The efficiency of the Community Dental Service in England: a data envelopment analysis

Objectives: To assess the efficiency with which health authorities' Communi ty Dental Services provide dental fare in England. Methods: A data envelopm ent analysis of inputs (hours worked by dental officers, therapists, hygien ists and others) and outputs (screening, treatment, prevention) of the Comm unity Dental Service (CDS) was conducted. Relative efficiency ratings of th e CDS by health authority were further analysed in order to identify extern al factors which effect efficiency and are outside the control of the Commu nity Dental Service. Results: The relative efficiency of the CDS varies wid ely in England - on average the CDS is operating at 75% of efficient levels compared to best-practice services. This could not be explained by plausib le factors outside the CDS's control, such as differences in deprivation an d urban-rural differences between health authorities. Conclusions: These re sults, if validated by further studies, should be disturbing since many Com munity Dental Sen ices services appear to be under-performing. However, thi s data-driven study could not uncover the detailed context of an individual service's performance. A useful next step would be detailed case-studies o f several "star" and under-performing services to search for deeper reasons underpinning relative performance levels.