Systematic Literature Review of Capitation and Fee-for-Service Payment Models for Oral Health Services: An Australian Perspective.

Jennifer H Conquest,Marc Tennant,Estie Kruger,Praveena Sivanujan,John Skinner,Nirjgot Gill

doi:10.3390/healthcare9091129

Abstract

The aim of this review was to assess relevant global literature on capped-fee (CF) and fee-for-service (FFS) payment models as used by public dental services. Research data were assessed through the PRISMA check list and sourced from MEDLINE, PubMed, ProQuest, Cochrane Library, and other methods. The inclusion criteria were peer reviewed articles published between 2004 and 2020 and (i) other countries’ health systems that were evaluated in contrast to Australia; (ii) care provided to individuals; (iii) payment models for private services that were the same as Australian government policy (CF and FFS); and (iv) care provided by dentists. We used a mixed methodology for data collection. A total of 262 references were reviewed with 10 references meeting the inclusion criteria with the quality rating being: three—strong, six—moderate, and one—weak. The literature included studies from Sweden (three references), Ireland (three references), United Kingdom (six references), United States of America (two references), and Norway (one reference). Four references included studies within multiple countries. The sample size varied between 20 and 106,874 participants. The two payment systems can impact on individual outcomes, such as by overtreatment in an FFS system and undertreatment in a CF system.

Highlights

Published: 30 August 2021The implementation of cost containment tools dates to 1970 but its universal use in Organization for Economic Cooperation and Development (OECD) countries has only been apparent since 1990 [1]
Global discussions about priority settings have focused on addressing efficiency and equity, targeting marginalised populations, and integrating oral health into other general medical services [3,4]
We decided to focus on more recent papers (2004–2020) to ensure that the systematic literature review would be relevant to today’s issues of procuring private practitioners/facilities to provide public dental care

Summary

Introduction

Published: 30 August 2021The implementation of cost containment tools dates to 1970 but its universal use in Organization for Economic Cooperation and Development (OECD) countries has only been apparent since 1990 [1]. Containing costs can be a useful tool for governments that provide public health care, but it may have a negative impact on innovation, quality of care, and profit margins for the private sector [2]. Both fee-for-service (FFS) and capped-fee/capitation (CF) are utilised in outpatient health and hospital settings; in the United States of America (USA) CF is used in both outpatient and inpatient settings [1]. Worldwide analysis has been undertaken in relation to the burden of disease as identified in epidemiological patterns

Methods

Discussion

Conclusion