Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms

Soc Sci Med. 2018 Jun:207:46-54. doi: 10.1016/j.socscimed.2018.04.041. Epub 2018 Apr 26.


Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities.

Keywords: Conditionality; Dental; Health policy; Inequality; Responsibility.

MeSH terms

  • Contracts
  • Dental Care / organization & administration*
  • Health Care Reform / organization & administration*
  • Health Policy*
  • Humans
  • Policy Making*
  • State Medicine / organization & administration*
  • United Kingdom