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Journal Article

Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992–2009


Publication date



Background:  There is a tension between financial
incentives and professional codes and norms, both of which are believed to
influence the behaviour of health care professionals. This study examined the
impact of changes to financial incentive structures on the behaviour of dentists
working in the English National Health Service (NHS) as a result of a new
national contract.
Methods:  Comparison of six reference treatments delivered by all NHS
dentists in England for the period 1992–2009.
Results:  Large and abrupt changes in the provision of the reference
treatments coincided with the introduction of changes in the incentive structure
in 2006. Treatments which can be provided in the least amount of time (and
therefore costs to dentists) such as extractions increased and treatments which
are time consuming or have significant additional materials costs such as
bridgework, crowns, root fillings and radiographs reduced
Conclusions:  Changes to financial incentive structures can produce
large and abrupt changes in professional behaviours. In the context of multiple
and conflicting goals, greater thought needs to be given to policies to change
incentive structures to mitigate their unintended consequences.

Published in

Community Dentistry and Oral Epidemiology



Public Policy and Health



online early; Albert Sloman Library Periodicals *restricted to Univ. Essex registered users*


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