Breaking News
February 22, 2019 - Phase 1 data reinforce safety profile of new drug for treating Duchenne muscular dystrophy
February 22, 2019 - Vitamin D supplementation less effective in the presence of obesity, shows study
February 22, 2019 - Sarepta Announces FDA Acceptance of Golodirsen (SRP-4053) New Drug Application for Patients with Duchenne Muscular Dystrophy Amenable to Skipping Exon 53
February 22, 2019 - An institutional effort to reduce the amount of opioids prescribed following lumbar surgery
February 22, 2019 - Failure to take statins leads to higher mortality rates | News Center
February 22, 2019 - Novel preclinical model mimics persistent interneuron loss seen in preterm infants
February 22, 2019 - Global health burden of glaucoma has increased, study reveals
February 22, 2019 - A holistic approach key to minimize treatment complexity in patients with interstitial lung disease
February 22, 2019 - 1 in 10 middle-aged Chinese adults are at high risk for heart disease, finds study
February 22, 2019 - More than half a million breast cancer patient’s lives saved by improvements in treatment
February 22, 2019 - Study finds no evidence that tougher policies prevent teenage cannabis use
February 22, 2019 - New blood test detects genetic disorders in fetuses
February 22, 2019 - Lower Self-Perception Observed in Children With Amblyopia
February 22, 2019 - Up to 15 percent of children have sleep apnea, yet 90 percent go undiagnosed
February 22, 2019 - Rare pulmonary defect prompts parents’ nationwide search for answers | News Center
February 22, 2019 - Lesbian and bisexual women at greater risk of being overweight, study finds
February 22, 2019 - UQ research may explain why vitamin D is essential for brain health
February 22, 2019 - Heart Attacks Rising Among Younger Women
February 22, 2019 - How your smartphone is affecting your relationship
February 22, 2019 - Orthopaedic surgeon receives prestigious award, $10 million grant | News Center
February 22, 2019 - New sepsis test could save thousands of lives
February 22, 2019 - Cervical cancer could be eradicated by 2100
February 21, 2019 - Sustained smoking cessation can lower risk of seropositive RA
February 21, 2019 - Thousands with chronic UTIs are not receiving the treatment they need
February 21, 2019 - Are teens getting high on social media? The surprising study seeking the pot-Instagram link
February 21, 2019 - Stanford expands biobank services | News Center
February 21, 2019 - Scientists identify link between drinking contexts and early onset intoxication among adolescents
February 21, 2019 - Strong social support may reduce cardiovascular disease risk in postmenopausal women
February 21, 2019 - Rapid expansion of interventions could prevent up to 13 million cases of cervical cancer within 50 years
February 21, 2019 - Motif Bio Receives Complete Response Letter From The FDA
February 21, 2019 - Researchers map previously unknown disease in children
February 21, 2019 - A skeptical look at popular diets: Going gluten-free
February 21, 2019 - Podcast: KHN’s ‘What The Health?’ How Safe Are Your Supplements?
February 21, 2019 - Factors associated with increased risk of developing surgical site infections
February 21, 2019 - Anticipatory signals in eye movements can help measure attentive capacity, learning with greater precision
February 21, 2019 - Study explores daily exposure to indoor air pollutants
February 21, 2019 - Evening exercise does not negatively affect sleep, may also reduce hunger
February 21, 2019 - Artificial intelligence technique can be used to identify alcohol misuse in trauma setting
February 21, 2019 - Overweight, obesity in adolescence associated with increased risk of renal cancer later in life
February 21, 2019 - BGU develops new AI platform for monitoring and predicting ALS progression
February 21, 2019 - Researchers discover a new promising target to improve HIV vaccines
February 21, 2019 - Brief Anesthesia in Infancy Does Not Mar Neurodevelopment
February 21, 2019 - Gaming system helps with autism diagnosis
February 21, 2019 - Heart Disease: Six Things Women Should Know
February 21, 2019 - More States Say Doctors Must Offer Overdose Reversal Drug Along With Opioids
February 21, 2019 - Researchers explore case studies focused on industries that kill more people than employed
February 21, 2019 - Only half of GP practice buildings are fit for purpose
February 21, 2019 - Intense exercise, fasting and hormones can enhance waste-protein removal, study shows
February 21, 2019 - Scientists can monitor brain activity to predict epileptic seizures few minutes in advance
February 21, 2019 - Study quantifies hepatic and intestinal mRNA expression of Ugt isoforms in rats
February 21, 2019 - ‘Apple-Shaped’ Body? ‘Pear-Shaped’? Your Genes May Tell
February 21, 2019 - Can we repair the brain? The promise of stem cell technologies for treating Parkinson’s disease
February 21, 2019 - Trump Plan To Beat HIV Hits Rough Road In Rural America
February 21, 2019 - PENTAX Medical introduces new electrosurgical and argon plasma coagulation platforms
February 21, 2019 - Trump plan to beat HIV hits rough road in rural America
February 21, 2019 - Eating blueberries every day could help decrease blood pressure
February 21, 2019 - ‘No Second Chances’ report calls for new measures to combat cardiovascular disease in Australia
February 21, 2019 - Mayo clinic researchers discuss local case studies of leprosy
February 21, 2019 - Scientists demonstrate key role of salt in allergic immune reactions
February 21, 2019 - Experts propose revising the criteria for diagnosis of Parkinson’s disease
February 21, 2019 - The med student and the machine
February 21, 2019 - Hey, Hey! Ho, Ho! Is Striking For School Nurses The Way To Go?
February 21, 2019 - Latest research encourages children to move out and learn through physical activity
February 21, 2019 - Proper oral hygiene and regular visits to dentist can promote heart health
February 21, 2019 - New, versatile technique for remote control of transplanted cells in Parkinson’s
February 21, 2019 - Why melanoma tumors in the brain may be worse?
February 21, 2019 - New project aims to improve lung disease care in Appalachia
February 21, 2019 - Drug increases melanin production in some people with albinism
February 21, 2019 - Over 1 in 3 adults miss the mark on protein, finds study
February 21, 2019 - CymaBay Therapeutics Announces Seladelpar Granted Breakthrough Therapy Designation by the FDA for the Treatment of Primary Biliary Cholangitis
February 21, 2019 - A correlation between obesity and income has only developed in the past 30 years
February 21, 2019 - Baby, then work: An effort to help resident-parents in emergency medicine
February 21, 2019 - Heavy cigarette smoking could damage vision, say researchers
February 21, 2019 - Some drug combinations may be more effective than others for schizophrenic patients
February 21, 2019 - Combination of common antibiotics can eliminate multi-drug resistant E. coli
February 21, 2019 - Number of calls to U.S. Poison Control regarding kratom exposure increased
February 21, 2019 - New computational tool searches for factors that cause specific diseases
February 21, 2019 - New method to assess effectiveness of psychotherapies for social anxiety disorder
February 21, 2019 - New technology measures hormones that influence reproductive health efficiently
February 21, 2019 - Bat influenza viruses could potentially attack the cells of humans and livestock
Patient exposure to X-rays depends on how dentists are paid

Patient exposure to X-rays depends on how dentists are paid

image_pdfDownload PDFimage_print
Credit:

Dentists’ calculation of the benefits vs the risks of X-rays is being distorted by financial incentives.

A major study looking into how financial arrangements with dentists affect what goes on in the dentist’s chair has found a marked increase in the number of X-rays when dentists receive payment for them.

The research, reported today in the Journal of Health Economics, examined extensive data from dentists and patients over a 10-year period and found a significant increase in the number of X-rays given to patients when dentists were paid on a ‘fee-for-service’ basis, where each item of treatment delivered is charged for, compared to when they are on a fixed salary.

The researchers detected the biggest increase in the rates of X-rays when patients were also exempt from charges.

While X-rays are a useful diagnostic tool to allow dentists to examine bones and dental tissues, they also expose patients to potentially harmful radiation. A known carcinogen, X-rays can cause damage to DNA and inhibit the mechanisms cells use to repair themselves.

The authors of the report are calling for a review into how dentists are paid and whether current guidelines go far enough to protect the public.

Co-lead author of the study Professor Martin Chalkley from the Centre for Health Economics at the University of York said: “Our study clearly shows that a potentially harmful treatment is being given in varying quantities according to how dentists are paid for it and we believe this is a genuine cause for concern”.

“Dental X-rays deliver a very small dose of radiation, but there are no safe levels—every last bit of radiation is potentially harmful. Each dentist has to weigh up the risks versus the benefits before they take the decision to X-ray and our findings indicate that this calculation is being distorted by financial incentives.”

The study examined a uniquely detailed data set gathered between 1998 and 2007 by NHS Scotland on Scottish dentists and their patients. Scotland employs a mixture of ‘fee-for-service’ and salaried dentists. This means that some dentists are able to charge separately for each service they provide- a cost that is then normally shared between the patient and the NHS – while other dentists receive a fixed wage regardless of the treatments they provide. The presence of the two payment methods in Scotland allowed the researchers to compare their effect on dentist’s behaviour.

Fee-for-service is a prevalent billing system in dentistry worldwide; Scottish data was used for the study because it is uniquely detailed.

Tracking dentists and patients over a long period of time allowed the researchers to observe the same dentists switching between ‘fee-for-service’ and salaried payment, as well as patients who changed dentists and moved from co-payment to exemption from charges. This enabled the researchers to isolate payment as the influencing factor on numbers of X-rays, as the trends the study observes can’t be explained by varying professional approaches and personality types between dentists or the demands of different patients.

“It could be argued for example that what we have observed is due to the fact that dentists who opt for salaries naturally tend to have more risk averse personalities, but as we were tracking the same dentists switching between payment methods that criticism does not apply to our study.

“Equally we also observed the same patients receiving an increased number of X-rays when they were with a fee-for-service dentist and particularly when they were exempt from charges – perhaps because exempt patients will offer the least resistance and may even welcome additional procedures,” added Professor Chalkley.

Co-lead author of the study Professor Stefan Listl said: “While dental X-rays are an important diagnostic tool and are important for some procedures such as root-canal treatment, current regulations and guidelines state that any unnecessary x-ray exposure should be avoided. We can’t say whether our study observed excessive X-raying, but we can say that the amount of X-raying differed according to the financial arrangement. “

The researchers suggest that there are a number of deliverable and low-cost reforms that would address the issues their research raises. These would require concerted actions from regulators, funders, and government. For example, improvements to IT and administrative systems could increase sharing of dental records between practices leading to a reduction in the numbers of X-rays at times when patients are more likely to receive one – such as when they first sign up to a new dentist.

Richard Niederman, professor and chair of epidemiology and health promotion at New York University College of Dentistry as well as director of the WHO Collaborating Center for Quality-improvement & Evidence-based Dentistry, added: “Patient safety is always of paramount importance. This study suggests that regulators need to pay careful attention to what clinicians are paid, if safety is to be assured. In addition to health care regulators, dental x-ray guideline developers also need to be cognizant of these financial incentives for doctors and patients. It is morally and ethically unacceptable for financial interests to supersede patient safety.”

“First Do No Harm – The Impact of Financial Incentives on Dental X-rays” is published in the Journal of Health Economics.


Explore further:
More dentists to discuss risks of HPV-related cancers with their patients

More information:
Martin Chalkley et al. First do no harm – The impact of financial incentives on dental x-rays, Journal of Health Economics (2017). DOI: 10.1016/j.jhealeco.2017.12.005

Journal reference:
Journal of Health Economics

Provided by:
University of York

Tagged with:

About author

Related Articles