A trial of a capitation system of payment for the treatment of children in the General Dental Service. Final report. Dental Health Services Research Unit, University of Manchester. September, 1989

Abstract

A 3-year clinical trial comparing capitation and fee-for-service remuneration systems for general dental practitioners for the treatment of children has been successfully completed. Capitation dentists restored carious teeth at a later stage in the disease process than fee-for-service controls, and carried out more preventive treatment and advice. However, the disease experience of their patients was little different from that of patients treated under fee-for-service. Capitation dentists saw their patients less frequently and took fewer radiographs than their fee-for-service colleagues. The prevalence of both fissue sealants and arrested caries was low in both groups, as was the prevalence of teeth extracted as a result of caries. Levels of oral cleanliness were similar under both systems. Private treatment was rarely prescribed for children, but was more prevalent for patients of fee-for-service dentists. The profession felt that capitation offered greater clinical freedom and more financial stability to dentists, but a greater temptation to under-prescribe treatment. The profession lacked commitment to capitation as a method of remuneration for the treatment of children in the General Dental Service. Fee-for-service dentists appeared to be more innovative, expressed a greater allegiance to their patients and felt a greater temptation to over-prescribe than capitation dentists. The parents had a high opinion of the service for children, irrespective of the remuneration system, and the children found the service very acceptable. Parents had a stronger allegiance to the fee-for-service than the capitation dentists. The study revealed several short-comings in the capitation model tested, but solutions to all of these became apparent. A capitation agreement of more than 12 months would simplify administration and reduce costs, as would a reduction in the number of forms. The need to notify parents when a dentist was replaced in a practice created considerable difficulties and increased expense. The treatment of trauma and extractions for orthodontic purposes should have been items excluded from the capitation fee. The need for information on dentists' activity in capitation was accepted but should be kept simple and relevant. Monitoring quality of care under capitation can be carried out from the routine data collected for administrative purposes. Capitation does not appear to increase participation. Costs of administering capitation are little different from those for fee-for-service. More resources were spent per dentist and per patient under capitation than fee-for-service. In the clinical trial fee-for-service was more cost-effective than capitation.(ABSTRACT TRUNCATED AT 400 WORDS)