YORK, UK: Radiographs are useful in diagnostics, but they expose patients to potentially harmful radiation. Thus, with every radiograph they take, dentists are advised to carefully calculate the benefits versus the risks for the patient. Research conducted by the University of York has now found that dentists are more likely to request or take radiographs when they are paid for each radiograph taken, even when it is not clinically necessary to do so.
When patients were exempt from charges, the number of radiographs also went up significantly. Fewer radiographs were taken, however, when dentists were on a fixed salary, according to the paper published in the latest Journal of Health Economics.
The extensive analysis at the University of York’s Centre for Health Economics looked at data from Scotland on NHS dentists who were either salaried or received fee-for-service payments and their patients over a ten-year period. Over one million treatments were included in the study. It confirmed earlier but limited research on the effects that different reimbursement schemes for dentists can have on the intensity of treatment and prevalence of check-ups.
“Our results indicate that a dentist’s reimbursement method induces a significant impact on X-ray use, with dentists who are paid a separate fee for each X-ray providing more X-rays,” the researchers state in their paper.
Although they encourage further research, they said that the findings could already have significant impact on public health policy, particularly in regard to protecting patients from overexposure to radiation from radiographs.
“Even if patients may voluntarily opt to receive a lower level of X-raying than would be optimal from a risk–benefit perspective, it nevertheless seems ethically questionable that the amount of X-rays received by patients who are exempt from treatment charges is significantly higher if the provider is paid fee-for-service than if (s)he is paid salary,” they concluded. “This either means that patients treated by salaried dentists receive less X-rays than optimal for their oral health or that exempt patients treated by fee-for-service dentists receive too many X-rays.”
The study, titled “First do no harm—The impact of financial incentives on dental X-rays”, was published in the March 2018 issue of the Journal of Health Economic.
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