Mobilizing private dental capacity toward equitable access: a national survey of supply-side conditions for public–private partnership in Thailand
A national survey of Thai private dental clinics reveals that while a significant latent pool of providers with spare capacity is potentially willing to join public–private partnerships for basic care, their actual participation is heavily constrained by full clinic schedules, administrative burdens, and a proposed fee schedule that often falls below market rates.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many countries, having a national health system that covers everyone is a major achievement, but it does not always mean everyone can actually get the care they need. This is especially true for teeth. While a government might promise free dental checkups, the people who need them most often cannot find a dentist who is willing to take those patients. This happens because the majority of dentists work in private clinics, where they set their own prices and choose their own patients. To fix this gap, health officials often try to build partnerships between the public system and private clinics. The idea is simple: the government pays private dentists to treat patients who have public insurance. However, for this to work, the private dentists must be willing to sign up, and they must have enough free time in their schedules to see new people. If a clinic is already full, or if the payment offered is too low to cover the cost of the work, the partnership will fail.
Researchers in Thailand decided to find out exactly what it would take to make this kind of partnership work on a national scale. They wanted to know if private dentists were ready to join, what would stop them from joining, and what price they would accept for common procedures like fillings or extractions. To get the answer, the team did not just guess or look at government records; they picked up the phone and spoke directly to hundreds of private dental clinics across the country. Between late 2019 and early 2020, before the global pandemic changed how medicine was practiced, they interviewed owners of 196 private clinics. They asked simple but crucial questions: Do you have room for more patients? Would you be interested in treating people with public insurance? What would you charge for a specific job, and what would you accept as a fair payment?
The results revealed a clear picture of the dental landscape in Thailand. The researchers found that there is indeed a large group of private dentists who are willing to help, but their willingness is tightly linked to one specific factor: how busy they already are. The most important predictor of whether a dentist would join the program was simply whether they had spare capacity. Clinics that were already at full capacity were almost never interested in taking on more public patients. In fact, a clinic that was full had an eighty-eight percent lower chance of wanting to join compared to one that was still accepting new patients. This finding suggests that the biggest barrier is not a lack of desire to help, but a lack of physical space and time in the clinic.
The study also looked at whether a dentist's past experience working for the government would make them more likely to join. Many people assumed that dentists who had worked in the public sector before would be more comfortable with the rules and paperwork of a government contract. The data showed this was not true. Whether a dentist had worked for the government in the past or was currently working there made no difference to their decision. Instead, the decision came down to practical concerns and personal values. Dentists who were interested in joining were often motivated by a desire to serve their community. Those who were unsure were mostly worried about the amount of paperwork and administrative hassle involved. Those who were not interested at all were often concerned about how treating public patients might affect their reputation or the image of their clinic.
When it came to money, the gap between what dentists currently charge and what the government proposed to pay was significant. For most of the thirteen common dental services the researchers asked about, the current price a dentist charged was higher than the price they said they would accept for a government contract. The government's proposed fees were often much lower than what dentists expected. For example, for a simple application of fluoride to prevent cavities, the government offered one hundred baht, while dentists said they would need three hundred baht to consider it acceptable. This mismatch meant that only a small fraction of dentists found the offer fair. However, there were exceptions. For services like a dental X-ray or a surgical tooth extraction, the government's proposed fee matched exactly what the dentists said was acceptable, and in those cases, acceptance rates were much higher.
The researchers also discovered that the willingness to join was not spread evenly across the country. While Bangkok, the capital city, had the highest number of private clinics, it had the lowest percentage of dentists willing to join the program. In contrast, the southern and northeastern regions had fewer clinics overall, but a much higher percentage of those dentists were eager to participate. This creates a difficult situation for health planners. The areas that need more dental care the most often have the fewest private clinics available to sign up, while the areas that are already well-served have the most clinics, but many of them are too busy to take on new public patients.
This study provides a clear roadmap for how to build a successful partnership between public health systems and private dentists. It shows that simply offering a contract is not enough. To succeed, the system must recruit dentists who actually have free time in their schedules, rather than assuming that any dentist will do. It also suggests that the paperwork needs to be simplified to win over the dentists who are on the fence. Finally, the payment schedule needs to be adjusted so that it reflects the true cost of the work, especially for preventive care and treatments for children. Without these changes, the promise of universal dental care will remain just that—a promise that cannot be kept because the supply of willing providers does not match the demand. The study concludes that while there is a hidden pool of private capacity ready to help, unlocking it requires a strategy that understands the real-world limits of time, money, and motivation.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.