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First do no harm – The impact of financial incentives on dental x-rays

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JournalJournal of Health Economics
DateAccepted/In press - 23 Dec 2017
DateE-pub ahead of print - 30 Dec 2017
DatePublished (current) - 29 Jan 2018
Number of pages30
Early online date30/12/17
Original languageEnglish


This article assesses the impact of dentist remuneration on the incidence of potentially harmful dental x-rays. We use unique panel data which provide details of 1.3 million treatment claims by Scottish NHS dentists made between 1998 and 2007. Controlling for unobserved heterogeneity of both patients and dentists we estimate a series of fixed-effects models that are informed by a theoretical model of x-ray delivery and identify the effects on dental x-raying of dentists moving from a fixed salary to fee-for-service and patients moving from co-payment to exemption. We establish that there are significant increases in x-rays when dentists receive fee-for-service rather than salary payments and when patients are made exempt from payment.

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© 2017 The Authors. Published by Elsevier B.V.

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