Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health

Analysis of spatial pattern and influencing factors of private clinics in the main urban area of Guiyang in China from 2021 to 2022 based on multi-source data

BACKGROUND

Private clinics are important places for residents to obtain daily medical care. However, previous researches mainly focused on public medical institutions but ignored the issue of systematic allocation of social medical resources such as clinics. It is critical to understand the private clinics distribution to analyze the rational allocation of medical resources and the spatial difference.

METHODS

Based on the field survey, land census, population density, and economic data from Guiyang, this study analyzes the spatial pattern of private clinics in the main urban area of Guiyang and the influencing factors by using spatial analysis methods such as kernel density, standard deviation ellipses, and geo-detector.

RESULTS

The private clinics in the main urban area of Guiyang are characterized by "inner dense, outer sparse dense," showing an overall spatial clustering feature of "four cores and two belts with many points" and "dense inside and sparse outside." Different types of private clinics have distinct spatial distribution characteristics and agglomeration forms. The growth of private clinics is closely linked to the population growth of mountainous cities. The most important factors influencing the spatial pattern of private clinics are residential land factors, followed by traffic factors and population density. The impact of economic, natural, and spatial factors is minimal. When using a geo-detector, the results of multi-factor interaction differ from those of single factors, and factor interactions have greater explanatory power than single factors in clinic distribution.

CONCLUSION

This study investigates the geographic distribution and influencing variables of private clinics in typical mountain cities and identifies the causes of the current disparity in the distribution of healthcare resources. It is necessary to gradually develop the primary healthcare system in mountainous cities with legislation, counterpart support, and social resources. While ensuring equal access to health care for low-income people and mobile populations, various medical needs of community members should be fully considered and implemented as soon as possible.

Shortage of dentists in Outer Regional and Remote areas and long public dental waiting lists: Changes over the past decade

OBJECTIVE

The shortage of dentists in Outer Regional and Remote areas of Australia and long public dental waiting lists have been the subject of media attention over the last decade. A number of state and federal initiatives were introduced over the years to address these problems. This study aims to gauge whether the waiting lists and shortage of dentists in Outer Regional and Remote areas have seen a positive change over the last decade.

DESIGN

This evaluation study analysed and compared the number of dentists full-time equivalent per 100 000 population, eligible population and waiting list size (New South Wales and Queensland) at various points in time over the last decade.

SETTING

National.

PARTICIPANTS

Data were extracted from practitioner registry reports.

MAIN OUTCOME MEASURES

Number of dentists practising in Outer Regional and Remote areas of Australia and number of people on the public dental waiting list (New South Wales and Queensland).

RESULTS

There was a significant improvement in the number of dentists practising in Outer Regional and Remote areas of Australia. The public dental waiting lists in New South Wales and Queensland (as of September 2016) were found to have surpassed their pre National Partnership Agreement levels in 2012. The growth of public dental waiting lists exceeded the growth of the eligible population by a significant margin.

CONCLUSION

The dentist-to-population ratios in Outer Regional and Remote areas have seen a significant improvement. The reduction in the number of people on the public dental waiting list was significant, but brief.

Dental care for the elderly through a Capped-fee funding model: Optimising outcomes for primary government dental services

OBJECTIVE

The objectives of this study were to (i) compare a Capped Payment formula for adults, to the fee-for-service model and the New South Wales Government services payment model; (ii) identify the presenting oral health needs of a 65+ years of age cohort during the period January 2011 to March 2015.

BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD

Australia faces an ageing population with the vast majority accessing free market dental care, whilst the poor access Government services. This cohort retains most of their dentition increasing demand on Government services.

MATERIALS AND METHODS

The analysis of New South Wales Government adult de-identified patients' record unit data was from 2011 to 2015, for the three payment models and undertaken in three stages; (i) development of the Capped Payment Model; (ii) evaluation of twenty (20) case studies of adults 65+ years of age; (iii) analyse the cost efficiency of the three payment models.

RESULTS

This study found that the Government model was the most cost effective. The Capped-fee model performed less efficiently, particularly in the 75+ age group, with the fee-for-service model generally more costly. It was $2580 (85%) more costly for the 65-74 age cohort, and $4619 (66%) for the 75+ age cohort.

CONCLUSION

Policy makers in partnership with Government and private service providers should seek to develop partnerships with Government, private services and universities, scope opportunities in applying a Capped-fee funding model, and one that helps address the oral needs of the elderly.

National dental waitlists: what would it take to reset to zero?

Objective Over the years, long public dental waitlists across Australia have received much attention from the media. The issue for eligible patients, namely a further deterioration of dental health because of not being able to address dental concerns relatively quickly, has been the subject of several state and Federal initiatives. The present study provides a cost model for eliminating public dental waitlists across Australia and compares these results with the cost of contracting out public dental care to private clinics. Methods Waitlist data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual State or Territory Dental Health body. Average costs associated with employing key dental personnel and performance figures were used from previously published data to estimate the potential financial commitment and probable public benefits. Results The cost model suggests that, on average, it would be more than twice as expensive to contract the work out to private dental clinics as to treat eligible patients within public dental clinics. It is estimated that the cost of eliminating the legacy dental waiting lists (over 12 months) would be between A$50 and A$100million depending on the method adopted. The effort would require some 360 dental teams. Conclusion The design of the Australian public dental care system that is targeted at meeting the needs of eligible patients into the future, in addition to being effective and sustainable, must also offer a level of protection to the taxpayer. The ability to address waitlist backlog identified in the present study clearly would require a mix of service models depending on service availability at different locations. Further research is needed to optimise the mix of service providers to address community needs. What is known about the topic? Long public dental waitlists across Australia have received much attention from the media. The topic has been the subject of debate at the government level and, over the years, has seen an increase in allocation of public funds in an effort to address the policy needs. What does this paper add? This study calculates the actual number of people on the public dental waitlist, provides a detailed analysis of the distribution of the demand for the services and offers a cost model for resetting public dental waitlists across Australia. What are the implications for practitioners? This study carries no implications for individual practitioners at the clinical level. However, at the state and national levels, this model offers direction to a more cost-effective allocation of public funds and human resources.

Geographic distribution of point-in-time access to subsidised dental services in Western Australia

Dental Health Services (DHS) is the largest public primary oral healthcare provider in WA. The objective of this study was to calculate probable distance patients are expected to travel to the nearest clinic, gauge utilisation rates and predict the direction of likely changes in future demand for subsidised dental care. Eligible population data was collected from the Department of Human Services and the Australian Bureau of Statistics websites and integrated with the waiting list and the recall list data provided by the DHS. In total, 65% of the eligible WA population are residing in the metropolitan area; however, only 19% of those are either on the waiting list or have already received subsidised care. In all, 35% of the total eligible WA population are residing in country areas. A total of 30% of the eligible country WA patients are located within a 100-km range of a Government Dental Clinic, with only 11% of those either on the waiting list or having already received subsidised dental care. Country WA residents are at a significant disadvantage by comparison to their metropolitan counterparts. Eligible WA country residents are up to 40% less likely to receive treatment when compared to the metropolitan residents.