Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health

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.