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First do no harm – The impact of financial incentives on dental x-rays


  • Martin Chalkley

    (Centre for Health Economics, University of York, York, UK.)

  • Stefan Listl

    (Department of Quality and Safety of Oral Health Care, Radboud University, Radboud, Netherlands.)


This paper assesses the impact of dentist remuneration on the incidence of potentially harmful dental x-rays. We use unique panel data which provide details of 1.3 million treatment claims by Scottish NHS dentists made between 1998 and 2007. Controlling for unobserved heterogeneity of both patients and dentists we estimate a series of fixed-effects models that are informed by a theoretical model of x-ray delivery and identify the effects on dental x-raying of dentists moving from a fixed salary to fee-for-service and patients moving from co-payment to exemption. We establish that there are significant increases in x-rays when dentists receive fee for service rather than salary payments and patients are made exempt from payment. There are further increases in x-rays when a patient switches to a fee for service dentist relative to them switching to a salaried one.

Suggested Citation

  • Martin Chalkley & Stefan Listl, 2017. "First do no harm – The impact of financial incentives on dental x-rays," Working Papers 143cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:143cherp

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    References listed on IDEAS

    1. Jostein Grytten & Dorthe Holst & Irene Skau, 2009. "Incentives and remuneration systems in dental services," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 259-278, September.
    2. 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, September.
    3. 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.
    4. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
    5. 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.
    6. Zweifel, Peter & Manning, Willard G., 2000. "Moral hazard and consumer incentives in health care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 8, pages 409-459, Elsevier.
    7. Whittaker, William & Birch, Stephen, 2012. "Provider incentives and access to dental care: Evaluating NHS reforms in England," Social Science & Medicine, Elsevier, vol. 75(12), pages 2515-2521.
    8. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    9. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 8th January 2018
      by Chris Sampson in The Academic Health Economists' Blog on 2018-01-08 18:00:21

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    More about this item


    Healthcare; incentives; matched data; dentistry;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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