The impact of changes in incentives and governance on the motivation of dental practitioners.

School of Dentistry, University of Liverpool, UK.
International Journal of Health Planning and Management (Impact Factor: 0.97). 01/2011; 26(1):70-88. DOI: 10.1002/hpm.1037
Source: PubMed

ABSTRACT Recent changes to the system of remuneration and contracting arrangements with Primary Care Trusts (PCTs) has meant that dental practitioners in the UK have experienced several types of incentive and governance arrangements. This paper uses data from a qualitative study of 20 dental practitioners to examine the influence of different systems of incentives and governance on their motivational system. Results show that a perceived reduction in autonomy was the least acceptable aspect of the health reforms. The study also suggests that conflict between self-interested and altruistic motives may occur where medical professionals operate as independent contractors in a small business environment. Whilst dentists appeared to show altruistic motives towards their patients, priorities towards running an autonomous business enterprise meant that PCT managerial requirements, for example, to widen access were not welcomed, because of their impact on managerial autonomy. Moreover, whilst dentists' professional ethos appeared geared towards achieving technically high quality standards of work, this produced tensions against a background of cost containment in a fee-per-item system of remuneration. The paper raises issues such as the person-system interaction associated with professional and individual autonomy and the importance of reciprocity and fair payment.

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: If the entirety of professional autonomy must be compromised in the face of a state-run social insurance, physicians may choose to preserve only certain dimensions of their professional autonomy. This study tests the relative importance of the target-income hypothesis versus the professional allegiance hypothesis in explaining physicians' behavior by collating economic interests against professional dignity. DATA AND METHOD: A self-administered questionnaire was used to collect the response data from the 1244 physicians who practiced as office-based providers under the contract with the National Health Insurance (NHI) in the South Region of Taiwan and had experienced a change in the utilization review system; 394 (31%) physicians completed the questionnaire. Chi-squared analysis, logistical ordered regression, and odds-ratio analysis were conducted to test the effects of the physicians' experience with the utilization review system on their satisfaction with the NHI program. RESULT: The ordered logistical regression verified the hypotheses of physicians' experiences on the satisfaction of the professional-controlled review system, and the odds-ratio analysis suggested that the physicians might give considerable value to their professional dignity. This effect was strong enough to balance out that of the loss in economic interests as the odds ratio was 0.5667 with the 95% confidence interval being (0.1014, 3.1682), which includes the odds ratio of 1. CONCLUSION: Economic incentives should not always take center stage if the policy makers are to co-opt physicians. The professional allegiance hypothesis is at work as strongly as the target-income hypothesis. Copyright © 2012 John Wiley & Sons, Ltd.
    International Journal of Health Planning and Management 07/2012; · 0.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Efficiency is concerned with producing maximum output with the minimum input, although what constitutes inputs and outputs within an organization is not always clear. Labour substitution is one method of achieving efficiency gains, although cost savings are found to be context dependent and may not be achieved in some situations. Because dental therapists (DTs) in England are permitted to work in dental practices, we set out to investigate how efficiency with respect to the use of DTs is conceptualized by practitioners to deepen our understanding of the potential for substitution to realize efficiency gains in dental practice. Nine dental practices were selected using a purposive sampling methodology to give a range of practice size and DT employment arrangements. Semi-structured interviews were held with 26 dentists. Transcripts were coded and analysed thematically. Efficiency was perceived as optimum use of surgery time to generate intermediate outputs of (i) managing patient flow to give patient satisfaction and business cash flow and (ii) volume of work (procedures and numbers of patients). DT efficiency gains were evaluated according to whether lower labour costs were offset by a slower working pace and higher rate of failed appointments. Patient need and demand, and whether the practice had health improvement goals, influenced whether DTs were deemed to improve efficiency. Findings are in accord with skill mix reviews in wider health care that substitution may be effective in improving efficiency but this may be limited to particular situations where conditions are conducive. More studies are needed to explore these issues further in other dental practice contexts and with other groups of dental auxiliary.
    Community Dentistry And Oral Epidemiology 02/2012; 40(3):247-56. · 1.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust). A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.
    Acta odontologica Scandinavica 03/2011; 69(6):343-54. · 1.41 Impact Factor


Available from
Jun 2, 2014