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

Listed author(s):
  • 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.

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File URL: https://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP143_impact_financial_incentives_dental_xrays.pdf
File Function: First version, 2017
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Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 143cherp.

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Length: 21 pages
Date of creation: Feb 2017
Handle: RePEc:chy:respap:143cherp
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  1. 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.
  2. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
  3. 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.
  4. 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.
  5. 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.
  6. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
  7. 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.
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