title: Multivariate analyses of patient financial systems and oral health-related quality of life.
abstract: OBJECTIVE
  Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co-existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee-for-service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health-related quality of life (OHRQoL).
  
  
  METHODS
  A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee-for-service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP-14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF-36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis.
  
  
  RESULTS
  When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee-for-service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL.
  
  
  CONCLUSIONS
  Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee-for-service care.
authors.affiliation: Department of Oral Public Health, Faculty of Odontology, Malmö University, Malmö, Sweden. veronica.johansson@mah.se
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; D000368:Aged; D000369:Aged, 80 and over; D003284:Contract Services / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007347:Insurance, Dental / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009909:Oral Health; D011788:Quality of Life; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult