EVIDENCE-based dentistry and the assessment of dental care within the community have become of greater interest since the introduction of the purchaser-provider split. There seem to be so many definitions of health services research that health professionals providing the care to patients are unsure of what this new subject is all about. Indeed, some of the more cynical have suggested that it is a surrogate measure for rationing health care.

When the Minister of (Public) Health initiated the formation of a National Oversight Committee for chronic non-communicable diseases, I recall writing in this column in late 1998 with a very similar suggestion. I had proposed the formation of a National Centre for Disease Control, which would combat and control chronic diseases holistically. Obviously, dental caries and periodontal disease would be included. One major reason is to equilibrate priority at the administrative level, and another is to emphasise the interrelation among the conditions. Health services research for developmental change is an important key to success.

Undoubtedly, ‘doctor knows best’ is no longer an acceptable reason for offering a particular solution to a patient’s ills. Governments and insurance companies want to know that a clinical treatment works and are looking for a treatment that gives the most benefit and the least cost. Detailed studies must be done before huge healthcare investments to ensure a balance between maximum population coverage, minimum costs and best clinical care.
Dental health services research may well be able to help all concerned by making sure the practitioners, patients and funding agencies work together for the greatest health gain. This may be a utopian ideal, but there is no doubt that health services research has much to offer.

One point should be made quite clear. Health services research is not a management tool dealing with the collection of data. The discipline represents an ethos of accountability and inquiry concerning dental health services. It is about trying to define and redefine the best way optimal oral health can be delivered to the greatest number of people. It, therefore, encompasses health promotion, disease prevention and service delivery involving general health – in both the public and private sectors.

The development of health services research has been driven by a growing recognition amongst health care administration, politicians and clinicians that increasing the resources dedicated to a service does not necessarily lead to greater ‘health output’. For example, having more dentists per head of population does not necessarily decrease the amount of dental ill-health suffered by the public. Brazil is a classic example.

Many factors impinge upon this mission to find the means of providing dental care to as many people as possible at the most acceptable cost. Dentistry cannot expect to command national resources unless the amount of benefit accrued per dollar spent can be measured and, even more importantly, justified. Therefore, the ultimate assessment of any dental health service to be instituted should be expressed in the form of the benefit and the cost to the patient and the funding agency providing it. In the final analyses, all chronic diseases affecting the population should be equally considered and there must be absolute justification from all angles viewed based on the input of all involved.