Who chooses prepaid dental care? A baseline report of a prospective observational study

Abstract

BackgroundAn optional capitation prepayment system has been implemented in Swedish dental care, supplementary to the traditional fee-for-service scheme within the Public Dental Service. The implementation of a new system may have a variety of preferred and adverse effects, arguably dependent on the individual patient’s attitudes, health beliefs and course of action.The aim of this study was to describe potential differences regarding socioeconomic and lifestyle factors, perceived oral health and attitudes towards oral health between patients in the two payment systems.MethodsQuestionnaire data were consecutively collected from 13,719 patients, who regularly attended 20 strategically selected clinics within the PDS in Region Västra Götaland, before they were offered the choice between the traditional and the new payment system.ResultsCapitation patients were more often female and well educated. They had healthier habits, were more motivated to follow self-care advice, more often judged their oral health to be very good and considered oral health to be very significant for their wellbeing. The results were statistically significant and described a gradient.ConclusionsThe more explicitly affirmative the answer, the more likely the patient was to choose the prepayment scheme. There appears to be a pattern of differences with respect to important individual views on oral health between patients choosing a capitation system or a fee-for-service system. These differences may be important when assessing outcomes in the new payment system and in public dental care.

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

“…An explanation for this could be that the annual fee was seven times higher in the very high risk group compared to the lowest risk category, indicating that the economical factor had a pivoting influence the patients’ choice of payment model. Our findings were therefore basically in support of the observations made by Andren Andås and Hakeberg [3] who suggested that patients choosing prepaid care were young, educated people that judged their oral health to be good or very good.…”

“…However, according Andrén Andås and Hakeberg [3] and a national social insurance report [9], young adults (20–29 years) were clearly overrepresented among subscription dental care patients and they were more often females. Interestingly, this gender difference was not unveiled in our present material.…”

“…There are some international low-quality evidence to suggest that the payment method does influence the behaviour of dentists in child dental care with a tendency to higher activity and more preventive advice in the capitation system [2]. Among adults, it has been shown that patients selecting the CP model had healthier habits and were more motivated to follow self-care advice than those adhering to FFS system [3]. As a consequence, fewer fillings were carried out among the patients in the pre-payment scheme [4].…”

A retro‐prospective effectiveness study on 3448 implant operations at one referral clinic: A multifactorial analysis. Part II: Clinical factors associated to peri‐implantitis surgery and late implant failures

“…Patients attending routine annual recall examinations at different clinics of the PDC in the Region Västra Götaland in Sweden (about 125 clinics/about 650 dentists) are to be assessed for various dental risk factors which are fed into the electronic chart system used by the PDC (T4, Practice Management Software, Carestream Dental, Stockholm, Sweden) . Overview data on 5 different clinical risk factors of the individual patients are automatically compiled into a computer assisted overview of distribution of risk among examined patient groups .…”

Behavioural characteristics in externalising children with low and elevated risk for dental caries

“…Information about caries risk, estimated by the computerised algorithm-based system R2 (Andas and Hakeberg 2014), used by the Public Dental Service in the Region of Västra Götaland (RVG), was obtained from the dental file system. The caries risk clinical assessment is made by child’s regular dentist, according to the regional standardised guidelines by the Region of Västra Götaland.…”