Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study

Petersson, Gunnel Hänsel; Twetman, Svante

doi:10.1186/s12903-016-0327-4

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…In a study on the oral ill health risk in FFS and DCH among young individuals in Sweden, Peterson & Twetman raised a discussion about the risk for divergent health development in the two payment models over time [ 23 ]. A free choice is likely to put the group of already resourceful individuals in a better position than those less resourceful to choose their most advantageous alternative.…”

Section: Discussionmentioning

confidence: 99%

Twelve years with a capitation payment system in Swedish dental care: longitudinal development of oral health

Andås

Hakeberg

2021

BMC Oral Health

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Background Since 2007, patients receiving oral health care within the Public Dental Service in Sweden have had the possibility to choose between the traditional fee-for-service (FFS) payment system or the new capitation payment system, ‘Dental Care for Health’ (DCH). Payment models are believed to involve different incentive structures for patients and caregivers. In theory, different incentives may lead to differences in health-related outcomes, and the research has been inconclusive. This 12-year longitudinal prospective cohort study of patients in regular dental care analyzes oral health development and self-reported oral health in relation to the patients’ level of education in the two payment systems, and compares with the results from an earlier 6-year follow-up. Methods Information was obtained through a questionnaire and from a register from n = 5877 individuals who kept their original choice of payment model for 12 years, 1650 patients in DCH and 4227 in FFS, in the Public Dental Service in Region Västra Götaland, Sweden. The data comprised manifest caries prevalence, levels of self-reported oral health and education, and choice of dental care payment model. Analyses were performed with chi square and multivariable regression analysis. Results The findings from the 6-year follow-up were essentially maintained at the 12-year examination, showing that the pre-baseline caries prevalence is the most influential factor for less favorable oral health development in terms of the resulting caries prevalence. Educational level (≥ university) showed an increased influence on the risk of higher caries prevalence after 12 years and differed between payment models with regard to the relation to self-rated oral health. Conclusions Differences in health and health-influencing properties between payment models were sustained from 6 to 12 years. Strategies for making use of potential compensatory mechanisms within the capitation payment system to increase oral health equality should be considered.

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Section: Discussionmentioning

confidence: 99%

Twelve years with a capitation payment system in Swedish dental care: longitudinal development of oral health

Andås

Hakeberg

2021

BMC Oral Health

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“…54 In Sweden, some argue that the current capitation function or service-purchasing model may contribute to or increase inequality. 55 Health economics are increasingly interested to expand evaluation of cost-effectiveness in integrated care for chronic conditions. 56 In the UK, the Quality and Outcomes Framework (QOF) pay for performance (P4P) scheme was explored as a potential model to reward primary care practitioners.…”

Section: The Information System Technology Vision In Healthcare Shouldmentioning

confidence: 99%

“…In the ideal capitation model, several measures such as age, gender, morbidity, additional health needs, local labor costs, rurality, patient turnover, and so on can be included and comprehensively examined to predict patient expenditure and base capitation on the prediction 54 . In Sweden, some argue that the current capitation function or service‐purchasing model may contribute to or increase inequality 55 . Health economics are increasingly interested to expand evaluation of cost‐effectiveness in integrated care for chronic conditions 56 .…”

Section: Framework For Test Lab Designmentioning

confidence: 99%

Testing cost containment of future healthcare with maintained or improved quality—The COSTCARES project

Swedberg

Cawley

Ekman

et al. 2021

Health Science Reports

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Background Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person‐centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies. Method In order to develop and test the roadmap, a COST Action project was initiated: COST−CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing. Conclusion Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries.

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“…The price range for CCS enrolment is based on risk assessments, carried out by the dental health care provider at a baseline examination. Peterson & Twetman [ 14 ] found that patients assigned to a higher risk group chose not to enroll, while patients assessed as low risk did. However, various types of risk assessments programs are used within the PDHS regions [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Apart from the patients’ own choice, this has further exacerbated the pronounced variations in dental attendance nationwide [ 8 , 19 , 26 , 27 ]. It is of interest to note that dental attendance by CCS patients is higher than those in FFS [ 12 , 14 ]. In addition to this, the CCS patients are more satisfied with their payment plan than the FFS patients [ 16 , 21 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Dentists´ and Dental Hygienists´ experiences of the Capitation Contract System—the dilemma of conflicting loyalties

2022

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Objective The Capitation Contract system (CCS) is a payment model adopted by the Swedish Public Dental Health Service (PDHS). Patients enrolled in the CCS are usually assessed as being at lower risk of dental disease and are more regular dental attenders than those treated by Fee for Service (FFS). With increasing numbers of patients and CCS enrolments, Sweden faces a shortage of dental personnel. Our aim was to analyse dentists´ and dental hygienists´ perceptions and experiences of the capitation contact system. Material and methods Eleven dentists and dental hygienists from three Swedish regions participated in online qualitative interviews conducted according to the Grounded Theory methodology. Results When working with CCS the informants tried hard ´to find a balance between attitudes, compliance with guidelines and clinical resources´. Not all patients were offered CCS, even though they qualified: among other determinants were the informants’ interpretations of guidelines and regulations, clinical resources, and patient interest. Conclusions When dental resources are in balance, the informants appreciate the CCS and consider it to be favourable to patient health but are aware of conflicting loyalties of their dual roles of insurance sales agent and care provider. The informants´ individual mindset affects which patients are offered CCS enrolment.

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Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study

Cited by 6 publications

References 12 publications

Twelve years with a capitation payment system in Swedish dental care: longitudinal development of oral health

Twelve years with a capitation payment system in Swedish dental care: longitudinal development of oral health

Testing cost containment of future healthcare with maintained or improved quality—The COSTCARES project

Dentists´ and Dental Hygienists´ experiences of the Capitation Contract System—the dilemma of conflicting loyalties

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