Queen's University Belfast

Academic Institute

Economic and Social Research Council

Yes

179

Previous research (Telford and O’Neill, 2012; Telford et al 2012), highlighted the existence of stark differences in the pattern of publicly funded oral healthcare delivered through general dental practice in Northern Ireland related to social class. The work used data collated through the Northern Ireland Longitudinal Study (NILS) and covered the period prior to changes in respect of public funding of orthodontic care. In brief, the study demonstrated a strong pro-poor gradient in service use related to restorative care among children and adolescents. This contrasted with a strong pro-rich pattern related to registration and orthodontic care. As public expenditures on orthodontic care dominated those on children and adolescents, it is not surprising that overall public expenditure on oral care exhibited a strong pro-rich socio-economic gradient. In April 2014 an objective measure of need governing access to publicly funded orthodontic care was introduced in Northern Ireland; formerly no threshold on need had existed. This change has the potential to change patterns of service use and impact on the efficiency and equity of publicly funded oral healthcare. In principle, the changes might be expected to produce a reduction in the level of activity associated with orthodontic care and a reduction in the extent of the pro-rich socio-economic gradient observed in orthodontic service use. Across child and adolescent dentistry more generally, they might be expected to produce a shift in the relative pattern of expenditure from orthodontics and toward other types of care with concomitant changes in the socio-economic gradient in overall expenditures. This study will use a record-linkage methodology to examine the relationship between use of publicly funded oral health care and the introduction of the index of treatment need (IOTN) for orthodontic care in Northern Ireland in 2014. It will utilize data from the 2011 Northern Irish Census returns and link them to reimbursement data for publicly funded oral health care (on all residents enumerated in the 2011 Census until the end of March 2017). By analyzing patterns in service use before and after the introduction of an objective measure of need as a criterion for public funding, we can ascertain the impact of the policy change on disparities in service use among children/adolescents, and compare that with its effects on adults and those from specific minority groups.

In practice, general dental practitioners can earn income from both public and private sources as well as among adults and children/adolescents. The potential to earn income though is constrained by the opportunities that exist in local markets which in turn depends on local demand and supply conditions for oral healthcare. Consistent with the target income hypothesis (Rizzo and Blumenthal, 1996; McGuire and Pauly, 1991) dentists may respond other than in the manner suggested to the introduction of the objective measure of need. The target income hypothesis posits that professionals have a target for their income and will adjust behaviour subject to local market constraints to achieve this. Confronted with a reduction in fee income from orthodontics provided to adolescents, for example, dentists may respond by increasing orthodontic activity supplied to adults simply substituting the latter for the former. If patterns of registration with respect to adults mirror those with respect to children and adolescents, while the socio-economic gradient in respect of the latter may attenuate, that in respect of the former may well sharpen. The impact of the changes in reimbursement across all age groups are thus ambiguous, conditional on local market conditions and require a full systems approach to be properly understood. The project will provide insights into the impact of a policy change in publicly funded oral healthcare in Northern Ireland. Specifically it will ascertain if the introduction of an objective measure of treatment need resulted in a reduction in publicly funded oral healthcare expenditure among children and adolescents and if the policy resulted in a reduction in socio-economic inequalities in patterns of expenditure that have been previously observed among this group. The study will provide insights into whether the policy change has had unintended consequences in respect of publicly funded adult care which have not yet been examined. The study provides the opportunity to evaluate the impact of a policy change in terms of both efficiency and equity and thereby inform the use of scarce public resources.

11/04/2019

TRE