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

TY - JOUR

T1 - First do no harm - The impact of financial incentives on dental X-rays

AU - Chalkley, Martin

AU - Listl, Stefan

N1 - Funding Information: Data used by courtesy of Information and Services Division of NHS National Services Scotland. This research was funded by the authors’ respective institutions. The views expressed are those of the authors and not necessarily those of the funders. We would particularly like to thank Colin Tilley, Hendrik Jürges, Steffen Reinhold, Kai Kruk, Edgar Vogel, Axel Börsch-Supan as well as two referees and the editor for helpful comments. The authors are also grateful for helpful comments and suggestions from participants and discussants of meetings held by the Health Economics Study Group (HESG) of the UK Health Economics Association, the Mannheim Research Institute for the Economics of Aging (MEA), the Ruhr Graduate School in Economics (RGS Econ), the Hanns Martin Schleyer Foundation, the American Society of Health Economists (ASHEcon), the International Health Economics Association (iHEA), the Center for Health Economics and Policy Analysis (CHEPA) at McMaster University, the Health Economics Research Group (COHERE) at the University of Southern Denmark, and the Harvard School of Dental Medicine (HSDM). Publisher Copyright: © 2017 The Authors

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

KW - Dentistry

KW - Healthcare

KW - Incentives

KW - Matched data

UR - http://www.scopus.com/inward/record.url?scp=85041400312&partnerID=8YFLogxK

U2 - 10.1016/j.jhealeco.2017.12.005

DO - 10.1016/j.jhealeco.2017.12.005

M3 - Article

C2 - 29408150

SN - 0167-6296

VL - 58

SP - 1

EP - 9

JO - Journal of Health Economics

JF - Journal of Health Economics

ER -