Salaried services in the delivery of dental care in Western industrialised countries: implications for the National Health Service in England.
OBJECTIVE
To examine the provision of dental services by salaried personnel in the countries of Western Europe, together with Australia, Canada and New Zealand, and to weigh the merits of this method against alternatives, namely, capitation and fee for item of service. In light of the findings, to consider the future role of salaried dental services in the National Health Service (NHS) in England.


METHODS
Information was gathered from published reports, the World Wide Web and by mailed questionnaire to national chief dental officers or equivalents.


RESULTS
Narrative descriptions of service provision in the countries with salaried primary dental care services were compiled. Demographic, macro-economic, workforce, and oral health data for the broader spectrum of Western industrialised countries were tabulated. Examination of the quantitative data showed no strong associations between variables.


CONCLUSIONS
Dental services delivered by a salaried workforce can be costly in relation to the volume of clinical activity produced. However, deployment of clinical auxiliary personnel can keep costs down. Salaried services foster a preventive approach to care and are particularly suitable where care is directed towards vulnerable groups within the community. Salaried staff generally receive a lower level of remuneration than private practitioners but usually work in an environment less subject to undue pressures of time.
Downer
M C
MC
m.downer@mailbox.ulcc.ac.uk
Drugan
C S
CS
Blinkhorn
A S
AS
D001315:Australia; D002170:Canada; D002204:Capitation Fee; D003695:Delivery of Health Care / Q000191:economics*; D003727:Dental Auxiliaries; D003752:Dental Health Services / Q000191:economics*; D019049:Developed Countries; D004739:England; D005060:Europe; D018588:Fee-for-Service Plans; D017048:Health Care Costs; D006801:Humans; D020407:Internet; D009520:New Zealand; D011313:Preventive Dentistry / Q000191:economics; D011331:Private Practice / Q000191:economics; D012456:Salaries and Fringe Benefits; D013218:State Dentistry / Q000191:economics*; D011795:Surveys and Questionnaires; D013997:Time Factors; D035862:Vulnerable Populations; D017132:Workplace