|
Table 1
The DeFriese and Barker3 paper classification system Projections from Manpower-to-Population Ratios.
This simple and straightforward technique attempts to estimate the supply
of dentists in some future year by examining 5 factors: the current stock
of practitioners, projections from current statistics of the future
retention of graduates of in-state dental schools, the influx from
out-of-state schools, retirements and deaths. Population estimates are
obtained from appropriate state or federal agencies, and
manpower-to-population ratios are calculated for each year from the
present to the target year. Such analyses usually suggest either an
oversupply or an undersupply of dentists according to an arbitrary ratio
standard. The method is usually employed when no other data are available. Dental Practitioner Opinion Surveys. A
questionnaire survey of the practising dentists in a state or sub-state
region asks them to describe briefly the structure and size of their
practices and to indicate whether, in their opinion, there is a shortage
of dental manpower in the vicinity of their practices. This sort of
question might be combined with one that asks how “busy” dentists are
or an estimate of the number of additional patients a practice might
handle. On the basis of the answers received, particular counties or
communities are defined as dental manpower shortage areas. Estimates of Requisite Demand to Absorb Current Capacity.
This method is less common and more complex than the practitioner opinion
survey, as it requires information on the practice structure and patient
volume, as well as estimates of demand for dental care services. Rather
than focus only on the supply of health manpower, this approach attempts
to measure the extent and manner in which demand must be stimulated by
some future date in order to utilize fully the supply of dental services
that will be available. Econometric Practice-Productivity Study. This
approach attempts to measure a large number of variables known to
correlate with the output (measured usually in terms of visits, patients,
procedures or time) of dental practice for a given period and to relate
these variables, through the use of regression equations, to the
utilization of (demand for) dental services. Such studies are somewhat
more complicated conceptually and methodologically than the first 3 types. Need-Based, Demand-Weighted Studies. This approach is distinguished from the others principally by its emphasis on the measurement of the incidence and prevalence of conditions (disease and other needs for service or treatment) in the general population and its use of these data as the basis for the estimation of manpower requirements. The technique involves the translation of epidemiological measures of dental conditions into standardized measures of treatment needs and the measurement of the productive capacity of dental practices. Estimates derived from this analysis are of the percentage increase in productivity — measured in units of time, procedures or visits — required to meet the treatment or service needs of the population. This approach can be supplemented, or weighted, through the use of a measure of demand for care. The approach is relatively uncommon because of the number of separate factors that must be measured and taken into account. |
Table 2 Position statement and experts' report not amenable to classification within the DeFriese and Barker system3
| Author/Year | HRP Factors | Study Summary (Design) | Conclusions/Recommendations |
| Document Type | |||
| Methods | |||
| Belliveau, 19687 | Demographic profile Supply of dentists Insurance schemes Technology improvement/development |
To outline the similarities and differences in the HR situation and in the future between medical and dental personnel, demographic and supply/demand phenomena are reflected upon. Technological change and increased access to care are deemed to be major agents for increased supply needs. | Conclusions: - While affected
by distribution problems, both medical and dental HRP should strive to get
more graduates to meet demand for service. - The demand for dental services could, and probably will, increase in response to public education efforts leading to higher dental IQ. - Dental schools' capacity cannot currently meet the applications for enrollment due to their large number. The situation for applicants to medical schools is the opposite. |
| Position statement | |||
| N/A | |||
| Botterell, 19698 | Dental insurance Supply of dentists and auxiliary personnel (universities and colleges), including gender restrictions Development of faculty/staff to train auxiliary personnel Policy on topical fluoridation and water fluoridation Support for ongoing evaluation of impact of health services and quality of care, including a school dental health program Demographic profile |
To satisfy large unmet needs reportedly affecting considerable segments of the population in Ontario, a selected committee examined various factors that hinder access to dental care. | Conclusion: There will be a
substantial increase in the demand. Recommendations: (1) The dental services within the Department of Health should be expanded. (2) The number of dentists, dental auxiliary personnel and dental therapists should be increased. Education facilities and faculty/staff should be expanded. (3) The dental auxiliary personnel should take over many tasks to free up time for dentists to the more sophisticated tasks. (4) To support the overall intervention for better oral health, water fluoridation measures, dental programs for schoolchildren and social assistance should be introduced. |
| Experts' report | |||
| Unclear | |||
| Lewis, 197222 | Supply of dentists Busyness Unmet and met needs |
To address the perception of HR shortages while some dentists report not being busy enough, attention is drawn to the position that judgements of HR adequacy should hinge upon actual needs for prevention or treatment, not only on perceived or expressed needs. | Conclusion: Lack of busyness
of some dentists does not mean there is no shortage of supply. Recommendations: - Consider actual dental health status in the community when assessing HR. - Try to restore balance between supply and demand by maximizing use of HR to improve dental health status. |
| Position statement | |||
| N/A | |||
| Lang, 197720 | Supply of professional personnel Busyness Immigration policy for dentists Inter-provincial supply balance |
To address the impending oversupply of dentists in the country, examples from other professional fields should guide the measures and monitoring of supply that is needed. | Conclusion: On the verge of
oversupply crisis at the national level. Recommendation: Supply planning should be implemented by bringing provincial governments, licensing bodies, dental associations and universities to yearly meetings. |
| Position statement | |||
| N/A | |||
| Clappison, 198013 | University funding Supply of dentists Versatility of dentists to refocus professional goals Dental insurance Changes in level and type of treatment needs |
To assess the evolving scenario in which future dentists will work, considerations are made of the underlying priorities to plan university professional training when reduced busyness is deemed widespread. | Conclusions: - There is an
oversupply of dentists, as evidenced by changing plans to establish
independent practices upon graduation. - University finances and the current scheme for government funding of higher and professional education stimulate dentists' overproduction. This is an incorrect framework for HRP. |
| Position statement | |||
| N/A | |||
| McDermott and Oles, 198528 | Demographic trends Dentist:population ratios Demand for dental services Technological changes affecting clinical practice Supply of dentists and auxiliary dental personnel Secular trends in oral health status |
A review of national and provincial dental HRP reports with special attention to Saskatchewan documents the perceived oversupply of dental personnel, together with demographic and demand factors that affect the balance of the dentist:population ratio. | Conclusions: - Dental manpower oversupply
exists in the country and will worsen because demand lags behind the
increase in supply. - Free market forces are expected to correct maldistribution of HR. - As a result of the imbalance between supply and demand, the income level of the dental profession will drop. A lowering of prestige and professional status will follow. |
| Position statement | |||
| Unclear Combination of surveys |
|||
| Johnson, 198519 | Dental hygienist supply and employment Demand Roles of auxiliary personnel and dentists to meet demand |
To address the relationship between supply and demand in the dental market, the complementary roles of various types of dental personnel are examined and reflected upon as the basis for HRP. | Conclusions: - No evidence of
oversupply of dental hygienists. - Current changes in disease trends support the increased involvement of dental hygienists in meeting the demand. Recommendations: - Changes in the number of dental hygienists should be implemented by adjusting dental hygiene class size rather than by closing dental hygiene training programs. - There is a need to consider expanded roles for dental hygienists in the future in the new dental care market. |
| Position statement | |||
| N/A | |||
| Beagrie, 19866 | Demographic profiles Treatment patterns and modalities Number and profile of dentists Preventive agents Dental insurance Cariogenic factors |
To reflect upon the necessary factors to offer a comprehensive appraisal of HRP, the author outlines the interaction between factors. The WHO view is incorporated together with some figures from B.C. to be used as a case demonstration. | Conclusion: HRP should be
based on data collection from the population, treatment need and demand,
type of care requested, care organization and financing, research in
prevention and care technology, education and re-education of personnel,
and political, social and economic policies. Recommendations: - Establish a national planning and monitoring group for oral health (with representation from the consumer, national associations and government). - Complete the change in the role of dentist to "oral physician". |
| Position statement | |||
| N/A | |||
| Pamenter, 198629 | Supply of dentists Busyness Atlantic provinces (mainly Nova Scotia) perspectives, but encompassing the national scenario |
To address the impending oversupply of dentists and its assorted sequels, there is a need to manipulate the supply/demand relationship. | Conclusions: - Atlantic
provinces are on the verge of oversupply. - There is a need to increase demand and reduce supply. - Through implementing a national program, the projected national demand should be monitored and measures introduced to achieve a favourable relationship. |
| Position statement | |||
| N/A | |||
| Schwartz, 198631 | Unclear Demands for dental care, met and unmet HRP evolving priorities |
To reflect upon the priorities that should guide HRP, a discussion of values implicit in setting the priorities and planning services is made. | Conclusion: The future of
dentistry depends on dental schools for education and research. HRP should
consider issues of access to care. Recommendation: HRP should involve professional representatives, government, universities and the public. |
| Position statement | |||
| N/A | |||
| Silver, 198632 | Supply of dentists Changes in level and type of treatment needs Demographic profile Enrollment adjustment |
To assess the viability of adjusting the supply of dentists to the actual needs of the profession (in terms of busyness), the relative contributions of changing disease profiles and demographic profile are considered. | Conclusions: - There is an oversupply of
dentists, as evidenced by reports of lack of busyness. - Changes in disease trends are not making up for a decrease in caries levels by substitution for other reasons for demand. - HR cohorts should reflect the needs of population cohorts. Recommendations: - While reduction in enrollment appears to be the first choice to adjust the supply, it would be a better strategy to close some faculties altogether. This measure would reduce supply and preserve the viability of remaining faculties. - HRP should contemplate shifts in the HR mix to reduce the number of dentists and increase auxiliary personnel. |
| Position statement | |||
| N/A | |||
| Bascombe, 19925 | Dental
hygiene working conditions Dental hygiene professional development Epidemiological and economic situations |
To reflect upon the issue at play while determining whether there is a shortage or a surplus of dental hygienists, the document reflects on the factors involved in HRP for the dental hygiene profession. | Conclusions: While HRP should be reviewed having the aspect of access to care in mind, it is difficult to select any one approach to design a comprehensive planning model. Emphases on economic, demographic and epidemiological needs should offer different results. |
| Position statement | |||
| N/A |
Table 3 Projections from manpower-to-population ratios (DeFriese and Barker system)3
| Author/Year | HRP Factors | Study Summary (Design) | Conclusions/Recommendations |
| Document Type | |||
| Methods | |||
| Lewis, 197423 | Supply of dental services/chairside hours,
productivity Profile of needs/sociodemographic and insurance components Dental auxiliary personnel (with and without expanded functions) Geographic distribution of personnel |
To summarize the main considerations and results for 4 HRP studies, a combination of frameworks and components was designed to offer an overview of HRP in Ontario. Three of the 4 studies were unpublished at the time. | Conclusions: Lewis and Brown25
- With current levels of productivity, the country needs between 2 and 2.6
times more dentists, whether denticare is introduced or not.
If there is an increase in the number of dental therapists, the
increase in the number of dentists would decrease by approximately 50%. Three unpublished studies - Without adding another dental school in Ontario, more dental auxiliaries need to be trained. There is a need to employ auxiliaries as a means to alleviate supply deficiencies in certain geographic areas. An incentive scheme would be needed to attain this goal. In areas with supply deficiencies, mobile clinics may need to be introduced. |
| Experts' report | |||
| Unclear Charting of trends, combination of surveys |
|||
| House and others, 198217 | Unclear Growth of dentists' supply Growth of population in B.C. Impact of auxiliaries on supply of dental services Impact of productivity of auxiliaries Impact of UBC enrollment on supply Impact of immigration Impact of retirement rates Impact of specialty training |
Unclear. Charting of supply and demand factors. |
Unclear conclusions; no recommendations. There is an excess number of dentists and dental hygienists. For dentists, the worst effects of this oversupply were finished at the time of publication (1982). For dental hygienists, the increase in supply and the uncertainty as to the demographic/labour/employment profiles made it difficult to predict the outcome. However, dental hygienist supply could be excessive. - Too many dentists graduated in the 1960s and 1970s. - B.C. would likely attract enough population to dilute the oversupply. - No significant change was estimated for 1982 to 2000 in the dentist:population ratio. - Factors affecting HR include immigration, retirement age, role of auxiliaries, number of graduates, etc. |
| Experts' report | |||
| Unclear | |||
| Peat, Marwick and Partners, 198230 | Supply
of dental personnel Demand for dental services Dental personnel:population ratios |
By reviewing past reports and consulting with professional/government authorities, ideal dental personnel:population ratios were designed and extrapolated to the future demographic growth in Western Canadian provinces. This strategy allowed the production of a series of adjustments to the actual HRP figures and sources for the 1980s and beyond. | Conclusions
for certified dental assistants and dental hygienists:
Potential exists for a small dental hygienist surplus in Western Canada,
but the impact of this situation is uneven across the 4 provinces and
partly constrained by oversupply of dentists. Recommendations for certified dental assistants and dental hygienists: No changes are recommended in the training programs at the time in any of the 4 provinces, except for minor adjustments for certified dental assistant enrollments. Conclusions for dentists: - Projected surplus exists in Western Canada and at the provincial level. Currently a surplus exists in B.C. (1982) and will increase. Other provinces are more stable. - Increases in productivity through technological change and changes in organization of practice will worsen the surplus as a side effect of increased capacity of the dental care system. - The impact of insurance coverage on demand for dental services in the future is unclear. - The immigration of dentists into Western Canada suggests that the control and monitoring of dentist supply must take into account the national situation. Recommendations
for dentists: - Maintain dentist enrollment in
Alberta, Saskatchewan and Manitoba at the current levels. |
| Original research | |||
| Charting of supply and demand trends for dental hygienists, certified dental assistants and dentists | |||
| House and others, 198318 | Unclear Population growth Dentist supply growth Mobility of dentists Policy changes Immigration of dentists Retirement age/financial outlook Number of graduates Full-time equivalents for dental personnel (mainly female) |
Unclear. Charting of supply for dentist, dental hygienist and certified dental assistant figures at the national and provincial levels, by age of dentist and gender. |
Conclusions: - Dentist supply will increase
40% in the next 20 years; population will grow much less.
Public sector opportunities unlikely to grow. - Policy changes alone have tightened immigration patterns; supply will decrease 5% to 6% by 2001. - Supply of dentists depends on number of graduates, net inflow from other provinces/countries, policy changes and retirement patterns (age and financial considerations). - These factors should be carefully considered in HRP. |
| Experts' report | |||
| Unclear |
Table 4 Dental practitioner opinion surveys (DeFriese and Barker DHHRP system)3
| Author/Year | HRP Factors | Study Summary (Design) | Conclusions/Recommendations |
| Document Type | |||
| Methods | |||
| MacLean, 197026 | Dental hygiene employment lifespan Dental hygiene graduates/year Dentist graduates/year Dentist supply |
Survey of dental hygiene graduates from the University of Alberta between 1963 and 1969 to determine province of origin, actual (potential) years of employment in various fields and practice location. An appraisal was made of the relationship between dentists and dental hygienists for HRP purposes. | -
Dental hygienists graduating from the University of Alberta and
participating in the survey had 3.18 years of work expectancy — not too
different from potential years. - To maintain the dentist:dental hygienist ratio, about 250 to 300 dental hygienists would need to graduate per year (Alberta). National figures suggest that over 2,000 dental hygienists graduate per year, compared to the current figure of 110 (1970). |
| Original research | |||
| Survey of opinion | |||
| Manning and others, 197927 | Current employment status of dental auxiliaries and unfilled vacancies (dental hygienists, chairside assistants, certified dental assistants), as well as projections within 2 years of the survey | To determine whether a need exists for expanding the number of auxiliary personnel in B.C., a survey of opinion amongst practising dentists was undertaken. Both the current situation and their perceived projection of need for hiring auxiliary personnel were surveyed. | Conclusions: - The hiring
pattern will remain the same except for changes in the ratio of employment
across various types of personnel. - The greatest need to supply personnel will be for dental hygienists. - While certified dental assistants will also increase, the change will be more modest. - Dental hygienists will become a majority of auxiliary personnel, thus replacing certified dental assistants. - The priority in HR would thus be dental hygienists, then certified dental assistants, then chairsides. |
| Experts' report | |||
| Survey of opinion | |||
| Leake, 198321 | Public health dentist positions available Public health dentist positions filled Public health dentist position expansion plans |
Survey of opinion among public health dentist authorities in the country to assess the immediate past and developments within the previous 10 years in terms of public health dentist personnel. This is not a clinical specialty but some public health dentists are practising clinicians. | Conclusions: - Not enough HR
in public health dentistry. Number of public health dentist positions will
increase, with an estimated need to train approximately 134 public health
dentists in the next 10 years. Quebec and the Prairies may suffer more to
address needs for public health dentists. - Lack of HRP has led to (i) positions being left unfilled, (ii) positions being filled with non-public health dentists and (iii) recruitment of foreign public health dentists. Recommendation: Increase salaries to make public health dentistry more attractive vis-a-vis number in private practice and increased training requirements. |
| Original research | |||
| Survey of opinion | |||
| Christensen, 198612 | Dentists' perceptions of shifts in demand, in supply and in the number/type of procedures performed | To achieve a better understanding of how the market is being perceived by Canadian and American dentists, a convenience sample was chosen and surveyed. | Conclusions:
While a decrease was noted in treatment items pertaining to
pediatric dentistry, dentures, extractions and adult restorations,
remaining areas in clinical dentistry remain unchanged or nearly so. The
volume of patients has not suffered major changes. The overall perception
of the 43% of subscribers who responded to the survey was that there were
too many dentists on the supply side. Recommendations: - Stop overproduction of dentists by dental education establishments. - Incorporate the clinical community into the dental education system, and vice versa. |
| Original research | |||
| Survey of opinion |
Table 5 Estimates of requisite demand to absorb current capacity (DeFriese and Barker DHHRP system)3
| Author/Year
Document Type Methods |
HRP Factors | Study Summary (Design) | Conclusions/Recommendations |
| Lewis and Brown, 197325 | Supply of dental services/chairside hours,
productivity Profile of needs/sociodemographic and insurance components Dental auxiliary personnel (with and without expanded functions) |
To provide a dynamic comparison of the relative impact of 2 prepayment systems and 2 combinations of dental personnel on the demand for dental services (scenarios A, B, C and D). | Conclusions:
Against a background of the 1971 ratio of 1 dentist for every 2,814
persons, this study indicates that (A) Dentist: population ratios of 1:1,222 to 1:1,424 are required to achieve desirable levels of utilization of dental care services in Canada in the future. (B) Anticipated increases in annual utilization and frequency of care resulting from a publicly financed dental prepayment program for the 0-18 year age group will require ratios of 1:1,100 to 1:1,291. (C) Target ratios of 1:1,822 to 1:2,042 for dentists (higher than A or B) are possible under the same utilization as in A when maximum use (with the 0-18 year age group) is made in private practice of dental therapists, who must be available in the ratio of 1:3,599 and 1:5,432 (total population), respectively, to counterbalance the decreased need for dentists. (D) Utilization of therapists in "1500-hour" school clinics to work on the age group (0-18) in a publicly financed prepayment scheme having a 90% patient utilization experience requires ratios of therapists to total population of from 1:2,681 to 1:3,551 coupled with dentist supply ratios of 1:1,681 and 1:1,912, respectively; note that here patient utilization is higher than C and only slightly above B. |
| Experts report | |||
| Economic modelling | |||
| Aziz and Leung, 19734 | Supply of dental services by dentists and by
dentists and auxiliary personnel Financing of services/voluntary type and publicly financed Demand for dental services (USA and Canada) |
Unclear. Seemed to use Lewis and Brown25 criteria to determine supply of dental manpower, assuming various sets of frameworks and charting assumptions. |
Conclusions: Unclear. It may be inferred from a subjective comparison of the 4 charts depicting the number of dentists and demand that the inclusion of publicly financed dental plans or the employment of auxiliary personnel in various capacities to provide services would reduce the discrepancy between the projected supply of dentists (1973-1981) and the required supply to meet the demand for dental services. |
| Experts' report | |||
| Charting of trends | |||
| House and others, 198216 | Unclear Changes in demographics Changes in disease trends Changes in modalities of payment Changes in attitudes Impact of higher levels of care/mass prevention Demand for dental services |
Unclear. Using some charts to depict current patterns/levels of treatment, there is an extrapolation to larger needs projected to grow between 1982 and 2001. The foundation of these projections is vague. |
Conclusions: - Demand will
double between 1982 and 2001. Insurance coverage, treatment affordability
and sustainability of trends are open to question. - Distribution of time in treatment will evolve but most will still be taken up by diagnosis, prevention and restoration procedures. - Profession should be aware of the financial implications of demand growth and participate actively in shaping events. |
| Experts' report | |||
| Unclear | |||
| Lewis, 198624 | Unclear Survey information on demand and supply in terms of dental visits |
To outline some of the most important facts and considerations in
the models, 4 major segments of the document were outlined. (1) A summary of a 2-year survey consisting of questionnaires sent to various dental personnel, a 3-year questionnaire to households and a multiple regression analysis to make a projection of HRP for Ontario. A demand-based model was also designed using population projections of provincial demographics. (2) Medium-term evaluation of the Ontario Dental Manpower Study. (3) Other HR considerations. (4) Critique/contrast of Douglass & Gammon14 study. |
Conclusions:
Overall picture unclear; numerous isolated conclusions. (1) Studies [a] Dentists' activity: general dentists one-third not busy enough; recent graduates half to two-thirds busy enough; lack of busyness may be dentist oversupply or perception. [b] Dental hygiene: level of employment doesn't reflect oversupply. [c] Insurance: insured have increased utilization. [d] Supply:demand projections: Overall there are excess dentists despite decreasing dentist:patient ratio, and policy decisions should be made soon to stimulate demand or curtail supply. The supply of dental hygienists is adequate now but there is a need to start curtailing for the future. (2) Medium-term [a] dentist projection accurate 6 years later. [b] Dental hygiene projection inaccurate 6 years later. (3) HR considerations [a] Demand continues to increase and is associated with increased income, increased access and availability of dental insurance. [b] Demand due to decreased caries may not be kept at its present levels due to increased periodontal needs. (4) Douglass and Gammon study [a] Unmet need not only new disease increments but also backlog. [b] Met and unmet need equals total potential market is not true. [c] Criteria for met need is actually potential capacity. [d] Lewis suggests that Douglass and Gammon data could be interpreted in a different manner; he is concerned with the idea of preserving enrollment. |
| Symposium proceeding | |||
| Design of HHR models (production-function based and demand based)
from surveys Contrast and review of selected publications |
|||
| Boyd & Diggens, 19879 | Changes
in diseases Demographic profiles in transition Dentist:population ratio Migration, attrition, enrollment trends for dentists Enrollment and curriculum changes in B.C. and elsewhere Demand for dental services |
To achieve a more stable scenario for HRP in B.C., demand and supply data were evaluated together with sociodemographic and dental education considerations. | Recommendations
from main report:
Manpower changes (1) Funding for dental studies at the University of British Columbia should be maintained at the current level during the attempt to respond to the manpower issue through adjustments to enrollment. (2) There is a "critical mass" of faculty required to provide the range of teaching expertise and research interests needed for a viable dental institution. (3) Implement a modification in student mix with a decrease in undergraduate enrollment balanced by graduate and post-graduate enrollment. (4) Immediately decrease undergraduate enrollment. The first-year class would have 32 rather than 40 students. (5) Consider registration only for dentists who hold full practising licenses in B.C. to ensure uncompromised quality of care to patients. (6) Further epidemiological study must be continued to monitor provincial and national dental manpower levels based on population growth and demand for services. (7) A specific timetable for review of provincial manpower and curriculum should be established. Recommendations from minority report: Since the data used for HR evaluations were poorly founded and there was a risk of bias in their interpretation, the minority report rejected the call for reducing enrollment. |
| Experts' report | |||
| Design of HHR models (production-function based and demand based)
from surveys Contrast and review of selected publications |
|||
| House, 198715 | Unclear Population growth Changing demographics Trends in oral health status Treatment demand |
Based on partial and assumed scenarios with regard to treatment needs and demand, an appraisal was made of the time spent per treatment procedure. This scheme was based on current treatment patterns and modalities, and subsequently extrapolated to hypothetical scenarios in the future. Some questionable assumptions exist, such as the equation of "demand" to "need" in high-care users and then basing the overall projections on this group. | Conclusions: - Demand will not keep pace with
population growth. - Demand will grow by less than 3% in the next 20 years, which is much lower than the expected trend in HR. - The modalities of utilization may alter projections due to changes in disease trends and demographics, as well as economic and social factors. |
| Experts' report | |||
| Unclear | |||
| Brodeur and others, 198810 | Dentist supply (Quebec) Demand for services Population (Quebec) |
To appraise the evolution of the supply:demand relationship in dental care for adults in Quebec (1971-1985), various sources of data were combined. These resources offered information on the number of dentists, the population at large and the demand for services. | Conclusions: - The
dentist:population ratio increased markedly during the interval under
study. - While the number of adults who visited a dental office once a year increased substantially, an increase in all age groups was identified for people visiting a dental office twice a year or even more often. - In spite of these trends showing higher utilization, dentists are more anxious about HR issues (even though the concern may be unwarranted). Recommendations: - Introduce studies to investigate supply and demand. - In the meantime, measures should be undertaken to reduce the number of applicants to dental schools and to increase the demand for services. |
| Original research | |||
| Combination of independent surveys | |||
| Brodeur and others, 199011 | Dentist supply (Quebec) Demand for services (Canada and USA) Population (Quebec) |
To examine the supply and demand for dental care in Quebec between 1985 and 1988. | Conclusions: While the number
of active dentists grew (although at a slower rate more recently), the
demand for services has reached a plateau. Utilization rate in Quebec is
similar to United States. Suggestion: Introduce additional education campaigns and dental insurance programs to improve utilization of services and dental health status. |
| Original research | |||
| Combination of surveys |
Table 6 Need-based, demand-weighted studies (DeFriese and Barker DHHRP system)3
| Author/Year | DHHRP Factors | Study Summary (Design) | Conclusions/Recommendations |
| Document Type | |||
| Methods | |||
| Douglass & Gammon, 198514 | Secular trends of oral health status (caries and
periodontal disease) in United States (Projected) growth in the at-risk dentate population Met treatment need and unmet treatment need, leading to (projected) total potential market |
To determine the implications for the dental
profession of the epidemiological trends, a need-based model was
developed. The model took into account the secular trends of oral health
status (extrapolating from U.S. figures), the changes in population size
and distribution and the estimates of met and unmet treatment needs
(assuming that people with dental treatment needs would effectively demand
services at least at the 1976 rates). Note: Root decay lacks reliable data to be included in the model but its impact is deemed to be considerable. |
Conclusions: Number of hours
for operative and periodontal treatment will steadily increase by 2001 by
many millions of hours — at least twice the 1981 figures. The trend is
driven by the increase in the number of dentate adults making up the older
cohorts in 2001. Recommendation: Policy planners should be aware of the interaction between the epidemiological trends of dental diseases in adults and the demographic changes. |
| Original research | |||
| Epidemiological profiles of caries, periodontal disease and
edentulousness in Canada (where lacking, figures from the U.S. were used). Need-based model to estimate hours of treatment needed/hours effectively demanded. |
|||
| Stangel, 199233 | Disease/needs profile Dental school enrollment Supply of dentists |
To determine whether there is an increased need for dental services in the future or not, the 3 main HR components were charted and projections made into the future. | Conclusions:
- There is no well-documented decline in the need for dentists. - Evidence suggests that there will be an increasing need for dental services in the future, insofar as (i) The changing patterns of dental disease that have been identified in younger age groups are offset by the large number of adults who are retaining teeth into older ages. (ii) The increasing demand will likely be due to demographic changes and increasing third-party payments, economic growth and dental IQ in older cohorts. - HRP should be based on data available on factors affecting need. Accurate understanding of these should be carefully sought and updated. |
| Original research | |||
| Combination of surveys and charting of trends |