Suchergebnisse

France possesses a mixed public-private oral health system with no out of pocket payments for most routine dental treatments. The "Convention" regulates tariffs between the elected dental trade unions, the National Health Insurance and Complimentary Health Insurers. It is periodically revised and negotiated by the three parties in order to introduce new procedures, improve the access to dental care of the population and to adjust procedure costs for inflation. At the beginning of the last negotiations in September 2016 health minister Marisol Touraine introduced a new legal procedure, the Arbitrary Judgment, which came into force if the Dentists failed to agree to the NHI's propositions. These propositions included setting caps on most of the previously unregulated dental prosthetics and a global price ceiling on the whole dental market. This sparked a nationwide strike of the profession, a blockade of all 16 Dental Schools and several national protests. This movement raised nationwide debates regarding the access to dental treatments, preventive care and out of pocket payments for patients. The political tensions generated between the stakeholders, as well as the lack of both robust epidemiological and economic data challenges the ability of this policy making process to produce comprehensive, evidence based and economically sustainable reforms.

The formulation of evidence-based policy necessitates rigorous, objective evaluation of policy initiatives and, consequently, there has been a significant growth in evaluation of social policy over the last ten years. Alongside this, there is a recognition that the application of new policy initiatives needs to be flexible in order to be relevant to local populations. As a result, pilots and pathfinders are encouraged to undertake local evaluations in addition to national evaluations commissioned by central government. These dual evaluations are seen as a vehicle to provide evidence on effectiveness whilst accommodating heterogeneity of needs and provision. We suggest that without clear delineation of roles, dual evaluations are inefficient, likely to put additional pressure on busy practitioners (and the recipients of new services) to comply with varying data demands, and present policy makers with confusing messages. In this article we focus on the potential for local and national evaluations to reach different conclusions by demonstrating how a simplistic application of quantitative techniques at local level can lead to inappropriate conclusions which contradict national findings. We make a number of recommendations that might facilitate better coordination of local and national evaluations.