Challenges, including funding constraints and limited input in policy changes, may prevent general dental practitioners (GDPs) from participating in publicly funded oral healthcare programs. This review study was recently published in Health Policy.
The study highlights the need for strategies to increase involvement in these systems, the authors wrote.
"The factors influencing GDP participation in state-funded, contracted dental care over private dental care are complex," wrote the authors, led by Paul Leavy, PhD, of the Trinity College Dublin Centre for Health Policy and Management in Ireland (Health Policy, January 13, 2025).
The study reviewed peer-reviewed articles and other sources from databases like Embase, Medline, Web of Science, and Google Scholar, along with gray literature and expert recommendations, covering 2000 to 2023. A total of 1,844 articles were identified, with 29 meeting inclusion criteria, plus 33 additional sources from adjunctive searches.
Systemic factors affecting GDP participation were identified, including a focus on treatment over prevention, low prioritization of oral healthcare, funding constraints, and poorly implemented changes lacking clinician consensus, they wrote.
Health systems often prioritize cost containment and treatment-focused care, leading to contractual restrictions that limit the treatments GDPs can offer. These pressures -- combined with low reimbursement rates, high patient volumes, and strict oversight -- contribute to stress, burnout, and a loss of professional autonomy among GDPs.
When contracts are developed without consultation and are perceived as unfair, GDPs often feel demotivated and mistrustful. GDPs may adopt a transactional approach to public contracts, exploiting loopholes or focusing on financially advantageous treatments while a stigma around state-funded dental care and low patient co-payments further contribute to their sense of being undervalued, pushing some toward private practice, they wrote.
However, the study had limitations, including a lack of data from regions outside the United Kingdom and North America, the authors added.
"The findings presented in this review have the potential to act as a good place to start leveraging health system change including better GDP engagement and increase participation in publicly funded systems," Leavy and colleagues concluded.