title: Role of the Chronic Dental Disease Scheme in Enhanced Primary Care: allied health or allied outlier?
abstract: This study aims to provide a comparative analysis of the Chronic Dental Disease Scheme (CDSS) and the Allied Health Profession (AHP) program as they related to the greater Enhanced Primary Care Scheme introduced by the Australian Government to manage patients with chronic and complex diseases. A retrospective analysis of data pertaining to Medicare items related to dentistry and the allied health professions were extracted from the Medicare Benefits Schedule database online, and formed the basis of this study. The highest proportion of services was provided in the state of New South Wales. There appears to be synergy in the utilisation of services with jurisdictions either overutilising or underutilising services. Costs to the Enhanced Primary Care Scheme under the CDSS model (fee for service) were up to 40 times more expensive compared with the AHP model (fee per visit). Costs and treatment associated with the CDSS experienced an increase of 13350% during the period 2007-08, coincident with an increase in subsidization. Reconstructive dentistry accounted for the majority of the increase. Gender disparities in dentistry were less distinct when compared with AHPs and were postulated to be due to males presenting with conditions that were more progressive requiring more invasive treatment. A comparative analysis indicates significant differences in costs, nature of treatment and the manner of remuneration between dentistry and the AHPs. A fee for service schedule as evidenced by the CDSS is dependent on the degree of financial incentive as indicated by patterns in utilisation over time. The amount of treatment considered necessary may be influenced by the level of subsidy with treatment that may not reflect disease management. The AHP model, which is based around a fee for visit schedule, is not without its deficiencies but has not experienced significant rises in cost compared with the CDSS.
authors.affiliation: Centre for Rural and Remote Oral Health, The University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Lam
authors.forename: Estie
authors.initials: E
authors.lastname: Kruger
authors.forename: Marc
authors.initials: M
authors.lastname: Tennant
mesh_terms: D016390:Allied Health Occupations / Q000145:classification*; D001315:Australia; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003729:Dental Care / Q000145:classification* / Q000331:legislation & jurisprudence; D003815:Dentists / Q000145:classification*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000145:classification* / Q000331:legislation & jurisprudence; D015980:Public Health Practice / Q000331:legislation & jurisprudence / Q000592:standards*; D012189:Retrospective Studies; D059039:Standard of Care; D009057:Stomatognathic Diseases / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D000078329:Workforce