on scientific method and performance in outcomes measurement. Finally, there should be some rationality to the regulation of professions.

Another consideration for the future is what defines success for new workforce models. All models should be tested and compared based on evidence of success. The success of these models could include cost-effectiveness and contribution to addressing challenges in oral health care. Another element of success includes leadership accountability, integrity, and collaboration. Success also means improved public knowledge and practices for oral health. Finally, other successes may include caries-free children and youth, the elimination of oral health disparities, and harmony within and among the members of the oral health workforce.

Elizabeth Mertz, M.A.

Center for the Health Professions, University of California, San Francisco

The many challenges in the oral health care system also provide many opportunities to improve oral health. One opportunity relates to evidence-based practice and design. More scientific evidence is necessary to support the rationale behind many basic oral health procedures and approaches in order to determine the effectiveness of these services as well as define which practitioners are able to provide those services. Also, as a better oral health care system is designed, alignment with the financial system needs to be ensured. For example, a fee-for-service system may actually create incentives for continued focus on salvage procedures instead of encouraging prevention, education, and coordination of care.

Another opportunity is the use of information technology to enhance collaboration. When considering community-based care delivery systems, information technology may be especially useful to support the necessary collaboration as well as to expand the definition of an oral health system. Electronic medical records are an obvious key element for improving care coordination.

Regulatory and licensing reforms also provide opportunities for improving the delivery of oral health services. This is a basic issue of competition and the ability to test potentially improved models of care. Current licensing and regulatory systems are not based on competency and may prevent some practitioners from providing the services they have demonstrated they are able to provide safely and effectively. International models are especially good examples of how services can be provided effectively and rationally.

Finally, the concept of a health system approach to oral health care is needed to improve the delivery of oral health services. In this approach, the patient is placed at the center of the care system and collaboration occurs in a systemic fashion, instead of focusing on individual disease data.

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