期刊
COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY
卷 39, 期 5, 页码 465-473出版社
WILEY-BLACKWELL
DOI: 10.1111/j.1600-0528.2011.00622.x
关键词
reimbursement; incentive; financing; professional practices
资金
- National Institute for Health Research Service Delivery and Organisation programme [08/1618/158]
- National Institutes of Health Research (NIHR) [CS/08/08/02] Funding Source: National Institutes of Health Research (NIHR)
- National Institute for Health Research [CS/08/08/02] Funding Source: researchfish
Background: There is a tension between financial incentives and professional codes and norms, both of which are believed to influence the behaviour of health care professionals. This study examined the impact of changes to financial incentive structures on the behaviour of dentists working in the English National Health Service (NHS) as a result of a new national contract. Methods: Comparison of six reference treatments delivered by all NHS dentists in England for the period 1992-2009. Results: Large and abrupt changes in the provision of the reference treatments coincided with the introduction of changes in the incentive structure in 2006. Treatments which can be provided in the least amount of time (and therefore costs to dentists) such as extractions increased and treatments which are time consuming or have significant additional materials costs such as bridgework, crowns, root fillings and radiographs reduced substantially. Conclusions: Changes to financial incentive structures can produce large and abrupt changes in professional behaviours. In the context of multiple and conflicting goals, greater thought needs to be given to policies to change incentive structures to mitigate their unintended consequences.
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