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Treatment intensity and provider remuneration: dentists in the British National Health Service

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  • Martin Chalkley

    (Department of Economic Studies, University of Dundee, Dundee, UK)

  • Colin Tilley

    (Dental Health Services Research Unit(DHSRU), University of Dundee, Dundee, UK)

Abstract

Dental service providers in the British National Health Service (NHS) operate under a number of remuneration arrangements that give rise to different incentives. Using data derived from the Scottish dental system, we examine the relationships between remuneration, patient exemption status and treatment intensity. After controlling for differences in patient need and dentist-specific preferences, we find that self-employed dentists treat patients who are exempt from payment more intensively than their salaried counterparts. The results imply that changes in remuneration can have a large effect on the distribution of treatments. More generally, our results provide support for economic models that view financial incentives as important determinants of physician behaviour. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • Martin Chalkley & Colin Tilley, 2006. "Treatment intensity and provider remuneration: dentists in the British National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 933-946.
  • Handle: RePEc:wly:hlthec:v:15:y:2006:i:9:p:933-946 DOI: 10.1002/hec.1162
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    1. Martin Gaynor & James B. Rebitzer & Lowell J. Taylor, 2004. "Physician Incentives in Health Maintenance Organizations," Journal of Political Economy, University of Chicago Press, vol. 112(4), pages 915-931, August.
    2. John M. Abowd & Francis Kramarz & David N. Margolis, 1999. "High Wage Workers and High Wage Firms," Econometrica, Econometric Society, vol. 67(2), pages 251-334, March.
    3. Edward P. Lazear, 2000. "Performance Pay and Productivity," American Economic Review, American Economic Association, vol. 90(5), pages 1346-1361, December.
    4. Chalkley, Martin & Malcomson, James M., 2000. "Government purchasing of health services," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 15, pages 847-890 Elsevier.
    5. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
    6. Ellis, Randall P. & McGuire, Thomas G., 1996. "Hospital response to prospective payment: Moral hazard, selection, and practice-style effects," Journal of Health Economics, Elsevier, vol. 15(3), pages 257-277, June.
    7. James J. Heckman & Justin L. Tobias & Edward Vytlacil, 2000. "Simple Estimators for Treatment Parameters in a Latent Variable Framework with an Application to Estimating the Returns to Schooling," NBER Working Papers 7950, National Bureau of Economic Research, Inc.
    8. Halvorsen, Robert & Palmquist, Raymond, 1980. "The Interpretation of Dummy Variables in Semilogarithmic Equations," American Economic Review, American Economic Association, vol. 70(3), pages 474-475, June.
    9. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    10. Chalkley, Martin & Malcomson, James M., 2002. "Cost sharing in health service provision: an empirical assessment of cost savings," Journal of Public Economics, Elsevier, vol. 84(2), pages 219-249, May.
    11. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575.
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    Cited by:

    1. Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2008. "The Effect of Financial Incentives on Quality of Care: The Case of Diabetes," Melbourne Institute Working Paper Series wp2008n12, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    2. 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.
    3. Martin Chalkley & Colin Tilley & Shaolin Wang, 2011. "Comparing the treatment provided by migrant and non-migrant health professionals: dentists in Scotland," Dundee Discussion Papers in Economics 249, Economic Studies, University of Dundee.
    4. Marton, James & Yelowitz, Aaron & Talbert, Jeffery C., 2014. "A tale of two cities? The heterogeneous impact of medicaid managed care," Journal of Health Economics, Elsevier, vol. 36(C), pages 47-68.
    5. Jones, A.M, 2010. "Models For Health Care," Health, Econometrics and Data Group (HEDG) Working Papers 10/01, HEDG, c/o Department of Economics, University of York.
    6. Bonnetti, Debbie & Chalkley, Martin & Clarkson, Jan & Tilley, Colin & Young, Linda, 2008. "The Effect of Activity-Based Payment on Dentists’ Activity: Evidence from a Natural Experiment in the UK National Health Service," SIRE Discussion Papers 2008-45, Scottish Institute for Research in Economics (SIRE).
    7. Harris, Rebecca V. & Sun, Ningwei, 2012. "Translation of remuneration arrangements into incentives to delegate to English dental therapists," Health Policy, Elsevier, vol. 104(3), pages 253-259.
    8. Martin Chalkley & Colin Tilley & Linda Young & Debbie Bonnetti & Jan Clarkson, 2008. "The Effect of Activity-Based Payment on Dentists’ Activity: Evidence from a Natural Experiment in the UK National Health Service," Dundee Discussion Papers in Economics 217, Economic Studies, University of Dundee.

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