Should the dental practice postcode be used for enhanced capitation payments for children?

Abstract

Objective Investigate the appropriateness of the under fives' enhanced capitation scheme. Design Calculation of mean caries indices for socially deprived wards (Jarman score 2.5 or greater) and less socially deprived wards (Jarman score below 2.5) in Sheffield using dental epidemiology data and social deprivation data. Calculation of electoral ward dental registration rate using health authority population register data and dental practice board data. Setting Within a health authority using population data already held by the health authority. Results Children living in deprived wards are 1.5 times as likely to have experienced decay (47% versus 31%). Of those children with decay, children in deprived wards have more teeth which have experienced decay (mean dmft (dmft > 0) 5.4) and more untreated decay (mean dt (dmft > 0) 3.4) compared with their peers in less deprived wards (mean dmft (dmft > 0) 4.6 and mean dt (dmft > 0) 3.1). Dental Practice Board data is based upon dental practice postcode, hence some Sheffield electoral wards have dental registration levels as high as 1400 per 1000 residents. Conclusions The principle of targeting dental need by use of Jarman Score is appropriate, however the targeting is undermined by the use of dental practice postcode as the basis of payments. Payment should be based upon the home postcode of the child patient.