatments to 21.3% for extractions, causing on average 14.4% higher cost level from use of private practitioners compared with public sector dentists.
Private practitioners systematically classified the treatment procedures they provided as more demanding, and therefore more economically rewarding, than their public sector counterparts. The findings indicate that the costs of publicly funded dental care may be increased by the use of private dental contractors.