title: Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study.
abstract: BACKGROUND
  To a) compare risk categories in patients selecting a capitation payment (CP) model with those in fee-for-service (FFS), b) determine the 3-year caries increment in the two groups, and c) compare the amount of delivered preventive care in the two groups.
  
  
  METHODS
  A comprehensive risk assessment was carried out in 1295 young adults attending eight Public Dental Clinics in the Scania region and 75% could be re-examined after 3 years; 615 had selected the CP model and 310 the traditional FFS. Caries was scored according to WHO and data concerning preventive care was extracted from the dental records.
  
  
  RESULTS
  More patients in the low risk category preferred the CP model (74% vs. 26%) while >80% with high risk selected FFS. The baseline caries level was significantly higher in the FFS group as well as the 3-year caries increment (1.6 vs. 0.8 DFS: p < 0.05). The amount of additional preventive care delivered to each patient was generally lower in the FFS model; it was most frequent among patients with "some" risk in the CP model (83.8%) while the lowest delivery rates were found among low risk patients in the FFS system (32.4%).
  
  
  CONCLUSIONS
  Young adults in public dental care with low risk preferred the prepaid model while those in the higher risk categories selected fee-for-service. As more additional preventive care was delivered to patients in the subscribed care, oral health planners and decision makers should be aware of the fact that capitation payment models may enhance inequalities in dental health over time.
authors.affiliation: Department of Cariology, Faculty of Odontology, Malmö University, SE-205 06, Malmö, Sweden. gunnel.hansel-petersson@mah.se.
authors.forename: Gunnel Hänsel
authors.initials: GH
authors.lastname: Petersson
authors.affiliation: Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Svante
authors.initials: S
authors.lastname: Twetman
mesh_terms: D002204:Capitation Fee; D003729:Dental Care / Q000191:economics*; D018588:Fee-for-Service Plans; D006801:Humans; D007347:Insurance, Dental / Q000191:economics*; D008297:Male; D057240:Patient Preference; D011446:Prospective Studies; D018570:Risk Assessment; D013548:Sweden; D055815:Young Adult
keywords: Caries prevention; Dental care models; Risk assessment; Sweden; Young adults