Policy Statement 2.5.3 - Capitation Dental Schemes

Position Summary

Capitation Dental Schemes involve a dental practitioner being contracted to provide dental services for a set fee per person for a given period. These schemes should not be introduced as a funding model for dental treatment.

1. Background

1.1. Capitation Dental Schemes are a form of funding or insurance for dental services, which have rarely been used in Australia. They have a minor role in USA and UK but are generally not popular.

1.2. Capitation schemes have been used more widely in consultative health practice such as general medical practice services under the National Health Service in the United Kingdom.

1.3. Capitation Dental Schemes may be designed as either maintenance plans or comprehensive plans. A maintenance plan typically covers yearly or twice-yearly examination and radiographs and emergency treatments only. A comprehensive plan generally offers a wider schedule of services and may be linked to a traditional dental insurance plan for more expensive treatment.

1.4. The reasons dentists choose not to participate in Capitation Dental Schemes include inadequate pricing schedule, concerns about opportunity to provide quality service, and a lack of control of patient treatment options.

1.5. Oral diseases are widespread and common and as such, do not have the essential characteristics of an insurable risk.

1.6. Most oral disease can be prevented through good personal oral hygiene and diet, abstinence from tobacco use, community-based preventive activities such as water fluoridation and regular dental visits.

1.7. Treatment costs are considerably higher than the costs of preventing oral disease.

1.8. Civil liberties and privacy issues will impede the ability of public or private administrators of capitation dental schemes to attribute dental risk classifications to individual patients.

Definition

1.9. CAPITATION DENTAL SCHEME is a dental benefits program in which a dental practitioner is contracted to provide specified dental services for a set fee per person for a given period.

2. Position

2.1. Capitation Dental Schemes in Australia are not supported for funding dental care.

2.2. The first priority for dental funding must be community-based preventive activities such as water fluoridation, oral health promotion, dietary education, and smoking cessation initiatives.

2.3. Publicly funded oral health programs should be targeted to eligible groups and individuals as per ADA Policy Statement 2.5.1 “Delivery of Oral Health Care: Funding: Government”.

2.4. Capitation Dental Schemes should be independent of dental care providers.