对芬兰减少私人牙科保健公共补贴的政策干预进行现实主义评估

IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Community dentistry and oral epidemiology Pub Date : 2023-12-13 DOI:10.1111/cdoe.12938
Märt Vesinurm, Olli Halminen, Miika Linna, Hennamari Mikkola, Paul Lillrank
{"title":"对芬兰减少私人牙科保健公共补贴的政策干预进行现实主义评估","authors":"Märt Vesinurm,&nbsp;Olli Halminen,&nbsp;Miika Linna,&nbsp;Hennamari Mikkola,&nbsp;Paul Lillrank","doi":"10.1111/cdoe.12938","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>The Finnish dental care market operates as a dual system, divided between a regulated, affordable public sector and a less regulated, more expensive private sector that receives public subsidies. In 2015 and 2016, two policy interventions were introduced to reduce these subsidies for private dental services. The aim of this study was to evaluate the impact of these policy changes on the dental care market.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This study was a realist evaluation. Context-Intervention-Mechanism-Outcome-configurations were applied to elicit an initial program theory (IPT) for the policy interventions. The IPT allowed a complicated system to be reduced to the main components, allowing for better understanding of the underlying mechanisms and the chain of events started by the interventions. The resulting hypotheses about the chain of events and outcomes were tested against a dataset collected from the Social Insurance Institution of Finland (SII) registries on public and private dental visits in the cities of Espoo, Helsinki and Oulu during the years 2010–2016. The used dataset consisted of <i>N</i> = 17 111 625 dental procedures or <i>N</i> = 8 139 990 individual visits (which can include several procedures) at a public (<i>n</i> = 9 097 407 procedures, <i>n</i> = 4 083 475 visits) or a private (<i>n</i> = 8 014 218 procedures or <i>n</i> = 4 056 515 visits) dental clinic. The system was studied during three time periods related to the two interventions in 2015 and in 2016. Changes were evaluated by statistically analysing changes in several key metrics: mean subsidy, mean out-of-pocket price, mean (non-subsidized) price, number of patients treated, number of professionals, procedures per professional, Case-Mix adjusted procedures per professional, patient-to-professional ratio, total procedures.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The 2015 and 2016 reductions to the subsidization of private dental care reduced the average subsidies paid to the private dental sector by 49% [−49.1, −38.8]. A 26% [25.2, 26.7] increase in the out-of-pocket price paid in the private sector was observed. Over the 2 years, 12.2% of patients left the private sector and an increase of 13% was observed in the number of patients treated in the public sector. The public sector increased its number of dental care professionals by 2.3% and the patient-to-professional ratio increased by 9.9% over the 2 years, while the private sector lost 4.6% of its dental care professionals and increased its prices by 4.0% [3.5, 4.5].</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The policy changes had tangible effects on both the private and public sectors of the Finnish dental care market. By reducing subsidies, the private sector became more expensive for patients, causing many to transition to the public sector for their dental needs. While the public sector increased its capacity to accommodate the rise in patients, the demand still outpaced the growth in professionals, hinting at capacity or resource constraints in the public sector. The results also show initial evidence that contrary to the objectives, the policy changes increased the cost to the public sector as subsidized patient cared for in the private sector costs less to the government than treating that same patient in the public sector.</p>\n </section>\n </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"52 4","pages":"452-461"},"PeriodicalIF":1.8000,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.12938","citationCount":"0","resultStr":"{\"title\":\"A realist evaluation of policy interventions to reduce public subsidies of private dental care in Finland\",\"authors\":\"Märt Vesinurm,&nbsp;Olli Halminen,&nbsp;Miika Linna,&nbsp;Hennamari Mikkola,&nbsp;Paul Lillrank\",\"doi\":\"10.1111/cdoe.12938\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>The Finnish dental care market operates as a dual system, divided between a regulated, affordable public sector and a less regulated, more expensive private sector that receives public subsidies. In 2015 and 2016, two policy interventions were introduced to reduce these subsidies for private dental services. The aim of this study was to evaluate the impact of these policy changes on the dental care market.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This study was a realist evaluation. Context-Intervention-Mechanism-Outcome-configurations were applied to elicit an initial program theory (IPT) for the policy interventions. The IPT allowed a complicated system to be reduced to the main components, allowing for better understanding of the underlying mechanisms and the chain of events started by the interventions. The resulting hypotheses about the chain of events and outcomes were tested against a dataset collected from the Social Insurance Institution of Finland (SII) registries on public and private dental visits in the cities of Espoo, Helsinki and Oulu during the years 2010–2016. The used dataset consisted of <i>N</i> = 17 111 625 dental procedures or <i>N</i> = 8 139 990 individual visits (which can include several procedures) at a public (<i>n</i> = 9 097 407 procedures, <i>n</i> = 4 083 475 visits) or a private (<i>n</i> = 8 014 218 procedures or <i>n</i> = 4 056 515 visits) dental clinic. The system was studied during three time periods related to the two interventions in 2015 and in 2016. Changes were evaluated by statistically analysing changes in several key metrics: mean subsidy, mean out-of-pocket price, mean (non-subsidized) price, number of patients treated, number of professionals, procedures per professional, Case-Mix adjusted procedures per professional, patient-to-professional ratio, total procedures.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The 2015 and 2016 reductions to the subsidization of private dental care reduced the average subsidies paid to the private dental sector by 49% [−49.1, −38.8]. A 26% [25.2, 26.7] increase in the out-of-pocket price paid in the private sector was observed. Over the 2 years, 12.2% of patients left the private sector and an increase of 13% was observed in the number of patients treated in the public sector. The public sector increased its number of dental care professionals by 2.3% and the patient-to-professional ratio increased by 9.9% over the 2 years, while the private sector lost 4.6% of its dental care professionals and increased its prices by 4.0% [3.5, 4.5].</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>The policy changes had tangible effects on both the private and public sectors of the Finnish dental care market. By reducing subsidies, the private sector became more expensive for patients, causing many to transition to the public sector for their dental needs. While the public sector increased its capacity to accommodate the rise in patients, the demand still outpaced the growth in professionals, hinting at capacity or resource constraints in the public sector. The results also show initial evidence that contrary to the objectives, the policy changes increased the cost to the public sector as subsidized patient cared for in the private sector costs less to the government than treating that same patient in the public sector.</p>\\n </section>\\n </div>\",\"PeriodicalId\":10580,\"journal\":{\"name\":\"Community dentistry and oral epidemiology\",\"volume\":\"52 4\",\"pages\":\"452-461\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2023-12-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.12938\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Community dentistry and oral epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/cdoe.12938\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Community dentistry and oral epidemiology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cdoe.12938","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0

摘要

芬兰的牙科保健市场实行双轨制,分为监管严格、价格低廉的公共部门和监管较松、价格较高并接受公共补贴的私营部门。2015年和2016年,芬兰出台了两项政策干预措施,以减少对私营牙科服务的补贴。本研究旨在评估这些政策变化对牙科保健市场的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

摘要图片

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
A realist evaluation of policy interventions to reduce public subsidies of private dental care in Finland

Objectives

The Finnish dental care market operates as a dual system, divided between a regulated, affordable public sector and a less regulated, more expensive private sector that receives public subsidies. In 2015 and 2016, two policy interventions were introduced to reduce these subsidies for private dental services. The aim of this study was to evaluate the impact of these policy changes on the dental care market.

Methods

This study was a realist evaluation. Context-Intervention-Mechanism-Outcome-configurations were applied to elicit an initial program theory (IPT) for the policy interventions. The IPT allowed a complicated system to be reduced to the main components, allowing for better understanding of the underlying mechanisms and the chain of events started by the interventions. The resulting hypotheses about the chain of events and outcomes were tested against a dataset collected from the Social Insurance Institution of Finland (SII) registries on public and private dental visits in the cities of Espoo, Helsinki and Oulu during the years 2010–2016. The used dataset consisted of N = 17 111 625 dental procedures or N = 8 139 990 individual visits (which can include several procedures) at a public (n = 9 097 407 procedures, n = 4 083 475 visits) or a private (n = 8 014 218 procedures or n = 4 056 515 visits) dental clinic. The system was studied during three time periods related to the two interventions in 2015 and in 2016. Changes were evaluated by statistically analysing changes in several key metrics: mean subsidy, mean out-of-pocket price, mean (non-subsidized) price, number of patients treated, number of professionals, procedures per professional, Case-Mix adjusted procedures per professional, patient-to-professional ratio, total procedures.

Results

The 2015 and 2016 reductions to the subsidization of private dental care reduced the average subsidies paid to the private dental sector by 49% [−49.1, −38.8]. A 26% [25.2, 26.7] increase in the out-of-pocket price paid in the private sector was observed. Over the 2 years, 12.2% of patients left the private sector and an increase of 13% was observed in the number of patients treated in the public sector. The public sector increased its number of dental care professionals by 2.3% and the patient-to-professional ratio increased by 9.9% over the 2 years, while the private sector lost 4.6% of its dental care professionals and increased its prices by 4.0% [3.5, 4.5].

Conclusions

The policy changes had tangible effects on both the private and public sectors of the Finnish dental care market. By reducing subsidies, the private sector became more expensive for patients, causing many to transition to the public sector for their dental needs. While the public sector increased its capacity to accommodate the rise in patients, the demand still outpaced the growth in professionals, hinting at capacity or resource constraints in the public sector. The results also show initial evidence that contrary to the objectives, the policy changes increased the cost to the public sector as subsidized patient cared for in the private sector costs less to the government than treating that same patient in the public sector.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Community dentistry and oral epidemiology
Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.40
自引率
8.70%
发文量
82
审稿时长
6 months
期刊介绍: The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.
期刊最新文献
Process Evaluation of a Secondary School-Based Digital Behaviour Change Intervention to Improve Toothbrushing: The BRIGHT Randomised Controlled Trial. Long-Term Oral Health Effects of Traumatic Events Among World Trade Center Health Registry Enrolees, 2003-2020. Issue Information Reviewer list 2024 Hospital Dental Admissions and Caries Experience Among Children With Neurodevelopmental Disabilities: A Population-Based Record Linkage Cohort Study.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1