Little is known about the effect of a pay-for-performance system (P4P) on primary medical care providers and even less is known about its potential impact in dentistry. Based on the growing acceptance of performance-based reimbursements in medicine and the dissemination of innovative technologies, structures, and processes of care from medical to dental services, it is likely that the dental profession will face performance-based payments in the not-too-distant future. In this paper, we present the current experience of P4P in primary medical care that has relevance to dentistry and discuss the dental performance-based programs to date. Taking into consideration these lessons, the structure of dental service delivery in the United States, and the paucity of evidence-based quality indicators in dentistry, we provide several guidelines for the design of P4P pilot programs for dental services. We conclude that large-scale implementation of P4P for dentistry may not be a realistic option before significant progress is achieved in quality of dental care indicators.
1Postdoctoral Fellow in the Department of General Dental Sciences, University of Alabama at Birmingham, Birmingham, AL
2Investigator and dental health provider at the HealthPartners, Minneapolis, MN
3Investigator at the Center for Health Research, Kaiser Permanente Northwest, Portland, OR
4Associate Professor in the Department of General Dental Sciences, University of Alabama at Birmingham, Birmingham, AL
5Professor and Chair of the Department of General Dental Sciences, University of Alabama at Birmingham, Birmingham, AL
6Associate Professor in the Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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