Implementation of altered provider incentives for a more individual-risk-based assignment of dental recall intervals: evidence from a health systems reform in Denmark.

Equipping health systems with suitable incentives for efficient resource allocation remains a major health policy challenge. This study examines the impacts of 2015 regulatory changes in Danish dental care which aimed at effectuating a transition from six-to-twelve-monthly dental recall intervals, for every patient, towards a model where patients with higher need receive dental recalls systematically more frequently than patients with lower need. Exploiting administrative data from the years 2012-2016 from the Danish National Health Insurance database containing 72,155,539 treatment claims for 3,759,721 unique patients, we estimated a series of interrupted time-series regression models with patient-level fixed-effects. In comparison to the pre-reform period, the proportion of patients with recall intervals of up to 6 months was by 1.2%-points larger post-implementation; that of patients with 6-12-monthly recalls increased by 0.7%-points; that of patients with more than 12-monthly dental recalls decreased by 1.9%-points. The composition of care shifted more substantially: the proportion of treatment sessions including preventive care increased by 31.5%-points (95%-CI: 31.4;31.6); that of sessions including scaling increased by 24.1%-points (24.0;24.2); that of sessions including diagnostics decreased by 34.5%-points (34.4;34.6). These findings suggest that dental care providers may have responded differently to regulatory changes than intended by the health policy.

Getting the Incentives Right: Improving Oral Health Equity With Universal School-Based Caries Prevention.

Despite significant financial, training, and program investments, US children's caries experience and inequities continued to increase over the last 20 years. We posit that (1) dental insurance payment systems are not aligned with the current best evidence, exacerbating inequities, and (2) system redesign could meet health care's triple aim and reduce children's caries by 80%. On the basis of 2013 to 2016 Medicaid and private payment rates and the caries prevention literature, we find that effective preventive interventions are either (1) consistently compensated less than ineffective interventions or (2) not compensated at all. This economic and clinical misalignment may account for underuse of effective caries prevention and subsequent overuse of restorative care. We propose universal school-based comprehensive caries prevention to address this misalignment. Preliminary modeling suggests that universal caries prevention could eliminate 80% of children's caries and cost less than one fifth of current Medicaid children's oral health spending. If implemented with bundled payments based on cycle of care and measurable outcomes, there would be an alignment of incentives, best evidence, care, and outcomes. Such a program would meet the Healthy People Oral Health goals for children, as well as health care's triple aim.

The 300 most cited articles published in periodontology.

OBJECTIVES: It is important to evaluate the characteristics of the most cited articles in any specialty. The number of citations may be a proxy for clinical and research activity. The objectives of the present methodological study were (1) to report the characteristics of the 300 most cited articles in periodontology and (2) to explore the association of these characteristics with the number of citations. METHODS: We searched in the Web of Science database for the 300 most cited articles published in periodontology on June 15, 2015. We described characteristics of the articles such as type of study, type of scientific journal, topic reported, year of publication, affiliation of the first author of the article, and impact factor. Linear regression analysis was used to investigate associations of these variables with the number of citations. RESULTS: The search retrieved approximately 155,356 publications; out of the studies that met the eligibility criteria, the 300 most cited were included for analysis. Comprising more than 50 % of the included articles, basic biology and the detection of bacteria were the most prevalent topics. Narrative reviews were the most frequent type of article (27 % of the sample). Regression analysis demonstrated that some characteristics, for example "narrative reviews," are more prone to be cited than others. CONCLUSION: We conclude that scientific evolution in periodontology has been based more on narrative reviews than on reproducible systematic reviews. CLINICAL RELEVANCE: Future research is encouraged to elucidate the extent to which scientific progress is improved through systematic compared with narrative reviews.

Once bitten, twice shy? Lessons learned from an experiment to liberalize price regulations for dental care.

In 2012, The Netherlands established the so-called "free market experiment", which allowed providers of dental care to set the prices for their dental services themselves. The introduction of market mechanisms is intended to improve the quality of care and to contribute to cost containment, but increasing health expenditures for citizens have been observed in this context. Using large-volume health insurance claims data and exploiting the 2012 experiment in Dutch dental care, we identified the effects of a liberalization of service prices. Using pooled regression with individual fixed effects, we analyzed changes in utilization patterns of prevention-oriented dental services in response to the experiment as well as the elasticities in demand in response to variations in out-of-pocket (OOP) prices. We found substantial increases in prices and patients' OOP contributions for dental services following the liberalization with differences in increases between types of services. In response to the experiment, the proportion of treatment sessions containing preventive-oriented services decreased significantly by 3.4% among adults and by 5.3% for children and adolescents. Estimates of short-run price elasticities of demand for different services point towards differences in price sensitivity. One potential explanation for the observed variations in prices and utilization could be different extents of asymmetric information for first-stage and follow-on services. Price liberalization seems to have affected the composition of treatment sessions towards a decreasing use of preventive services, suggesting a shift in the reason for seeing a dental care provider from a regular-preventive perspective to a symptom-based restorative approach.

Detecting and Resolving Data Conflicts when Using International Claims Data for Research.

Using claims data for research is well established. However, most claims data analyses are focused on single countries. Multi-national approaches are scarce. The application of different anonymization techniques before data are shared for research as well as differences in the reimbursement systems hamper the use of claims data from multiple countries. This paper analyses data conflicts that occur when international claims data sets are used for research and develops a generic process to detect and resolve these conflicts. The approach was successfully applied in the EU-funded ADVOCATE (Added Value for Oral Care) project that acquired data from health insurance providers, health funds or health authorities in six European countries.