A dental workforce strategy to make Australian public dental services more efficient

BACKGROUND

Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years.

METHODS

Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled.

RESULTS

The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved.

CONCLUSION

An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.

Expanded function allied dental personnel and dental practice productivity and efficiency

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia. The survey identified practices that currently use expanded function allied dental personnel and the specific services/procedures delegated. Practice productivity was measured using patient visits, gross billings, and net income. Practice efficiency was assessed using a multivariate linear program, Data Envelopment Analysis. Sixty-four percent of the practices were found to use expanded function allied dental personnel, and on average they delegated 31.4 percent of delegatable services/procedures. Practices that used expanded function allied dental personnel treated more patients and had higher gross billings and net incomes than those practices that did not; the more services they delegated, the higher was the practice's productivity and efficiency. The effective use of expanded function allied dental personnel has the potential to substantially expand the capacity of general dental practices to treat more patients and to generate higher incomes for dental practices.

Impact of dental therapists on productivity and finances: III. FQHC-run, school-based dental care programs in Connecticut

In many developed countries, the primary role of dental therapists is to care for children in school clinics. This article describes Federally Qualified Health Center (FQHC)-run, school-based dental programs in Connecticut and explores the theoretical financial impact of substituting dental therapists for dentists in these programs. In schools, dental hygienists screen children and provide preventive services, using portable equipment and temporary space. Children needing dentist services are referred to FQHC clinics or to FQHC-employed dentists who provide care in schools. The primary findings of this study are that school-based programs have considerable potential to reduce access disparities and the estimated reduction in per patient costs approaches 50 percent versus providing care in FQHC dental clinics. In terms of substituting dental therapists for dentists, the estimated additional financial savings was found to be about 5 percent. Nationally, FQHC-operated, school-based dental programs have the potential to increase Medicaid/CHIP utilization from the current 40 percent to 60 percent for a relatively modest increase in total expenditures.

Impact of dental therapists on productivity and finances: II. Federally Qualified Health Centers

This article estimates the impact of dental therapists treating children on Federally Qualified Health Center (FQHC) dental clinic finances and productivity. The analysis is based on twelve months of patient visit and financial data from large FQHC dental clinics (multiple delivery sites) in Connecticut and Wisconsin. Assuming dental therapists provide restorative, extraction, and pulpal services and dental hygienists continue to deliver all hygiene services, the maximum reduction in costs is about 6 percent. The limited impact of dental therapists on FQHC dental clinic finances is because 1) dental therapists only account for 17 percent of children services and 2) dentists are responsible for only 25 percent of clinic expenses and cost reductions are related to the difference between dental therapist and dentist wage rates.

Impact of dental therapists on productivity and finances: I. Literature review

This study examined the financial impact of dental therapists on Federally Qualified Health Center dental clinics (treating children) and on private general dental practices (treating children and adults). This article, the first of four on this subject, reviews the dental therapy literature and the dental access problem for low-income children. Dental therapists now practice in many developed countries, tribal areas of Alaska, and Minnesota. These allied dental professionals vary in their training and required dentist supervision, but all provide routine restorative and other related services to children and adults. The limited literature on the impact of dental therapists suggests that they work mainly in school and community clinics and some private practices, are well accepted by patients, provide restorations that are comparable in quality to those of dentists, expand the supply of services, do not increase private practices' net revenues, and in school programs decrease the number of untreated decayed teeth. Of the approximately 33.8 million children enrolled in Medicaid and the Children's Health Insurance Program (CHIP), some 40 percent now receive at least one annual dental visit. To increase utilization for all children to 60 percent--the rate seen in children from upper-income families--another 6.7 million children need to receive care; dental therapists may help to accomplish that objective.

Increasing productivity in dental practice: the role of ancillary personnel

Dentistry has achieved substantial improvements in productivity which have the effect of making more care available at reasonable cost. Data are presented documenting trends in productivity. These are analyzed with respect to number of dentists, hours worked by dentists, and the use of ancillary personal in dental offices. There is strong evidence linking increased productivity to the use of ancillary personnel. The history of creation, recognition, and integration of ancillary personnel into dental practice is also presented.

Are procedures performed by dental auxiliaries safe and of comparable quality? A systematic review

The objective of the current study was to systematically evaluate the existing evidence in relation to the safety, quality, productivity or cost-benefit, and patient satisfaction of the procedures performed by the different groups of dental providers. Due to the diversity of the procedures performed and the outcomes measured, it was not possible to create pooled estimates in a meaningful manner. Therefore, summary results of individual studies are presented and critically evaluated.

Orthodontic therapists--the current situation

The promise of the U.K. being allowed to use auxiliary help in orthodontics is slowly gaining momentum. At long last, key factors are under discussion, such as permitted duties, length of training, etc. This article describes the present situation and highlights the disappointing rate of progress

Fostering employee involvement

Every year, the ODA's Economics of Practice Committee, with the help of an independent consulting firm, carries out the Cost of Practice Monitor which tracks the various costs of running a dental practice in Ontario. This article is the result of a joint ODA-Arthur Andersen initiative to provide members with detailed information from the Monitor. Over the next year, there will be a series of articles published under the heading "Best practises for Ontario's Dental Practices." The article featured in this issue focuses on wage expenses in dental practices and how to foster employee involvement as a means of addressing cost-productivity issues. Furthermore, information relating to wage expenses may be used by practitioners to benchmark their practice against the average Ontario dental practice. Appendix C was developed for this purpose. Through benchmarking, the practitioner may gain insight into ways of evaluating their practice and in addressing issues that could improve the management of the practice. For a long time, concepts of best business practises were applied only to manufacturing organizations or large multi-national corporations but experience has demonstrated that these activities are universal to all organizations, including service companies, schools, government and not-for-profit organizations.