Centre for Research Excellence in Health Services Research
Dental health services research for improved oral health outcomes
Dentistry is a substantial component of the health services sector. Health services research is important in terms of the widespread nature of health problems and large expenditure on health services. We need to know more about what works, and how it can be delivered best to improve health outcomes of all Australians.
The CRE was funded by NHMRC in 2012 to generate new knowledge to improve oral health outcomes and to inform oral health policy. It will develop Australia’s researchers and research capacity in this important area of health services research.
The CRE responds to a pressing need to generate new knowledge to improve oral health outcomes through the investigation of research themes in the areas of expenditure and financing of dental care, dental practice performance, and the impact of dental services on oral health outcomes.
These research themes cover a broad spectrum of health services research from access to services,
Overview of research themes
- Expenditure and financing of dental care: this theme of research spans considerations of how to best fund dental care in ways that can improve access to dental services taking into account considerations of equity, affordability of dental care, and allocative and efficiency issues.
- Dental practice performance: this theme of research seeks to understand what works best in dental practice configurations and number and mix of personnel to produce optimal outcomes for patients.
- Dental services and health outcomes: this research theme examines the health outcomes of dental service provision spanning types of public programs, comparisons of private and public sector dental care, and what works in the private sector such as insurance coverage.
- Research theme 1: Expenditure and financing of dental care
In Australia, the cost of dental care falls largely on the individual rather than on government sources. As a result of the way dentistry is financed and organised in Australia, the issues of affordability and hardship in relation to dental care are salient for a substantial proportion of the population.
analysetrends over time in affordability of dental care.
- To investigate dental programs and policy in terms of willingness-to-pay.
- To investigate affordability of dental care and use of dental services.
analysepublic subsidy, dental expenditure and use of dental services.
Trends in affordability of dental services: this objective will be
analysedusing the available time-series data from National Dental Telephone Interview Survey (NDTIS). This will capture a time-series of self-reported dental attendance patterns from 1993 through to 2010 along with reported problems associated with the cost of dental care.
Willingness-to-pay: This objective involves analysis of a completed data collection (WTP) to assess dental policy options using a willingness-to-pay or contingent valuation econometrics approach.
Affordability and use of services: This objective will be based on analysis of data from the Financial Impact of Dental Care Study (FIDS). This will report on affordability and cost of dental care such as avoiding or delaying dental care because of cost, mechanisms used by households to cover
costs,and the opportunity costs of dental service use within households.
Dental expenditure: This objective will be based on analysis of studies to investigate personal dental expenditure in relation to use of dental services among a population sample of adults (Dental Expenditure Panel Survey - DEPS), and to examine the drivers of dental expenditure over time among a cohort of older adults (SA Dental Longitudinal Study – SADLS 2011-14).
Improved understanding of the issues relating to dental expenditure, and affordability of dental care in relation to use of dental services and the impact on oral health is needed in order to inform health policy on
deliveryof dental care in a way that promotes improved oral health outcomes.
- Research theme 2: Dental practice performance
The Australian dental
labourforce is increasing and changing in mixas it strives to meet the needs of the population. Change in the mix and roles of dental professionals can impact on the people who visit a practice, the oral diseases with which they present, the dental care provided, their cost, and outcomes for patients.
Projecting supply capacity is made difficult by the shifting nature of services provided, with trends indicating that the mix of services provided by dentists has changed and is continuing to change. Conversion to a common scale of work effort will make this process more transparent and as well as enable economic analyses of productivity and efficiency. Such a
standardisedmeasure of output adjusted for quality of care can be used to measure comparative performance of dental practices and will allow benchmarking to encourage the adoption of bestdental practice.
- To assess trends over time in visits supplied and dental services provided.
- To examine the impact of changing dental personnel on dental practice.
- To investigate the outputs and outcomes of dental service provision.
Dentist Practice Activity: This objective will initially be investigated through time-series
modellingof existing data on dentists in Australia (from the Longitudinal Study of Dentists’ Practice Activity - LSDPA). This unique data set provides a time series of six points at five-yearly intervals acrossa 25 year period. Dependent variables of patient visits supplied, and number and types of dental services provided will be modelledover time to account for age, period and cohort effects.
Dental Personnel and Practice: This objective will be investigated through
collectionof data from dentists and from oral health practitioners. The data collected relates to the three conceptual domains of structure; numberof visits supplied, types of services provided, work satisfaction and job-related fatigue and burnout.
Outputs and Outcomes of Practice: This objective will be pursued through data collection on valuing work effort required to produce dental services and then applied in productivity analyses, determination of practice profiles and assessment of practice performance. A cross-sectional survey of dentists will assess work effort involved in providing dental services. The estimates of work effort will be used in conjunction with pre-existing survey data on dental service provision from the
LSDPAto create a standardisedmeasure of output for each service. The association between these standardisedoutputs, dentist and practice characteristics will then be analysed. modelled.
Assessment of outputs and outcomes of dental care can provide a basis for comparative performance to benchmark performance and suggest areas for improvement. The assessment of practice outcomes will identify characteristics of the dental delivery system that work best and which don’t work as well in delivering productive outputs with good outcomes.
- Research theme 3: Dental services and health outcomes
If proposed alternatives to use of government funds to target public subsidies to oral health for those with the worst oral health and extending eligibility for public dental services using private practice are to be acted upon then health policy needs better evidence from prospective study designs to prove if changes in oral health are associated with different pathways of dental care for adults.
Dental caries is the most common childhood infection resulting in costly treatment and poorer quality of life. Dental services are a determinant of oral health. However, we lack specific evidence to inform policy for child dental services to achieve an effective delivery of services and improved oral health.
- To assess trends over time in use of dental services.
- To evaluate adult health outcomes in relation to insurance and types of care provided.
- To examine child oral health and dental system performance.
Use of dental services: this objective will be analysed using time series data from National Dental Telephone Interview Survey (NDTIS) on time since last dental visit. This will capture a time series of dental attendance patterns from 1993 through to 2010. Changes in inequality in use of dental services, adjusted for self-reported need for dental care will be analysed and related to shifts in dental policy.
Adult health outcomes: this objective will be investigated through a project on dental insurance (DIS) as well as additional data collection utilising prospective cohort designs to measure changes in health spanning clinical, self-rated health, quality of life and health state utility values that are associated with provision of dental care.
Child oral health: this objective will be pursued through analysis of an ongoing project collecting data as part of a National Survey of Child Oral Health ( NCOHS ). This will permit investigation of dental health system performance using domains based on the Health System Performance Committee (2001) report and relate these to clinical measures of child oral health status.
Recent policy initiatives in dentistry have focussed on insurance schemes for private care, while policy discussions have raised the potential for universal coverage. While surveillance data are available on dental care in Australia these have not been analysed so as to address specific research problems. The findings of this project will considerably advance our knowledge in this field through the use of panel and longitudinal cohort study designs aimed at testing whether oral health outcomes show change over time in relation to the type of dental care received.
People from lower socioeconomic background tend to have poorer health, including oral health. Different pathways of health care (e.g. private or public sector care) will also influence health status. It is often assumed that private dental care is better, but this may simply reflect access issues such as waiting time or selection issues - if public patients have worse oral health status associated with lower socioeconomic position.
Aim of the study: The main purpose of the study is to determine if different pathways of dental care (public or private) in a cohort of adults influence longitudinal change in oral health outcomes among groups with differing socioeconomic backgrounds.
Expected outcomes: The study will help to answer questions in relation to oral health and dental care, especially on how best to organise and deliver dental care in ways that are economically efficient. While the study may not benefit you directly, the information will be valuable for future policy and planning for oral health and dental services in Australia.
The core research team comprises of researchers based in the Health Services Research Unit of the Australian Research Centre for Population Oral Health (ARCPOH), the University of Adelaide.
Further information on the study can be obtained by contacting the research team in the University of Adelaide.
Contact: Sergio Chrisopoulos
Health Services Research Unit
Australian Research Centre for Population Oral Health
Adelaide Dental School, The University of Adelaide
SOUTH AUSTRALIA 5005
Tel: (08) 8313 0141