Financing and delivering oral health care: what can we learn from other countries?

In Canada, the delivery of dental care is left largely to private markets; public funding is limited to targeted groups of the population and substantial variation between provinces exists. In this article, the levels and sources of expenditures on dental care, the levels and distribution of service use associated with these expenditures and the oral health outcomes "produced" in Canada are considered in an international context. The international trend toward an increasing share of public funds for dental care expenditures is not observed in Canada. Instead an increasing reliance on private funds is associated with greater barriers to care, particularly among less prosperous groups. In the absence of oral health data at the national level, the impact of these trends on oral health outcomes is unknown. Several key messages are identified in the comparative analysis to inform any future oral health strategy for Canada.

Management of dental trauma in primary care: a postal survey of general dental practitioners

OBJECTIVES

To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care.

DESIGN AND SETTING

A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England.

MAIN OUTCOME MEASURES

Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables.

RESULTS

The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Eighty-eight per cent of GDPs felt that aids to management would be useful.

CONCLUSIONS

Although GDPs believed that financial remuneration was inadequate, this did not prevent them treating trauma cases. They strongly agreed that they had responsibility for the management of dental trauma in primary care and that they believed trauma could be treated more effectively in practice if payment was greater. Time constraints were perceived as a barrier to long-term management of complex trauma cases in primary care. GDPs would welcome the use of management aids.

[Notes on the GKV-modernization law (GMG)--a dentist's trend analysis]

Effective January 1st 2004 medical aid for patients receiving aid by means of the Federal German social welfare act has been transferred from the local social welfare offices to the statutory health insurances by decree regarding act modernisation of the statutory health insurance (GMG). The authors analyse the epidemiological and economical parameters concerning dental medical care for the city of Wuppertal on the basis of the experiences from 1994 to 2003 and attempt a well-founded forecast: the quality of medical standards will decline, whereas cost will rise.

Distribution of NHS resources for children's dental care in general dental practice in England

OBJECTIVE

To determine the relationship between the distribution of NHS resources in general dental practice and dental need and access to services for the population in England under the age of 18 in different socio-economic areas.

BASIC RESEARCH DESIGN

A proxy for the oral health of under 18 year olds was made from prevalence surveys undertaken on five year old children in each health authority area in 1999/2000. The level of spending per head of the population was ascertained from Dental Practice Board data. Health authorities were grouped according to the eleven United Kingdom Office of National Statistics socio-economic groups. Access was measured by using registration levels of children.

SETTING

General dental practices providing National Health Service treatment for children aged 0-18 in England.

RESULTS

There was no correlation (r = -0.03) between increasing need for dental care using mean dmft as a proxy and increasing spending per head of the population for each health authority. There was a correlation (r = 0.38) between increasing registration rates and increased spending per head. The populations under 18 had more spent on their oral health care living in areas classified as Mixed Economies, Services and Education and Most Prosperous. Those in Inner London, Manufacturing, Ports and Industry had proportionately the least. The difference between the highest and lowest group was 33%. The groups of Authorities were not homogenous in their level of resources with variations between Authorities in the same groups.

CONCLUSIONS

The distribution of NHS resources to general dental practice for people under 18 does not reflect population need. The higher the registration rate for children the greater the amount resources deployed in an area.

Evaluating the Cost-Effectiveness of Orthodontic Provision

The assessment of orthodontic provision is important to determine if treatment was necessary and undertaken appropriately. The ICON objectively quantifies orthodontic treatment need, complexity and outcome and is a valuable occlusal index in the assessment effectiveness of orthodontic care. It is possible to develop cost-effectiveness models by analysing the costs and effectiveness of orthodontic treatment. Several methods are illustrated to compare the orthodontic provision of specialist orthodontists.