Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health.

OBJECTIVE: In Australia, access to dental care has been available through several different pathways: (1) private practice; (2) public clinics; (3) Aboriginal Medical Services (AMS)-based clinics; and (4) until recently, the Chronic Disease Dental Scheme (CDDS). The aim of the present study was to compare the types of dental services most commonly delivered in the various clinical pathways based on the hypothesis that disease-driven care should lead to similar mixes of dental care provided. METHODS: Data from a series of previously published sources was used to identify and compare the most commonly performed dental procedures in the different pathways. A comparison was also made with the available international data (US). RESULTS: There was a marked difference between service mixes provided through the four pathways. Patients obtaining dental care through AMS-based and public pathways had more extractions and less restorative and preventive care compared with private and CDDS pathways. Compared with the international data, dental service mixes in Australia were found to be not as evenly distributed. Value of care provided through private and CDDS pathways were two- to threefold higher than that of AMS-based and public pathways. CONCLUSION: The data indicate that the original hypothesis that the disease-driven care should lead to similar mixes of provided dental care, is not supported.