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The Effect of Activity-Based Payment on Dentists’ Activity: Evidence from a Natural Experiment in the UK National Health Service

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  • Bonnetti, Debbie
  • Chalkley, Martin
  • Clarkson, Jan
  • Tilley, Colin
  • Young, Linda

Abstract

The extent to which remuneration systems affect the behaviour of health care professionals is of considerable importance in the administration of publicly funded heath care systems. Using data across two jurisdictions in the United Kingdom, in only one of which remuneration was changed, we compare the extent of measured dental activity at the dentist level in order to ascertain the impact of moving to activity-based remuneration. We find that there are large and statistically significant increases in activity as dentists moved to the activity-based system and that a dentist’s previous form of contract is an important determinant of the magnitude of the effect. We also explore the extent to which dentists’ professional attitudes can explain differences in their activity and find that some aspects of self-reported attitudes are associated with observable differences in activity.

Suggested Citation

  • 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).
    • Handle: RePEc:edn:sirdps:58
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    File URL: http://hdl.handle.net/10943/58
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    References listed on IDEAS

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    1. 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.
    2. Richard Blundell & Monica Costa Dias, 2009. "Alternative Approaches to Evaluation in Empirical Microeconomics," Journal of Human Resources, University of Wisconsin Press, vol. 44(3).
    3. 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.
    4. Martin Chalkley & Colin Tilley, 2005. "The Existence and Nature of Physician Agency: Evidence of Stinting from the British National Health Service," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 647-664, September.
    5. 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.
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