Surgery costs
Table 3: Total and average cost of day case attendance in secondary care OS
Day cases (ISD 2012) Net Expenditure
£000s 4,949
Continued »
Since it was a like-for-like comparison, application of any statistical test was not consid- ered relevant.
Results The results indicate a wide differential in the costing of services. It is difficult to compare accurately codes in primary care versus secondary care as they are not set on similar lines for the same procedure. The basis for setting codes
in primary care was found to be the level of difficulty of the procedure, commonly extrac- tions. However, in secondary
Cases 4,563
Cost per case (£)
1,085
care it was based on whether the procedure was inpatient, day case or a simple consulta- tion as an outpatient. In other words, the same
procedure performed under local anesthesia in a primary care setting would possibly cost 20 times (outpatient), 90 times (day case) or about 200 times (inpatient) more in secondary care.
Discussion Broadly, there are some factors we need to consider to under- stand how oral surgery care is provided in the primary and secondary care sectors. There are many situations in general dental practice
Table 4: Total and average cost of inpatient attendance in secondary care OS
Inpatients (ISD 2012) Net Expenditure
£000s 3,638
Cases 1,227
where dentists may not be happy taking teeth out as they foresee complications. This results in referral to secondary care specialist, where they are treated as routine referral unless an airway or sepsis issue is present, which triggers emer- gency response. From a patient care perspective, extraction is probably the procedure which induces anxiety and even phobia in patients. Minor oral surgery in
secondary care differs in its perspective. Extractions are probably the least in terms of priority as they are dealing with complex cases in a secondary care unit such as a DGH (District General Hospital)
Cost per case (£)
2,965
based OMFS unit where these referrals are treated as routine and hence the patients end up waiting longer. Even if the patient is in pain with an attempted extraction, they can be seen only as routine as seeing them urgently and treating them is very difficult, taking in to consideration the number of referrals.
SDR allocations for minor oral surgery There is a disparity of cost codes for similar procedures in primary and secondary care. Costs allocated in the SDR (Table 5) are a fraction of costs
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Scottish Dental magazine 65
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