Do economic incentives influence the provision of dental services in a third-party funded dental scheme?

Objectives: To investigate whether the provision of dental services is influenced by
economic incentives in a third-party funded dental service in the Republic of Ireland.
Methods: Four treatment items were identified as outcome variables. These items
were characterised by variation in regulation among administrative regions or
variation in regulation over time. The items were Extra Oral Radiographs,
Endodontics, Prolonged Periodontal Treatment, and Surgical Extractions. Claims data
were obtained from the Primary Care Reimbursement Service (PCRS), formerly
known as the General Medical Services Payments Board (GMSPB). Population data
were obtained from the Central Statistics Office. Data were obtained from the
Principal Dental Surgeons in Ireland who apply local regulatory or price controls for
certain items of treatment. The data were analysed to determine the impact of the
variation in regulatory approach on claims data among the eight regional health
administrative areas whilst controlling for known clinical or population structural
factors.
Results: There was a substantially lower than average provision of Extra-Oral
Radiographs in regions where regulation was stringently applied. The provision of
Prolonged Periodontal Treatment was positively correlated with price. The dentist-to-
population ratio is positively correlated with claims for Surgical Extractions.
Conclusions: There is evidence from within the funding system that economic
incentives, arising from either the contract itself or due to the geographical structure
of the dentist workforce in Ireland, leads to variations in certain items of service
provision which are potentially inefficient and independent of known treatment need