SCEINTIFIC RESEARCH REPORT

International Dental Journal 2015; 65: 32–38 doi: 10.1111/idj.12131

Design of an innovative paediatric capitation payment approach for public sector dentistry: an Australian experience Jennifer Conquest1, Michael Jacobi1, John Skinner1 and Marc Tennant2 1

Centre for Oral Health Strategy NSW, Sydney, NSW, Australia; 2University of Western Australia, Crawley, WA, Australia.

Abstract: Aim: The aim of this study was to trial the methodology and administration processes of a public paediatric capitation programme provided in the period 1 July 2011 to 31 December 2011 through a Bachelor of Oral Health programme in rural New South Wales (NSW), Australia, where access to public dental services is limited. Basic Research Design: The principal structure of the programme was the development of three diagnostic pathways: active caries and pain (Pathway A); active caries and no pain (Pathway B); and no active caries and no pain (Pathway C). In 2011, deidentified treatment data for NSW public dental services’ patients under 18 years of age were analysed to identify the top 10 dental treatment items. These items were clustered according to the mean decayed and/or filled surface of patients under 18 years of age who had decayed, filled or missing teeth. Each treatment item was allocated 60% of the 2011 Australian Government Department of Veteran Affairs Schedule of Fees. Clinical Setting: The programme was trialled in Charles Sturt University dental facility in Wagga Wagga, NSW. Participants: The programme targeted patients in the following age groups: 0–5 years; 6–11 years; and 12–17 years. Result: The 6-month trial provided 361 patients with a capitation pathway, at a total cost of $47,567.90, averaging $131.76 per capitation pathway. The total number of items provided (n = 2,070) equated to an average of 5.7 items per capitation diagnostic pathway. Conclusion: This model offered an early entry point for paediatric patients to access dental care that addressed their needs, whilst being flexible enough to be fiscally attractive. Key words: Dental public health, capitation, paediatric

INTRODUCTION In 2001, Australian children had the fifth lowest average number of decayed, missing and filled permanent teeth among 12-year-old children from 41 countries. However, research shows that children from disadvantaged backgrounds and those living in rural and remote areas have poorer dental health across all ages in Australia1. Funding oral health care in developed countries continues to remain a complex issue with which governments wrestle. It is particularly evident in countries where there is a mix of private and governmentfunded models and is more problematic when the balance between the two sectors is substantially skewed towards the private sector, which disadvantages people in areas where public dental services are limited or non-existent2. Previous research has highlighted the advantages and disadvantages of different remuneration models 32

for dental care, such as in-house public services (fixed salary), per capitation and via a private sector voucher scheme (fee-for-item). The research concluded that per-capitation payments secure effective treatment by developing a preventive care plan for the patient, whilst the fee-for-item payments secure quality and fixed salary is impacted by political decision-making3. In Australia, current State, Territory and Federal governments use a mixture of funding models in an attempt to address barriers to providing total population coverage. In some jurisdictions this funding is provided for free dental programmes that target specific eligible population groups, whilst other jurisdictions employ fee-for-items, co-payments or capitation procurement programmes4. Like many developed countries, Australia has a complex mix of dental professionals. In 2011 the ratio of the following oral health professionals in New South Wales (NSW) per 100,000 population was 65.0 (dentists), 4.9 (dental hygienists), 3.4 (dental © 2014 FDI World Dental Federation

Oral health capitation in Australia therapists), 5.7 (dental prosthetists) and 2.8 (oral health therapists)5. The implications of this highly privatised workforce are that oral health services are mainly provided by the private sector (87%). The NSW Oral Health 2020 states that there is a need to create incentives for both public and private sectors; this includes promoting the relocation of dental services to rural areas6. Australia has a population of 7.3 million, with nearly one-third of Australia’s population living in NSW7. Patients under 18 years of age have the opportunity to access State government-subsidised free public dental care that is predominately provided through public dental clinics8. Patients who access the service are triaged on the basis of urgency to dental care, resulting in a patient flow of: (i) direct appointments; (ii) outsourcing fee-for-item vouchers; or (iii) waitlisted9,10. The aim of this study was to trial the methodology and administration processes of a public paediatric capitation programme provided in the period July 2011 to December 2011 through a Bachelor of Oral Health (BOH) programme in rural NSW, Australia. The trial also gave students the opportunity to enhance their clinical skills and to gain knowledge of cultural and socio-economic differences, whilst providing dental care to the underserved local population11. METHODS This study was completed under ethics approval from The University of Western Australia and the Greater Western Area Health Service Human Research Ethics Committee. These organisations comply with the Declaration of Helsinki. Furthermore, both organisations granted a ‘waiver’ to the requirement for verbal or written consent for the analyses in this study. The researchers declare that there is no conflict of interest. All monetary values are in Australian dollars (at the time of writing the Australian dollar was equal in value to the US dollar), and all item numbers use the coding and definitions of the Australian Schedule of Dental Services Glossary 9th edition12. Pathways The three diagnostic pathways were as follows: active caries and pain (Pathway A); active caries and no pain (Pathway B); and no active caries and no pain (Pathway C). These pathways were employed in the three age groups 0–5 years, 6–11 years and 12–17 years, resulting in a total of nine separate pathways. These nine pathways offered an annual full course of care paid by a capitation amount that included any recalls for follow-up treatment during the 12-month period. The inclusion of recalls was to support a minimal intervention that emphasised education and self-care, © 2014 FDI World Dental Federation

including remineralisation techniques focused at preventing future active caries13. Access To access patients, the researchers used the Murrumbidgee Local Health District child dental waiting lists. This was considered to be the most cost-effective process and had the potential for a high level of consumer satisfaction. Thus, a preclinical assessment to enter into the study was not required14. Baseline data To provide a baseline for the diagnostic pathways of evidence, clinical activity de-identified data for patients under the age of 18 years who accessed public dental services in NSW for the 2011 calendar year were extracted from the NSW Oral Health software application. All items (n = 1.9 million) were filtered to identify the top 10 diagnostic, preventive, prophylactic, exodontic and restorative items in each age group (0–5, 6–11 and 12–17 years). A total of 14 item numbers were included in the development of the capitation programme: nine (64%) were used for patients 0–5 years of age, eight (57%) for patients 6–11 years of age and 10 (71.4%) for patients 12–17 years of age. Table 1 shows the high use of some items in all age groups and in similar diagnostic pathways. Calculation of capitation value Monetary values for each item number were obtained from the Australian Government Department of Veteran Affairs (DVA) Schedule of Fees (2011). A nominal monetary weighting of 60% for dental care was allocated to each item number provided by the BOH students participating in the trial. Charging of full-price fees for services provided by students is not common practice. The University of Washington: School of Dentistry, USA, charges patients approximately 40% of the full treatment cost, on average which is lower than the standard fee of the private dentists in their local area15. The 2012 Australian Dental Association National Dental Fees Survey shows that the DVA Schedule of Fees was 19.5% lower than the fee structure of private practitioners16. The monetary weighting of 60% was considered to be a reasonable incentive to promote the dental services being provided by students. The range of items included in the diagnostic pathways is first of all price-reduced by the aforementioned 60% and then multiplied by the relevant age groups’ caries experience (weighting) as identified in Table 1. These weightings (decayed mean) were obtained for each age group from the New South 33

Conquest et al. Table 1 Capitation pathway items according to cluster weighting and to age group Item no. 011 014 022 113 114 121 123 131 141 161 311 513 521 531

Description

Comprehensive examination Consultation to seek advice Radiographs Recontour restorations Removal of calculus Topical application of remineralisation Concentrated remineralisation Dietary advice Toothbrush instruction Fissure sealant Removal of tooth or parts Metallic restoration Anterior adhesive restoration Posterior adhesive restoration Total

DVA amount 2011

0–5 years

6–11 years

12–17 years

Weighting

Pathways

Weighting

Pathways

Weighting

Pathways

$51.65 $37.55 $66.20 $19.95 $88.05 $33.90

1.00 1.00 2.00

A, B A A

1.00

A, B, C

2.00

A, B, C

1.00 1.00 2.00 1.00 1.00

A, B, C B A, B, C C A, B

1.18

B

$26.55 $35.70 $48.55 $45.20 $81.20 $149.65 $113.30 $121.00 $918.45

1.18 1.00 1.00

A, B A, B A, B

B A, B, C A, B, C A, B, C

A A

A, B A, B, C A, B, C B, C A

1.18 1.00 1.00 4.00

0.09 0.34

1.18 1.00 1.00 4.00 0.09 0.40

A

0.40 0.67

A A, B

DVA, Australian Government Department of Veteran Affairs.

Wales Child Dental Health Survey 200717. Table 1 identifies the sum of all the items at the full schedule value, totalling $918.45. The totals of the capitation pathways were either rounded up or rounded down to the nearest 5 cents. The Capitation programme’s payment for the nine paediatric diagnostic pathways were as follows: Pathway A: $131.50 for patients 0–5 years of age, $236.10 for those 6–11 years of age and $273.20 for those 12–17 years of age; Pathway B: $42.00 for patients 0–5 years of age, $163.70 for those 6–11 years of age and $263.20 for those 12–17 years of age; and Pathway C: $22.10 for patients 0–5 years of age, $145.25 for those 6–11 years of age and $157.00 for those 12–17 years of age. Clustering by weightings Table 1 shows the decayed mean for exodontic and restorative items in the different age groups and pathways. Diagnostic, dietary advice and toothbrushing instruction items were not given a monetary or cariesexperience weighting. Diagnostic items To adhere to NSW Health’s policy on ‘The Use of Pit and Fissure Sealants’, the capitation pathways were allocated two radiographs (022) with the exception of patients 0–5 years of age in Pathways B and C18. Radiographs were given one full fee for the first exposure and a reduced fee for the second exposure, which totalled $66.20, as per the 2011 DVA schedule of fees. Preventive and prophylactic item Recontour of a restoration (113) and removal of calculus (114) were included in the 12–17 year’s capi34

tation pathways, with the monetary values being $11.97 and $51.78, respectively. A total of four fissure sealants (161) for patients 6–11 and 12–17 years of age was included in their pathways to support a preventive approach for posterior molars and was priced at $106.32. To provide further support for minimal intervention the decayed mean (1.18) for a 5-year-old patient was allocated to the item numbers of topical application of remineralisation (121) and/or concentrated mineralisation (123) across all nine pathways. Topical application (121) is one application to a surface of a tooth with a remineralising and/or cariostatic agent. Concentrated mineralisation (123) is a procedure to promote caries resistance in a tooth with prolonged application of concentrated fluoride or remineralising and/or cariostatic agents. The monetary calculation resulted in a cost of $23.55 for item 121 and a cost of $18.45 for item 123. Exodontic item In patients 0–5 years of age in Pathway A, the removal of tooth or parts item (311) was multiplied by the 5–6 years’ decay mean (0.9). For the extraction of primary teeth, the DVA fee for a second extraction (311) in the same day was allocated the cost of $81.20 because extracting primary teeth is not as complex as extracting permanent teeth. This reduced the price to $43.84. Restorative items In patients of 6–11 years of age in Pathway A, 531 (posterior adhesive 1 surface restoration) multiplied by the decayed mean (0.40). decayed mean (0.40) was also multiplied by

item was This item

© 2014 FDI World Dental Federation

Oral health capitation in Australia 521 (anterior 1 surface adhesive restoration) for patients 12–17 years of age in Pathway A. However, for patients 12–17 years of age in Pathways A and B, item 531 was multiplied by the decayed mean (0.67). The NSW Child Dental Health Survey identified the age group 5–6 years as having a decayed and filled surface mean of 3.21, whereas only 0.34% of this age group had filled teeth. The NSW Health’s policy on ‘Dental Amalgam – Its Clinical Use and Disposal’ recommends amalgam as a suitable material for larger restorations of posterior permanent teeth in children, young adults and adults19. Thus, the item number 513 (three-surface metallic restoration) was allocated to patients 0–5 years of age in Pathway A. The amount for item 531 (one-surface posterior adhesive restoration) was $29.04 for patients 6–11 years of age in Pathway A and $48.64 for patients 12–17 years of age in Pathways A and B. Item 521 (one-surface anterior adhesive restoration) was costed at $27.19 and item 513 (three-surface metallic restoration) was costed at $182.65. Adjustment of model to articulate with other programmes Pathway C for patients 12–17 years of age was allocated the monetary amount of $157.00 from the then Commonwealth Government’s Medicare Teen Dental Plan as a result of the treatment similarities in examination, radiographs and fissure sealants. There was a $3.17 difference between the student’s capitation formula for Pathway C of this age group ($160.17) and the Teen Dental Plan. Fee-for-item To support students’ university clinical requirements, the following treatment items were paid by fee-foritem: metallic crown (576); splinting and stabilisation (981); and the provision of a mouth guard (151). To maintain consistency in payment, the capitation 60% weighting was used: metallic crown ($148.40); splinting and stabilisation ($56.00); and mouth guard ($86.70). Capitation voucher To ensure robust data collection (both for financial probity and analysis purposes) patient data were captured on a specifically designed capitation voucher for BOH students to enter the treatment items provided, relevant tooth, tooth surface/s at each appointment and if the treatment was completed. © 2014 FDI World Dental Federation

METHODOLOGY AND ADMINISTRATION TRIAL The methodology and administration processes were trialled over a 6-month period from July 2011 to December 2011 through a signed agreement with Murrumbidgee Local Health District (LHD) and Charles Sturt University School of Dentistry and Health Sciences in Wagga Wagga (CSU). The Murrumbidgee LHD employed a project officer to: recruit patients for treatment; coordinate appointment bookings with CSU; and enter data from the returned capitation vouchers into the NSW Health oral health software application. The patients for the trial were sourced from the existing Murrumbidgee LHD Wagga Wagga oral health waiting list (n = 418) who had responded to the telephoned triaged questionnaire according to the NSW Priority Oral Health Program that weights the patient’s oral health needs in conjunction with both socio-economic and medical risk factors20. Patients were then placed on a relevant wait list with associated waiting times and the capitation pathway was offered to patients on that list. RESULTS Of the 418 children waitlisted, 361 received one capitation diagnostic pathway though the programme with the third-year BOH students (n = 13) providing the care. The trial programme expenditure total was $47,567.90, with 195 female patients and 166 male patients treated. During the trial, 2,070 items were provided, with an average number of 5.7 items per capitation diagnostic pathway (voucher). The highest number of children treated were in the 6–11 years’ age group (n = 254), mostly in Pathways C (n = 144) and B (n = 96). Conversely, the lowest number of visits during the trial was in the 12–17 years’ age group (n = 16). The analysis from the trial in Table 2 showed that if the pathways were paid by a fee-for-item system without any weighting, the total expenditure would have been $61,335.12. Further analysis indicated that the average cost of a course of care paid under the capitation pathways was $131.76, compared with a full fee-for-item, which would have amounted to $169.90. Independently of this trial, Murrumbidgee LHD conducted satisfaction surveys (n = 94) as part of their community consultation processes. The surveys were posted to randomly selected families with a stamped addressed return envelope. The de-identified returned surveys (n = 42) rated the service that their child received at CSU as extremely high overall, with the majority happy to return for future care through the capitation pathways. 35

36

$92.97 $0.00 $0.00 $0.00 $79.44 $0.00 $0.00 $0.00 $0.00 $0.00 $31.86 $21.42 $29.13 $0.00 $0.00 $44.79 $0.00 $0.00 $0.00 $0.00 $0.00 $290.40 $0.00 $0.00 $28.71 $618.72

$30.99 $25.77 $16.20 $22.53 $39.72 $31.68 $11.97 $52.83 $34.35 $20.34 $15.93 $21.42 $29.13 $27.12 $77.31 $44.79 $61.38 $75.24 $89.79 $67.98 $82.53 $72.60 $91.14 $109.59 $28.71

011: comprehensive examination 012: periodic examination 013: limited examination 014: consultation to seek advice 022: radiograph 111: removal of plaque 113: recontour surfaces 114: removal of calculus (first appointment) 115: removal of calculus (second appointment) 121: topical application 123: concentrated remineralising 131: dietary advice 141: toothbrush instruction 161: fissure sealing 311: removal of tooth or parts 414: pulpotomy 511: metallic restoration 512: metallic restoration 513: metallic restoration 521: anterior adhesive restoration 522: anterior adhesive restoration 531: posterior adhesive restoration 532: posterior adhesive restoration 533: posterior adhesive restoration 572: provisional restoration Total $20.34 $159.30 $299.88 $466.08 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $363.00 $0.00 $0.00 $143.55 $3,316.32

$0.00

$1.301.58 $0.00 $32.40 $0.00 $79.44 $126.72 $0.00 $52.83

Pathway B

Pathway A

14 $3,683.40

Pathway C

$0.00 $111.51 $128.52 $262.17 $244.08 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $145.20 $273.42 $0.00 $57.42 $2,615.16

$0.00 $0.00 $95.58 $85.68 $87.39 $705.12 $463.86 $44.79 $0.00 $0.00 $0.00 $0.00 $0.00 $435.60 $91.14 $328.77 $26.71 $3,446.16

$0.00

$433.86 $0.00 $0.00 $0.00 $476.64 $63.36 $0.00 $105.66

Pathway A

96 $15,715.20

Pathway B

6–11 years

$1,177.62 $51.54 $48.60 $22.53 $39.72 $0.00 $0.00 $52.83

Pathway A

Item fee 60%

46 $1,016.60

Pathway C

Treatment items provided

42 $1,746.00

Pathway B

0–5 years

3 $393.90

Pathway A

0–5 years

(B)

Number of vouchers Capitation total cost

(A)

$61.02 $350.46 $792.54 $1,485.63 $3,606.96 $1,391.58 $89.58 $0.00 $0.00 $0.00 $203.94 $0.00 $3,920.40 $1,731.66 $0.00 $258.39 $19,808.79

$0.00

$2,882.07 $77.31 $0.00 $0.00 $1,827.12 $760.32 $0.00 $369.81

Pathway B

6–11 years

144 $20,916.00

Pathway C

$81.36 $286.74 $749.70 $1,514.76 $6,210.48 $1.623.51 $44.79 $61.38 $225.72 $0.00 $407.88 $82.53 $4,283.40 $1,822.80 $219.18 $114.84 $26,415.18

$34.35

$4,307.61 $77.31 $0.00 $0.00 $2,661.24 $760.32 $0.00 $845.28

Pathway C

8 $2,185.60

Pathway A

$0.00 $79.65 $21.42 $58.26 $840.72 $541.17 $0.00 $0.00 $0.00 $0.00 $67.98 $0.00 $217.80 $0.00 $0.00 $57.42 $2,529.15

$0.00

$247.92 $0.00 $0.00 $0.00 $238.32 $0.00 $0.00 $158.49

Pathway A

$0.00 $79.65 $21.42 $29.13 $786.48 $0.00 $0.00 $0.00 $0.00 $0.00 $67.98 $0.00 $0.00 $0.00 $0.00 $0.00 $1,369.20

$0.00

$185.94 $0.00 $0.00 $0.00 $198.60 $0.00 $0.00 $0.00

Pathway B

12–17 years

6 $1.579.20

Pathway B

12–17 years

$0.00 $0.00 $0.00 $29.13 $433.92 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $435.60 $0.00 $0.00 $0.00 $1,216.44

$0.00

$92.97 $0.00 $0.00 $0.00 $119.16 $0.00 $0.00 $105.66

Pathway C

2 $314.00

Pathway C

Table 2 (A) Number of vouchers provided in the capitation trial, with their associated total cost; (B) Conversion of items provided under the capitation trial to a fee-for-item system

Conquest et al.

© 2014 FDI World Dental Federation

Oral health capitation in Australia Table 3 Monetary analysis of the trial between the capitation formula and fee-for-item voucher amounts Age group and pathway 0–5 years

Number of vouchers Capitation price per voucher Fee-for-item voucher prices with treatment formula only Fee-for-item voucher prices with all treatment provided

6–11 years

Pathway A

Pathway B

Pathway C

Pathway A

Pathway B

Pathway C

Pathway A

Pathway B

Pathway C

3 $131.30 $181.74

42 $42.00 $71.75

46 $22.10 $47.48

14 $236.10 $206.39

96 $163.70 $175.95

144 $145.25 $159.53

8 $273.20 $308.97

6 $263.20 $228.20

2 $157.00 $608.22

$206.24

$78.96

$56.85

$246.15

$206.34

$183.44

$316.14

$228.20

$608.22

DISCUSSION Internationally, the use of diagnostic pathways and rate of active caries experience in developing capitation remuneration for children and adolescents is not unique21. However, to change NSW government policy on procurement payment type, especially in rural communities, consideration must be given to the benefits of a paediatric capitation preventive model. Furthermore, in situations with increased demand on dental services, an attractive and flexible alternative must be able to be implemented in various settings22. The innovation of this model is that the child and adolescent (‘patient’) are not dentally fit before receiving a capitation course of care. The dental care provided through the programme has the ability to be compared with state-wide de-identified patient record unit data collected from in-house and fee-for-item procurement services. In relation to the weighting formula by dmft/DMFT, regular evaluation against current and future independent NSW and national oral health studies of children has the ability to be adopted in other States and Territories23. Roberts-Thompson recognises that a diagnostic capitation pathway in comparison with a flat-fee capitation model improves the health of an individual, supports a pro-active health approach and changes a public emergency service to one with a prevention focus24. This pro-active approach can also result in evidence-based information to change health policy and practice25. In the programme, a prevention focus was carefully considered as the patient receives a full course of care. This care approach stabilises active caries and focuses on oral health education and changes in oral health behaviour through follow-up appointments. A capitation programme reflects the private practitioners’ perspective as it does not have a prescribed treatment plan like that of NSW’s fee-for-item model, ultimately allowing more clinical freedom26. A capitation programme does not need to be stringent or inflexible in administration and can increase access to dental care by utilising university students, such as a © 2014 FDI World Dental Federation

12–17 years

BOH programme27. Before the trial a consultation process for approval on the capitation pricing, diagnostic pathways, capitation voucher and administration processes were undertaken by the researchers. It is only through this trial that the programme’s formula can be externally ratified for its accuracy and ability to become a state-wide programme. The use of the capitation methodology is at risk of misallocation to the capitation pathways as initially the parent or guardian defines the patient’s needs through the telephone triage questionnaire. Anecdotal evidence suggests that the telephone triage questionnaire has the potential to encourage overdiagnosis to reduce the waiting time to access care. Table 3 presents comparisons of the capitation monetary amounts according to pathway type and the conversion to a fee-for-item payment. In Pathway A (patients 6– 11 years of age), the capitation amount was higher than the fee-for item conversion that included only the treatment items within the study’s formula. However, the capitation amount was $10.05 lower than the fee-for item conversion that included all treatment items. Pathway C (12–17 years) clearly flags the need for further analysis and continuation of the study to identify the accuracy of the methodology, training of students to understand the different diagnostic pathways and the possible evaluation of the telephone triage questionnaire. CONCLUSION The use of diagnostic capitation pathways according to paediatric age groups and active caries experience has been trialled internationally, yet lacked the use of an initial triage system weighted by socio-economic and health risk factors. The NSW Health telephone triage questionnaire has the potential to offer multiple pathways to reduce long wait lists and wait times and provide various levels of dental care. The study’s trial offered an early entry point to access care and addressed individual needs with prevention focus whilst being flexible enough to be financially attractive to non-government organisations. The trial also 37

Conquest et al. showed the positive impact on BOH students in achieving their competency requirements and the reduction of public dental waiting lists. The Murrumbidgee LHD satisfaction survey clearly indicates the parental support for having their children treated by students through a publicly funded programme. Evaluation of the trial identified: the requirement to present the study results to the BOH students on the different pathways trialled; and the need for further analysis to refine the capitation formula accuracy and pertinence to be a preventive model of care in rural and remote settings.

11. Perez RA, Veerasathpurush A, Howell H et al. Comparison of clinical productivity of senior dental service in a dental school teaching clinic versus community externship rotations. J Dent Educ 2012 74: 1125–1132.

Acknowledgements

16. Australian Dental Association Inc. Federal Budget Submission 2013–2014. St Leonards: Australian Dental Association Inc; 2013: 9.

This study was commissioned by the Centre for Oral Health Strategy NSW with a supporting funding grant. The researchers would like to acknowledge Professor Clive Wright (Chief Dental Officer NSW 2006– 2011) for his support and opportunity in developing the Capitation programme. Special thanks is given to Charles Sturt University School of Dentistry and Health Sciences and Murrumbidgee Local Health District for supporting the study’s trial. REFERENCES

12. Australian Dental Association Inc. The Australian Schedule of Dental Services and Glossary, 9th ed. St Leonards: Australian Dental Association Inc; 2009. 13. Mount GJ. Minimal intervention dentistry: cavity classification & preparation. J Minim Intervent Dent 2009 2: 150 & 153. 14. Turner S, Tripathee S, MacGillvray S. Evidence of improved access to dental care with direct access arrangements. Evid Based Dent 2013 14: 36–37. 15. University of Washington. Patient Care, patient services information/appointments: dental student clinics. 2014. Available from: http://dental.washington.edu/dental-care/dental-studentclinics/. Accessed 22 January 2014.

17. Centre for Oral Health Strategy NSW. The New South Wales Child Dental Health Survey 2007. Ministry of Health; 2009. Available from: www.health.nsw.gov.au/cohs. Accessed 17 June 2013. 18. Centre for Oral Health Strategy NSW. Pit and Fissure Sealants: Use of in Oral Health Services NSW PD2008_028. Sydney, NSW, Australia: NSW Ministry of Health; 2008. 19. Centre for Oral Health Strategy NSW. Dental Amalgam – Its Clinical Use and Disposal Policy Guideline PD2011_002. Sydney, NSW, Australia: NSW Ministry of Health; 2011. 20. Centre for Oral Health Strategy NSW. Priority Oral Health Program and List Management Protocols PD2008_056. Sydney, NSW, Australia: Ministry of Health; 2008.

1. Armfield JM, Slade GD, Spencer AJ. Socioeconomic Differences in Children’s Dental Health: The Children Dental Health Survey Australia 2001. Canberra, ACT, Australia: Australian Institute of Health and Welfare; 2006.

21. Holloway PJ, Blinkhorn AS, Hassall DC et al. An assessment f capitation in the General Dental Service Contract 1. The Level of caries and its treatment in regularly attending children and adolescents. Br Dent J 1997 182: 418–423.

2. Grytten J. Models for financing dental services. A review. Community Dent Health 2005 22: 75–85.

22. Blinkhorn AS, Hassall DC, Holloway PJ et al. An assessment of capitation in the new General Dental Service contract. Community Dent Health 1996 13: 3–20.

3. Ordell S. Organisation and management of public dentistry in Sweden. Past, present and future. Swed Dent J, 2011 210: 10– 92. 4. NSW Ministry of Health. Oral Health Plan 2020: A Strategic Framework for Dental Health in NSW. North Sydney, NSW: Centre for Oral Health Strategy; 2013: 4. 5. Australian Institute of Health and Welfare. Dental Workforce 2011. Canberra, ACT: Australian Government, Cat. no. HWL 50; 2013: 5. 6. NSW Ministry of Health. Oral Health Plan 2020: A Strategic Framework for Dental Health in NSW. Sydney, NSW, Australia: Centre for Oral Health Strategy NSW; 2013: 15. 7. Australian Bureau of Statistics. Australian Demographic Statistics. Canberra, ACT: Australian Bureau of Statistics; 2012. Available from: http://www.abs.gov.au/. Accessed 24 January 2013. 8. Centre for Oral Health Strategy NSW. Oral Health – Eligibility of Persons for Public Oral Health Care in NSW PD2009_074. Sydney: NSW Ministry of Health; 2009. 9. Centre for Oral Health Strategy NSW. Oral Health Fee for Service Scheme Policy Directive PD2008_065. Sydney, NSW, Australia: NSW Ministry of Health; 2008. 10. Centre for Oral Health Strategy NSW. Priority Oral Health Program and List Management Protocols PD2008_056. Sydney, NSW, Australia: NSW Ministry of Health; 2008.

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23. Mejia GC, Amarasena N, Ha DH et al. Child Dental Health Survey Australia 2007: 30-Year Trends in Child Oral Health. Dental statistics and research series, Cat. no. DEN 217. Canberra: AIHW; 2012. 24. Roberts-Thompson K. Targeting in a population health approach. Commun Dent Oral Epidemiol 2012 40: 22–27. 25. Redman S, Stickney B, Mitchell J. Policy-relevant population health research: new approaches and opportunities. N S W Public Health Bull 2011 22: 1–2. 26. Reid S. Care Payment & Quality Indicator Domains. Belfast, UK: Department of Health, Social Sciences & Public Safety; 2009. 27. McLeod HST, Morris AJ, Hill KB. Evaluation of personal dental services first wave pilots: the alternative to general dental services offered by the capitation-based pilots. Br Dent J 2003 195: 644–650.

Correspondence to: Jennifer Conquest, Centre for Oral Health Strategy NSW, PO BOX 533, Wentworthville, NSW 2145, Australia. Email: [email protected]

© 2014 FDI World Dental Federation

Design of an innovative paediatric capitation payment approach for public sector dentistry: an Australian experience.

The aim of this study was to trial the methodology and administration processes of a public paediatric capitation programme provided in the period 1 J...
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