Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.578776
Title: Variation in treatment : an analysis of dental radiographs using matched patient provider data
Author: Elouafkaoui, Paula
Awarding Body: University of Dundee
Current Institution: University of Dundee
Date of Award: 2011
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Abstract:
Variation in health care, whether it be in terms of the utilisation of resources, observed health outcomes, costs, quality or access to health care is a well recognised and ever present feature of the modern day health care system. Health care variations challenge basic assumptions about the nature of the health care economy and raise questions about efficiency, equity and where best to direct policy instruments in health care markets. Despite the vast literature documenting variation, and the many discussions around ways to reduce variations in health care markets, the field of dental care has received little interest, in comparison to that of general medical care. This thesis will address this gap and will analyse the variation observed in a specific dental care treatment (dental radiographs) within NHS Scotland, with particular emphasis on the contribution of both dentist and patient unobserved heterogeneity. The thesis takes its focus from two strands of the literature; the underlying theoretical aspect draws on the literature concerning the theory of incentives and physician agency, whilst the empirical component makes use of recent advances in micro-econometric methods, documented in the labour economics literature. Although the thesis is predominantly an empirical analysis, the estimation strategy combines ideas from both the theoretical and empirical literature. A matched patient provider dataset from NHS Scotland is used to conduct an analysis of the variation in dental radiographs, in the presence of, and controlling for unobserved dentist and patient heterogeneity. The results indicate that the remuneration structure alone has little or no impact on the treatment decision to provide a radiograph. When a dentist changes from being on a fixed salary contract to being paid on a fee-for-service basis, they are in fact less likely to provide a radiograph. This result changes in the presence of insurance (identified as being when patients are exempt from the patient charge) and indicates that when the self employed dentist can identify the patient as being exempt, they are more likely to provide a radiograph. This result provides some support for the theory that in the presence of insurance, financial incentives do influence the treatment decision. A final result of the study highlights the importance of accounting for unobserved patient and provider heterogeneity, a factor that has had little attention in the healthcare literature. The results suggest that patient variation, as opposed to the variation across dentists, is much more important in explaining total variation. This is a similar result to that found in both the labour and education literatures.
Supervisor: Not available Sponsor: Medical Research Council Capacity Building Studentship
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.578776  DOI: Not available
Keywords: Dental radiographs ; Matched data ; Financial incentives ; Patient fixed effects ; Dentist fixed effects
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