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Pay‐for‐performance and dental procedures: A longitudinal analysis of the Brazilian Program for the Improvement of Access and Quality of Dental Specialities Centres
Author(s) -
Cabreira Fabiana da Silva,
Hugo Fernando Neves,
Celeste Roger Keller
Publication year - 2022
Publication title -
community dentistry and oral epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.061
H-Index - 101
eISSN - 1600-0528
pISSN - 0301-5661
DOI - 10.1111/cdoe.12717
Subject(s) - incentive , medicine , odds , dental insurance , dental care , logistic regression , quality (philosophy) , odds ratio , family medicine , philosophy , epistemology , pathology , economics , microeconomics
Objective Evaluate the impact of a pay‐for‐performance program on changes in the number of dental procedures performed by public secondary dental care services in Brazil. Methods A longitudinal study was carried out with 932 public Dental Specialities Centres (Centro de Especialidades Odontológicas – CEO) that participated in the pay‐for‐performance Program for the Improvement of Access and Quality of Dental Specialities Centres Services (PMAQ/CEO) and 379 non‐CEO centres with secondary dental production. The non‐CEO and a group of CEOs did not receive financial incentives from the PMAQ‐CEO and served as control groups. Three CEOs groups received additional financial incentives of 20%, 60% or 100% over maintenance values, based on their performance scores. The outcome was the increase (yes/no) in the number of dental procedures between 2011/2013 and 2015/2017. Analyses were carried out using logistic regressions. Results The number of specialized procedures increased in 48.4% of the services, 44.6% among non‐CEO, 52.3% among CEO with no financial incentive and 59.1% among CEO with 100% incentive. The fully adjusted model showed that CEOs receiving 100% of the financial incentive had greater odds of increasing the production of dental procedures (OR = 1.65, 95%CI: 1.09–2.51). Services that increased the number of specialist dentists had (OR = 2.35, 95%CI 1.88–2.94). Municipalities that increased in coverage of private dental insurance had OR = 0.98 (95%CI: 0.94–1.02), and those with higher coverage of primary dental care had OR = 1.02 (95%CI: 0.99–1.05). Conclusion Pay‐for‐performance may increase the production of dental procedures by CEOs, and mechanisms explaining it must be further investigated.