title: Using dental care resources optimally: quality-efficiency trade-offs in a competitive private market.
abstract: OBJECTIVE
  Modern lifestyle changes led to increased dental care needs in India. Consequently, there has been a sharp rise in dentist numbers. Karnataka state alone produces 2,500 dentists annually, who are engaged in the non-government sector owing to inadequate public sector opportunities. This article aims to assess Karnataka private dental clinic quality and efficiency.
  
  
  METHODS
  Dentists were interviewed using a close-ended, structured interview schedule and their clinics were assessed using a checklist adopted from guidelines for providing machinery and equipment under the National Oral Health Care Programme (NOHCP). Dental "hotel" and clinical quality were scored based on this checklist.
  
  
  RESULTS
  Clinical quality was "excellent" in 12 per cent of clinics and poor in 49 per cent. Clinics with better infrastructure charged higher price (p < 0.05). Multi-chair clinics charging fixed rates were high (81 per cent). According to 59.5 per cent of dentists, competition did not improve quality while 27 per cent felt that competition increased price, not quality. About 30.9 per cent of the poor quality clinics, 41 per cent average quality clinics and 26 per cent good quality clinics were technically efficient.
  
  
  CONCLUSIONS
  The multi chair clinics offered better quality at higher prices and single chair clinics provided poorer quality at lower prices. In other words, they had a sub-optimal price-quality mix. Therefore, there is a need to regulate price and quality in all clinics to arrive at an optimal price-quality mix so that clients are not overburdened financially even while receiving good quality dental care.
  
  
  CONCLUSIONS
  The article advocates that resources are used optimally as a way to achieve value for money and to achieve break-even points thereby providing quality care in a competitive market. Factors that influence dental practitioner behaviour are evaluated.
authors.affiliation: AMCHSS, Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, India. drprasadbm@gmail.com
authors.forename: Banuru Muralidhara
authors.initials: BM
authors.lastname: Prasad
authors.forename: D
authors.initials: D
authors.lastname: Varatharajan
mesh_terms: D003365:Costs and Cost Analysis; D003752:Dental Health Services / Q000458:organization & administration*; D003797:Dental Staff / Q000458:organization & administration; D003815:Dentists / Q000458:organization & administration; D004465:Economic Competition / Q000458:organization & administration*; D017598:Efficiency, Organizational; D004864:Equipment and Supplies; D006801:Humans; D007194:India; D017149:Private Sector / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*