Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health
Yevgeni Dudko A , Estie Kruger A B and Marc Tennant AA International Research Collaborative–Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, Faculty of Science, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia. Email: yevgeni.dudko@uwa.edu.au; marc.tennant@uwa.edu.au
B Corresponding author. Email: estie.kruger@uwa.edu.au
Australian Health Review 39(1) 51-55 https://doi.org/10.1071/AH14064
Submitted: 29 April 2014 Accepted: 1 September 2014 Published: 27 October 2014
Abstract
Objective In Australia, access to dental care has been available through several different pathways: (1) private practice; (2) public clinics; (3) Aboriginal Medical Services (AMS)-based clinics; and (4) until recently, the Chronic Disease Dental Scheme (CDDS). The aim of the present study was to compare the types of dental services most commonly delivered in the various clinical pathways based on the hypothesis that disease-driven care should lead to similar mixes of dental care provided.
Methods Data from a series of previously published sources was used to identify and compare the most commonly performed dental procedures in the different pathways. A comparison was also made with the available international data (US).
Results There was a marked difference between service mixes provided through the four pathways. Patients obtaining dental care through AMS-based and public pathways had more extractions and less restorative and preventive care compared with private and CDDS pathways. Compared with the international data, dental service mixes in Australia were found to be not as evenly distributed. Value of care provided through private and CDDS pathways were two- to threefold higher than that of AMS-based and public pathways.
Conclusion The data indicate that the original hypothesis that the disease-driven care should lead to similar mixes of provided dental care, is not supported.
What is known about the topic? The pricing of dental care is a topic that gets substantial discussion in the private sector. However, its effect in the government sector is very limited in its consideration. This research is a bold first step in Australia to look at the influence of different modes of care delivery on the mix of care provided.
What does this paper add? This research is a unique first effort to examine the influence of different modes of care delivery on the type of care provided. It clearly highlights that the pathway for care in the government sector do have very different care outcomes.
What are the implications for practitioners? The implications are clear; practitioners need to be aware that care is provided in the context of the pathway in which the care is offered and this will influence the type of care provided. Care is not a single outcome and multiple factors influence the outcome for patients.
Additional keywords: care pathways, dental service mixes, oral health.
References
[1] Australian Institute of Health and Welfare (AIHW). Adult oral health and dental visiting in Australia: results from the National Dental Telephone Interview Survey 2010. Dental Statistics and Research Series no. 65. Cat. no. DEN 227. Canberra: AIHW; 2013.[2] Lam R, Kruger E, Tennant M. Experiences in the implementation of a national policy: a retrospective analysis of the Australian Chronic Dental Disease Scheme. AMJ 2012; 5 551–9.
| Experiences in the implementation of a national policy: a retrospective analysis of the Australian Chronic Dental Disease Scheme.Crossref | GoogleScholarGoogle Scholar | 23173020PubMed |
[3] Tennant M, Kruger E. A national audit of Australian dental practice distribution: do all Australians get a fair deal? Int Dent J 2013; 63 177–82.
| A national audit of Australian dental practice distribution: do all Australians get a fair deal?Crossref | GoogleScholarGoogle Scholar | 23879252PubMed |
[4] Dental Health Services. Eligibility information for adults; 2008. Available at: http://www.dental.wa.gov.au/adult/eligibility.php [verified 10 July 2014].
[5] Kruger E, Tennant M, George R. Application of geographic information systems to the analysis of private dental practices distributed in Western Australia. J Rural Remote Health 2011; 11 1736
[6] Australian Dental Association. Inquiry into adult dental services in Australia; 2013. Available at: http://www.ada.org.au/App_CmsLib/Media/Lib/1304/M578038_v1_635018044353624420.pdf [verified 20 February 2014].
[7] Dyson K, Kruger E, Tennant M. Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments. Aust J Rural Health 2012; 20 334–8.
| Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.Crossref | GoogleScholarGoogle Scholar | 23181819PubMed |
[8] Roth P. Call to reprieve dental care scheme:– but is it worth saving? Melbourne: Monash University 2012. Available at: http://artsonline.monash.edu.au/mojo/call-to-reprieve-dental-care-scheme-but-is-it-worth-saving/ [verified 09 July 2014].
[9] Kruger E, Perera I, Tennant M. Primary oral health service provision in Aboriginal Medical Services-based clinics in Western Australia. Aust J Prim Health 2010; 16 291–5.
| Primary oral health service provision in Aboriginal Medical Services-based clinics in Western Australia.Crossref | GoogleScholarGoogle Scholar | 21138696PubMed |
[10] Armfield J, Brennan D, Carter K, Chalmers J, Kriven S, Stewart J,Szuster F, Spencer A J, Mathew R, Narayanan A, Slade G, Roberts-Thomson K. Patterns of dental service provision in general practice. Adelaide: Australian Institute of Health and Welfare; 1998. Available at: https://www.adelaide.edu.au/arcpoh/downloads/publications/newsletters/newsletter-IX-no-1.pdf [verified 10 February 2014].
[11] Manski RJ, Macek MD, Brown E, Carper KV, Cohen LA, Vargas C. Dental services mix among working-age adults in the United States, 1999 and 2009. J Public Health Dent 2013; 74 102–9.
| 24032402PubMed |
[12] Australian Dental Association. The Australian Schedule of Dental Services and Glossary 2013. Available at: http://www.ada.org.au/app_cmslib/media/lib/1303/m538110_v1_10th%20editon%20schedule%20and%20glossary_web.pdf [verified 16 February 2014].
[13] Bloomfield, K. Fundamental Review of Dental Remuneration 1992. Department of Health, London.
[14] Chrisopoulos S, Beckwith K, Harford JE. Oral health and dental care in Australia: key facts and figures 2011. Cat. no. DEN 214. Canberra: Australian Institute of Health and Welfare; 2011.
[15] Australian Dental Association. Socioeconomic status and oral health; 2006. Available at: http://www.ada.org.au/app_cmslib/media/lib/0702/m44818_v1_socioeconomic%20status%20and%20oral%20healthsep_06.pdf [verified 10 July 2014].
[16] McAuliffe A, Nanda-Paul S, Dooland M. National oral health plan. Inequities in Oral Health; 2004. Available at: http://oralhealthplan.com.au/inequities-oral-health [verified 09 July 2014].
[17] Australian Research Centre for Population Oral Health. Geographic variation in oral health and use of dental services in the Australian population 2004–06; 2009. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455420 [verified 10 July 2014].
[18] Butani Y, Weintraub J, Barker J. Oral health-related cultural beliefs for four racial/ethnic groups; assessment of the literature. BMC Oral Health 2008; 8 26
| 18793438PubMed |
[19] Australian Dental Association. Demand for dental services in Australia; 2013. Available at: http://www.ada.org.au/App_CmsLib/Media/Lib/1311/M709141_v1_demand_for_dental_services_australia.pdf [verified 12 July 2014].
