title: Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992-2009.
abstract: BACKGROUND
  There is a tension between financial incentives and professional codes and norms, both of which are believed to influence the behaviour of health care professionals. This study examined the impact of changes to financial incentive structures on the behaviour of dentists working in the English National Health Service (NHS) as a result of a new national contract.
  
  
  METHODS
  Comparison of six reference treatments delivered by all NHS dentists in England for the period 1992-2009.
  
  
  RESULTS
  Large and abrupt changes in the provision of the reference treatments coincided with the introduction of changes in the incentive structure in 2006. Treatments which can be provided in the least amount of time (and therefore costs to dentists) such as extractions increased and treatments which are time consuming or have significant additional materials costs such as bridgework, crowns, root fillings and radiographs reduced substantially.
  
  
  CONCLUSIONS
  Changes to financial incentive structures can produce large and abrupt changes in professional behaviours. In the context of multiple and conflicting goals, greater thought needs to be given to policies to change incentive structures to mitigate their unintended consequences.
authors.affiliation: School of Dentistry, Oxford Road, University of Manchester, Higher Cambridge Street, Manchester, UK. martin.tickle@manchester.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
authors.forename: Jarrod
authors.initials: J
authors.lastname: Franklin
authors.forename: Vishal R
authors.initials: VR
authors.lastname: Aggarwal
authors.forename: Keith
authors.initials: K
authors.lastname: Milsom
authors.forename: David
authors.initials: D
authors.lastname: Reeves
mesh_terms: D004739:England; D018166:Health Care Reform; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D010816:Physician Incentive Plans / Q000191:economics*; D019239:Practice Patterns, Dentists' / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive / Q000191:economics*; D013218:State Dentistry / Q000191:economics*