title: Patients' health in contract and fee-for-service care. I. A descriptive comparison.
abstract: Fee-for-service care, paying afterwards for services provided, is the traditional adult patient financial system in dentistry in Sweden. The public dental health service (PDHS) in the county of Värmland has since 1999 also an alternative system, contract care. There, a fixed sum of money is paid annually for dental care, which then is received without additional costs. This study compares the demographics, general health and oral health-related quality of life (OHRQoL) in the patient financial systems fee-for-service and contract care in the PDHS in Värmland. A questionnaire was answered by 1,324 patients, response rate 57%. A non-response analysis was undertaken. The non-response analysis showed that the likelihood for answering the questionnaire was higher for women, for respondents in contract care and for increasing age. Further analyses revealed that the non-respondents were healthier than the respondents and that experience of pain in the mouth was the only variable increasing the likelihood of response. General health was studied with the SF-36 and OHRQoL with the OHIP-14. The demographics studied were gender, age, birth country, marital status, education and social network. The results showed that there were differences in patients' health between the patient financial systems. Respondents in contract care had better OHRQoL than those in fee-for-service care. They also had better general health in four of the dimensions of SF-36, were younger, better educated, born in Sweden and were married/living with somebody to a larger extent than fee-for-service care respondents. Fee-for-service care respondents experienced higher social affinity with their housing area. In conclusion, patients in contract care had better general health and OHRQoL than patients in fee-for-service care. There were social differences in choice of financial system and biased non-response.
authors.affiliation: Department of Oral Public Health, Malmö University, Sweden.
authors.forename: Veronica
authors.initials: V
authors.lastname: Johansson
authors.forename: Björn
authors.initials: B
authors.lastname: Axtelius
authors.forename: Björn
authors.initials: B
authors.lastname: Söderfeldt
authors.forename: Francesca
authors.initials: F
authors.lastname: Sampogna
authors.forename: Jörgen
authors.initials: J
authors.lastname: Paulander
authors.forename: Katarina
authors.initials: K
authors.lastname: Sondell
mesh_terms: D000328:Adult; D003752:Dental Health Services / Q000191:economics*; D018588:Fee-for-Service Plans; D005260:Female; D006304:Health Status; D006801:Humans; D007347:Insurance, Dental / Q000191:economics*; D008297:Male; D009909:Oral Health; D017149:Private Sector; D011636:Public Health Dentistry / Q000191:economics; D017150:Public Sector; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden