Johansson Veronica, Axtelius Björn, Söderfeldt Björn, Sampogna Francesca, Paulander Jörgen, Sondell Katarina
Department of Oral Public Health, Malmö University, Sweden.
Swed Dent J. 2007;31(1):27-34.
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.
按服务付费，即在服务提供后支付费用，是瑞典牙科领域传统的成年患者财务体系。自1999年以来，韦姆兰郡的公共牙科保健服务（PDHS）也采用了另一种体系——合同式医疗。在该体系下，每年会支付一笔固定金额用于牙科护理，患者接受护理时无需额外付费。本研究比较了韦姆兰郡PDHS中按服务付费和合同式医疗这两种患者财务体系下患者的人口统计学特征、总体健康状况以及与口腔健康相关的生活质量（OHRQoL）。1324名患者回答了一份问卷，回复率为57%。进行了无应答分析。无应答分析表明，女性、合同式医疗的受访者以及年龄较大者回答问卷的可能性更高。进一步分析显示，未应答者比应答者更健康，口腔疼痛经历是唯一增加应答可能性的变量。使用SF-36量表研究总体健康状况，使用OHIP-14量表研究OHRQoL。所研究的人口统计学特征包括性别、年龄、出生国家、婚姻状况、教育程度和社交网络。结果表明，两种患者财务体系下患者的健康状况存在差异。合同式医疗的受访者OHRQoL优于按服务付费的受访者。在SF-36量表的四个维度上，他们的总体健康状况也更好，年龄更小，受教育程度更高，出生在瑞典，并且在更大程度上已婚/与他人同居，相比按服务付费的受访者而言。按服务付费的受访者与他们居住区域的社会亲和力更高。总之，合同式医疗的患者总体健康状况和OHRQoL优于按服务付费的患者。在财务体系选择上存在社会差异，且存在有偏差的无应答情况。
