Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Remuneration”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources
PubMed2004

Surgery or general medicine--a study of the reasons underlying the choice of medical specialty.

CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP). METHODS: A randomized sample of resident doctors in general medicine (30) and surgery (30) was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30%) choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%). Most residents in both fields (73% general medicine, 70% surgery) said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%), intellectual activities (30%) and knowledge of the field (27%). For surgeons the main reasons were practical intervention (43%), manual activities (43%) and the results obtained (40%). Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries with different social and educational characteristics. This congruence indicates that the choice involves very similar desires and needs in different settings and has little dependence on the students' educational context.

Adult↗
PubMed1993

Reorganization of craniofacial/cleft care delivery: the Massachusetts experience.

Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center.

Child↗
PubMedDate not supplied

Current status of prospective drug utilization review.

BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use. OBJECTIVE: We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness. SUMMARY: A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems. CONCLUSION: DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.

Drug Therapy↗
PubMed1999

Trends in medical employment: persistent imbalances in urban Mexico.

OBJECTIVES: This study examined the extreme medical unemployment and underemployment in the urban areas of Mexico. The conceptual and methodological approach may be relevant to many countries that have experienced substantial increases in the supply of physicians during the last decades. METHODS: On the basis of 2 surveys carried out in 1986 and 1993, the study analyzed the performance of physicians in the labor market as a function of ascription variables (social origin and gender), achievement variables (quality of medical education and specialty studies), and contextual variables (educational generation). RESULTS: The study reveals, despite some improvement, persistently high levels of open unemployment, qualitative underemployment (i.e., work in activities completely outside of medicine), and quantitative underemployment (i.e., work in medical activities but with very low levels of productivity and remuneration). The growing proportion of female doctors presents new challenges, because they are more likely than men to be unemployed and underemployed. CONCLUSIONS: While corrective policies can have a positive impact, it is clear that decisions regarding physician supply must be carefully considered, because they have long-lasting effects. An area deserving special attention is the improvement of professional opportunities for female doctors.

Employment↗
PubMed1998

Costs and effects associated with a community pharmacy-based smoking-cessation programme.

OBJECTIVE: The aim of the study was to determine the costs and effects associated with a community pharmacy-based smoking-cessation programme in Northern Ireland, using the perspective of the payer in the main analysis. DESIGN AND SETTING: Data from a pilot study conducted in 2 community pharmacies in Northern Ireland were used as the basis of the current study, which examined the cost effectiveness of a formal counselling programme for smoking cessation by community pharmacists throughout Northern Ireland. A number of assumptions were made in the baseline analysis (e.g. annual rate of smoking cessation in the absence of the programme; lifetime relapse rate), and these were varied in the sensitivity analysis. PATIENTS AND PARTICIPANTS: The pilot study upon which the main analysis was based was carried out in 2 Belfast pharmacies over a 2-year period. 52 people entered the smoking-cessation programme (group 1), 48 bought nicotine gum and gave their address so that additional information could be sent and they could be followed-up (group 2), and 60 people who expressed a wish to stop smoking were chosen on the basis that they matched, by age, gender, social status and disease status, those in group 1. Thirty-five of those in group 1 requested to use nicotine gum. A statistically significant difference (p < 0.01) was found in cessation rates between intervention and control patients. INTERVENTIONS: The Pharmacists Action on Smoking (PAS) model was the only active intervention used in the study. The model was developed by the PAS group in association with the National Pharmaceutical Association (NPA) in the UK in 1994, and was designed specifically for use by community pharmacists to provide advice and motivation to help smokers stop smoking. The 4-stage model involves a written 'contract' between the patient and pharmacist (including a 'stop date'), and a series of brief counselling meetings over a period of approximately 6 months. MAIN OUTCOME MEASURES AND RESULTS: Our findings indicate that the cost per life-year saved when using the PAS programme ranges from 196.76 pounds sterling (Pounds) to 351.45 Pounds for men and from 181.35 Pounds to 772.12 Pounds for women (1997 values), depending on age. This compares favourably with other disease prevention medical interventions such as screening for hypertension or hypercholesterolaemia. CONCLUSIONS: These findings provide an argument for adoption and remuneration of the PAS model in the community pharmacy (primary healthcare) setting.

Cost-Benefit Analysis↗
PubMed1987

Canadian federalism and the Canadian health care program: a comparison of Ontario and Quebec.

The Quebec and Ontario health insurance and health service delivery systems, developed within the parameters of federal regulations and national financial subsidies, provide generally universal and comprehensive basic hospital and medical benefits and increasingly provide for the delivery of long-term care services. Within a framework of cooperative federalism, the health care systems of Ontario and Quebec have developed uniquely. In terms of vital statistics, the health of Ontario and Quebec residents generally is comparable. In viewing expenditures, Quebec has a more clearly articulated plan for providing accessible services to low-income persons and for integrating health and social services, although it has faced some difficulties in seeking to achieve the latter goal. Its plans for decentralized services are counter-balanced by a strong provincial role in health policy decision-making. Quebec's political culture also allows the province to play a stronger role in hospital planning and in the regulation of physician income than one finds in Ontario. These political dynamics allow Quebec an advantage in control of costs. In Ontario, in spite of some recent setbacks, physician interests and hospital sector interests play a more active role in health system bargaining and are usually able to influence remuneration and resource allocation decisions more than physician interests and hospital sector interests in Quebec.

Canada↗
PubMed1995

Open the black box: paradoxes and lacunas in Swedish health care reforms.

The idea of using contracting-out as a means for improving public administration dates back to the 1850s, but was then found to be infeasible. The same idea has now become a major building-block in Sweden's health care reforms. Driven by a productivity-focused political discourse and the premises of neoclassical economics, these reforms ignore motivational structures among health care staff. The result may be a delegitimizing of the welfare state from within--either through the extinction of care rationality and its replacement by wage rationality, or, at worst, through the spread of a commercial spirit among health care staff and/or staff frustration at the unavoidable downward adjustments in remuneration rates. The author points to three strategic choices that arise when insights from a labor-process perspective are taken into consideration.

Attitude of Health Personnel↗
PubMed1991

Older women in the post-Reagan era.

This article explores the social, economic, and institutional factors that affect older women throughout the life cycle, and recent policy and ideological changes that will continue to affect older women in the decades ahead. The situation of the older woman is shown to result from lifelong patterns of socioeconomic and gender stratification in the larger society. The consequences for women flow from the complex and often subtle relationships in the social institutions of the family, the labor market, and the state and its social policy. The female roles of worker, unpaid caregiver, and beneficiary of public policies continue to be systemically unequal to those of men. The patriarchal structure of (and control over) the labor market and policy-making promotes the informalization of long-term care, ageism and sexism toward older women attempting to reenter the labor market, and the devaluing of female work that is not economically remunerated. The failure of social problems to address the underlying structural inequities of women perpetuates their disadvantaged economic and health situation throughout old age. Changes in social policies are required to address the problem of access to basic resources, including Social Security, housing, health, and long-term care, but most importantly, to abridge and compensate for the gendered division of labor and the lifelong discrimination that women experience.

Aged↗
PubMed1995

The World Bank, pensions, and income (in)security in the global south.

The authors describe and analyze recent reductions and reorganizations of public pension programs in Latin America, as well as trends in pensions in the global South more broadly. They consider the role of the World Bank in the current pension "reform" process and situate the Bank's policies in the context of privatization, reduction of social budgets, and other aspects of structural adjustment. Chilean pension changes are analyzed in particular, showing that even by the Bank's criteria, the reforms have not been successful. The authors then discuss pension changes in China, where the World Bank is also deeply involved. The article concludes with the consideration of a number of arguments about pensions and support mechanisms in later life--including family support and means-tested welfarism--and argues in favor of global policy approaches, such as globally funded pensions and full access by older persons to productive and remunerated labor.

Aged↗
PubMed1991

Characteristics of physicians practicing in alternative primary care settings: a Quebec study of local community service center physicians.

Since the early 1970s, there have been two primary care networks in Quebec: the traditional one characterized by private practice remunerated on a fee-for-service basis, and the public one comprising 15 percent of physicians and characterized by salaried practice within publicly funded local community health service centers (CLSCs). Using data collected on 616 Quebec generalists, 333 in private practice and 283 in CLSCs, we compared physicians' profiles in both networks. In contrast to their colleagues in private practice, CLSC physicians are younger, more often women, and more often graduates of innovative primary care training programs. They are more sensitive to the biopsychosocial nature of health problems and to giving patients an active role in their care. Significant differences were also observed in physicians' self-reported clinical practices, more so for women than for men. The study suggests that alternative primary care settings attract physicians that are more preventive and socially oriented. As a result, they may contribute to the emergence of a more comprehensive type of medical practice in health care delivery systems.

Adult↗
PubMed1993

Radiologists in the United States: demographic, professional, and practice characteristics.

OBJECTIVE: The purpose of this report is to present a statistical portrait of radiologists in the United States based on the 1990 American College of Radiology Manpower Survey. Unlike previous surveys, this survey included radiologists who were not members of the College and was thus more representative of all radiologists. (Approximately three quarters of radiologists are College members.) We examined how the demographic, professional, and practice characteristics of radiologists vary among major groups within the profession. MATERIALS AND METHODS: A stratified random sample of 2804 radiologists and nuclear medicine specialists was drawn from the American Medical Association Physician Masterfile, which is the most complete and extensive single source of information on physicians in the United States. Because the total numbers of female radiologists, nuclear medicine specialists, and radiologists less than 35 years old are relatively small, these groups were deliberately "oversampled" (hence the term stratified random sample) to ensure sufficient numbers of responses in these categories for meaningful analysis. A total of 1845 completed questionnaires were received, which yields a response rate of 68% if the questionnaires sent to invalid addresses are excluded. Responses were weighted to make the data representative of all radiologists, despite differences in sampling rates. RESULTS: Findings for professionally active radiologists who completed their training included the following: 94% were certified by the American Board of Radiology, 13% were women, 47% were less than 45 years old, fees for service were the primary remuneration for 62%, and 72% are in practices owned by physician members of the practice. By major activity in radiology, 69% were diagnostic radiology generalists; 11% were radiation oncologists; 18% were diagnostic radiology subspecialists; and 2% were nuclear medicine specialists. A breakdown by age indicated that the age group of radiologists less than 45 years old included more women, diagnostic subspecialists, and persons who had fellowship training than other age groups did. Percentages of diagnostic radiology generalists and solo practitioners were lower among younger radiologists. Radiation oncologists, compared with all others, were the most likely to practice solo or in small groups of two to four members. The subfields with the highest percentages (60% or more) of diagnostic radiologists reporting expertise or proficiency were CT, mammography, and sonography. Among radiologists who were retired, half had retired by the time they were 65 years old. However, a majority of radiologists 65-69 years old were still working, as were 40% of those 70-74 years old. CONCLUSION: The profession of radiology is changing, with more women, subspecialists, and fellowship-trained radiologists in younger age groups and fewer solo practitioners. Only a small percentage of radiologists are not board certified. Radiologists typically remain professionally active into their late 60s or even beyond.

Adult↗
PubMed2002

Compliance with prompt payment legislation: the initial experiences of New Jersey radiologists.

OBJECTIVE: Prompt payment has emerged as a dominant issue in managed care reform, with 47 states passing laws or regulations requiring prompt remuneration for medical services. The New Jersey Prompt-Pay Act, effective on December 28, 1999, requires payment within 30 days of electronic submission and within 40 days for nonelectronic submission. This study was undertaken to assess compliance with the New Jersey Prompt-Pay Act for radiology claims submitted 1 and 5 months after implementation (7-11 months after passage of the statute). MATERIALS AND METHODS: A retrospective prompt payment analysis was undertaken of all claims submitted in February and June 2000 to six major payers by a common third-party billing company on behalf of 11 radiology practices of various sizes, settings, and locations in New Jersey. A total of 33,537 claims were assigned to one of six time periods on the basis of timeliness of payment: less than or equal to 30 days, 31-40 days, 41-50 days, 51-60 days, 61-90 days, and greater than 90 days or a separate unpaid category after 170 days had elapsed. A detailed analysis of 3156 claims from one practice was performed to estimate a clean claims submission rate. RESULTS: The overall percentage of claims paid within 40 days was 70%. After 170 days, the overall percentage of paid claims was 93%. The annualized interest lost on delayed payments was $23,939 for the practice analyzed. CONCLUSION: Prompt payment for radiology services remains an elusive goal in New Jersey, despite passage and implementation of prompt payment legislation.

Guideline Adherence↗
PubMed1993

Evaluation of a structured treatment and teaching program for non-insulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians.

OBJECTIVE: To evaluate the practicability and efficacy of a structured treatment and teaching program for non-insulin-treated type II diabetic patients in routine primary health care. RESEARCH DESIGN AND METHODS: All physicians (n = 139) and their office staffs in Hamburg, Germany, who had participated in a special training course from 1 April 1991 to 31 December 1991 were contacted for a standardized interview. A random sample of 17 of these offices was selected for office visits during which the documented data of all patients who had received the standardized treatment and teaching in the same period were collected and evaluated. RESULTS: The program was well received by the physicians, and the data collected on 179 patients (5.1 mo median after the intervention) demonstrated the efficacy of the program at the treatment level: reduction of body weight (mean 2.8 kg, P < 0.0001) and HbA1c levels (from 8.11 +/- 1.68 to 7.47 +/- 1.64%, P < 0.0001) was substantial. The individual prescribed volume of oral antidiabetic agents was approximately 50% lower after patient attendance of the program (significant decrease from 1.41 +/- 1.42 to 0.76 +/- 1.11 tablets/patient/day, P < 0.0001). The proportion of patients treated with oral antidiabetic drugs decreased from 63 to 42% (P < 0.0001). CONCLUSIONS: Subsequent to the introduction of nationwide remuneration of outpatient education for type II diabetic patients by office-based physicians, a relevant improvement was observed in the quality of care, comparable with the effects of the program in a previous prospective controlled trial.

Adult↗
PubMed2003

Evaluation of the impact of chiropodist care in the secondary prevention of foot ulcerations in diabetic subjects.

OBJECTIVE: To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers within 1 year. RESEARCH DESIGN AND METHODS: Ninety-one diabetic outpatients with healed foot ulcers (age 65 +/- 11 years, 40 women and 51 men, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 +/- 4.4, diabetes duration 16 +/- 11 years, HbA(1c) 8.4 +/- 1.6%) were randomized to a group that received monthly remunerated routine chiropodist care (n = 47) or a control group (n = 44). RESULTS: Within a median follow-up of 386 days, ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group (hazard ratio [HR] 0.60; 95% CI, 0.32, 1.08; P = 0.09). Analysis of ulceration per foot demonstrated a significant reduction (20 vs. 32 ulcerations; Cox relative risk [Cox RR] 0.52; 95% CI, 0.30, 0.93; P = 0.03) in favor of chiropodist care. Per protocol, analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients (HR, 0.53; 95% CI, 0.30-1.01; P = 0.05) and in 15 vs. 37 feet (Cox RR, 0.46; 95% CI, 0.24-0.90; P = 0.02) for the intervention and control groups, respectively. Minor amputation was required in two patients in the intervention group and one patient in the control group. Four patients in the control group and two patients in the intervention group died during the trial. CONCLUSIONS: These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients.

Adult↗
PubMed1996

Psychiatrists working in primary care: a survey of general practitioners' attitudes.

OBJECTIVES: To collect information on current working arrangements between general practitioners (GPs) and mental health professionals and to assess GPs' attitudes towards developing closer working practices with psychiatrists in the primary care setting. METHOD: Six hundred and three GPs from South Australia were surveyed with questionnaires. Main outcome measures included information about existing primary care links between GPs and mental health professionals, GPs' preferred working arrangements with psychiatrists in the primary care setting and their attitude towards developing these practices, including perceived obstacles, advantages and disadvantages. RESULTS: One hundred and eighty-one completed questionnaires were returned. One in 11 GPs returning the questionnaire (RGPs) had established primary care links with a psychiatrist, 1 in 6 with clinical psychologists and 1 in 17 with psychiatric nurses and social workers. RGPs held positive attitudes towards developing closer links at their work settings with psychiatrists when it le8ads to improved collaboration and access to psychiatrists. Reservations were expressed about the public weakening of the GPs' primary care role. CONCLUSIONS: The joint needs of clinical care and GPs' further training in psychiatry could be addressed by further development of schemes to attract psychiatrists to work in primary care settings. This is mostly viewed very positively by GPs, although the percentage of GPs responding make these conclusions tentative. It is more likely to occur with changes to current funding of both private psychiatric care and GP remuneration, with a recognition of time spent in liaison.

Adult↗
PubMed2000

The sometimes uncertain world of Canadian obstetrics, 1900-1950.

All specialties in medicine in the first half of the twentieth century partook of the prestige of medical science and their practitioners looked to the past as a gauge to how far their specialty had progressed. Obstetrics was no different. The introductions to most obstetric textbooks and articles contained almost mandatory praise for the advances made. The writers acknowledged the art of obstetrics and, at times, gave it equal rhetorical standing, but in emphasis, the "science" of obstetrics dominated. Yet underlying the bravado was an unease that not all was well with the field. Several issues contributed to the sense of anxiety-the deficiencies in obstetrical education, its status vis-à-vis other medical specialties, the reality of practice, including the remuneration received, and the perception of competition from "unqualified" individuals. Such concerns are important for historians of childbirth to recognize.

Canada↗
PubMed2006

Senior veterinary students' perceptions of using role play to learn communication skills.

Recent studies of veterinary practice have suggested a correlation between well-developed communication skills and job satisfaction, career retention, customer satisfaction, decreased lawsuits, and financial remuneration for veterinarians. Veterinary educators are under growing pressure to teach functional communication skills to veterinary students; however, the methods employed have not been well evaluated. In this study we have evaluated veterinary student's attitudes to learning communication skills by participating in role play. The study indicates that experiential learning modalities such as role play are perceived as effective by students, despite reluctance to participate and some discomfort surrounding participation.

Adult↗
PubMed2006

Systematic review of the effectiveness and cost-effectiveness of HealOzone for the treatment of occlusal pit/fissure caries and root caries.

OBJECTIVES: To assess the effectiveness and cost-effectiveness of HealOzone (CurOzone USA Inc., Ontario, Canada) for the management of pit and fissure caries, and root caries. The complete HealOzone procedure involves the direct application of ozone gas to the caries lesion on the tooth surface, the use of a remineralising solution immediately after application of ozone and the supply of a 'patient kit', which consists of toothpaste, oral rinse and oral spray all containing fluoride. DATA SOURCES: Electronic databases up to May 2004 (except Conference Papers Index, which were searched up to May 2002). REVIEW METHODS: A systematic review of the effectiveness of HealOzone for the management of tooth decay was carried out. A systematic review of existing economic evaluations of ozone for dental caries was also planned but no suitable studies were identified. The economic evaluation included in the industry submission was critically appraised and summarised. A Markov model was constructed to explore possible cost-effectiveness aspects of HealOzone in addition to current management of dental caries. RESULTS: Five full-text reports and five studies published as abstracts met the inclusion criteria. The five full-text reports consisted of two randomised controlled trials (RCTs) assessing the use of HealOzone for the management of primary root caries and two doctoral theses of three unpublished randomised trials assessing the use of HealOzone for the management of occlusal caries. Of the abstracts, four assessed the effects of HealOzone for the management of occlusal caries and one the effects of HealOzone for the management of root caries. Overall, the quality of the studies was modest, with many important methodological aspects not reported (e.g. concealment of allocation, blinding procedures, compliance of patients with home treatment). In particular, there were some concerns about the choice of statistical analyses. In most of the full-text studies analyses were undertaken at lesion level, ignoring the clustering of lesions within patients. The nature of the methodological concerns was sufficient to raise doubts about the validity of the included studies' findings. A quantitative synthesis of results was deemed inappropriate. On the whole, there is not enough evidence from published RCTs on which to judge the effectiveness of ozone for the management of both occlusal and root caries. The perspective adopted for the study was that of the NHS and Personal Social Services. The analysis, carried out over a 5-year period, indicated that treatment using current management plus HealOzone cost more than current management alone for non-cavitated pit and fissure caries (40.49 pounds versus 24.78 pounds), but cost less for non-cavitated root caries ( 14.63 pounds versus 21.45 pounds). Given the limitations of the calculations these figures should be regarded as illustrative, not definitive. It was not possible to measure health benefits in terms of quality-adjusted life-years, due to uncertainties around the evidence of clinical effectiveness, and to the fact that the adverse events avoided are transient (e.g. pain from injection of local anaesthetic, fear of the drill). One-way sensitivity analysis was applied to the model. However, owing to the limitations of the economic analysis, this should be regarded as merely speculative. For non-cavitated pit and fissure caries, the HealOzone option was always more expensive than current management when the probability of cure using the HealOzone option was 70% or lower. For non-cavitated root caries the costs of the HealOzone comparator were lower than those of current management only when cure rates from HealOzone were at least 80%. The costs of current management were higher than those of the HealOzone option when the cure rate for current management was 40% or lower. One-way sensitivity analysis was also performed using similar NHS Statement of Dental Remuneration codes to those that are used in the industry submission. This did not alter the results for non-cavitated pit fissure caries as the discounted net present value of current management remained lower than that of the HealOzone comparator ( 22.65 pounds versus 33.39 pounds). CONCLUSIONS: Any treatment that preserves teeth and avoids fillings is welcome. However, the current evidence base for HealOzone is insufficient to conclude that it is a cost-effective addition to the management and treatment of occlusal and root caries. To make a decision on whether HealOzone is a cost-effective alternative to current preventive methods for the management of dental caries, further research into its clinical effectiveness is required. Independent RCTs of the effectiveness and cost-effectiveness of HealOzone for the management of occlusal caries and root caries need to be properly conducted with adequate design, outcome measures and methods for statistical analyses.

Adolescent↗