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Provider incentives and access to dental care: Evaluating NHS reforms in England

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Author Info

  • Whittaker, William
  • Birch, Stephen

Abstract

Changes were made to the management and delivery of primary dental care in the NHS in England in 2006 aimed at improving access to NHS dental services among populations with low use. These included: (i) commissioning of NHS dental services by primary care trusts (ii) replacing item of service patient charges by Course of Treatment cost bands and (iii) changing the remuneration of dentists providing NHS dental care. Using longitudinal data from the 1991-2008 waves of the British Household Panel Survey, we estimate the effects of these changes on the levels and distribution of dental care in the population and on the public–private mix of primary dental care services in England using dynamic probit models. We find evidence of a decrease in NHS use, driven by reductions in use among populations with previously good access to care and a positive effect of the reforms on consumer transitions from NHS to private practice. Our results highlight the potential (unintended) consequences of reforming public health care systems. It appears that contrary to expanding NHS access, the dental reforms contracted NHS use amongst those with previously good access. This contraction relied upon the ability of the private sector to absorb this group.

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Bibliographic Info

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 75 (2012)
Issue (Month): 12 ()
Pages: 2515-2521

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Handle: RePEc:eee:socmed:v:75:y:2012:i:12:p:2515-2521

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Related research

Keywords: Dynamic modelling; Unobserved heterogeneity; Dental care; Access; England;

References

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  1. Jones, Andrew M, 1992. "A Note on Computation of the Double-Hurdle Model with Dependence with an Application to Tobacco Expenditure," Bulletin of Economic Research, Wiley Blackwell, vol. 44(1), pages 67-74, January.
  2. Grytten, Jostein & Holst, Dorthe & Laake, Petter, 1993. "Accessibility of dental services according to family income in a non-insured population," Social Science & Medicine, Elsevier, vol. 37(12), pages 1501-1508, December.
  3. Birch, Stephen, 1988. "The identification of supplier-inducement in a fixed price system of health care provision : The case of dentistry in the United Kingdom," Journal of Health Economics, Elsevier, vol. 7(2), pages 129-150, June.
  4. Jones, Andrew M, 1989. "A Double-Hurdle Model of Cigarette Consumption," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 4(1), pages 23-39, Jan.-Mar..
  5. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 31(3), pages 129-137.
  6. Jeffrey M Wooldridge, 2002. "Simple solutions to the initial conditions problem in dynamic, nonlinear panel data models with unobserved heterogeneity," CeMMAP working papers CWP18/02, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.
  7. Jostein Grytten & Rune S�rensen, 2000. "Competition and dental services," Health Economics, John Wiley & Sons, Ltd., vol. 9(5), pages 447-461.
  8. Cragg, John G, 1971. "Some Statistical Models for Limited Dependent Variables with Application to the Demand for Durable Goods," Econometrica, Econometric Society, vol. 39(5), pages 829-44, September.
  9. Mcintyre, Di & Thiede, Michael & Birch, Stephen, 2009. "Access as a policy-relevant concept in low- and middle-income countries," Health Economics, Policy and Law, Cambridge University Press, vol. 4(02), pages 179-193, April.
  10. Urpo Kiiskinen & Anna Liisa Suominen-Taipale & John Cairns, 2010. "Think twice before you book? Modelling the choice of public vs private dentist in a choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 19(6), pages 670-682.
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Cited by:
  1. Listl, Stefan & Chalkley, Martin, 2014. "Provider payment bares teeth: Dentist reimbursement and the use of check-up examinations," Social Science & Medicine, Elsevier, vol. 111(C), pages 110-116.

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