Public Dental Service, PO Box 7163, 40233, Gothenburg, Region Västra Götaland, Sweden.
Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMC Oral Health. 2021 Mar 6;21(1):103. doi: 10.1186/s12903-021-01463-w.
Since 2007, patients receiving oral health care within the Public Dental Service in Sweden have had the possibility to choose between the traditional fee-for-service (FFS) payment system or the new capitation payment system, 'Dental Care for Health' (DCH). Payment models are believed to involve different incentive structures for patients and caregivers. In theory, different incentives may lead to differences in health-related outcomes, and the research has been inconclusive. This 12-year longitudinal prospective cohort study of patients in regular dental care analyzes oral health development and self-reported oral health in relation to the patients' level of education in the two payment systems, and compares with the results from an earlier 6-year follow-up.
Information was obtained through a questionnaire and from a register from n = 5877 individuals who kept their original choice of payment model for 12 years, 1650 patients in DCH and 4227 in FFS, in the Public Dental Service in Region Västra Götaland, Sweden. The data comprised manifest caries prevalence, levels of self-reported oral health and education, and choice of dental care payment model. Analyses were performed with chi square and multivariable regression analysis.
The findings from the 6-year follow-up were essentially maintained at the 12-year examination, showing that the pre-baseline caries prevalence is the most influential factor for less favorable oral health development in terms of the resulting caries prevalence. Educational level (≥ university) showed an increased influence on the risk of higher caries prevalence after 12 years and differed between payment models with regard to the relation to self-rated oral health.
Differences in health and health-influencing properties between payment models were sustained from 6 to 12 years. Strategies for making use of potential compensatory mechanisms within the capitation payment system to increase oral health equality should be considered.
自 2007 年以来，在瑞典公共牙科服务中接受口腔保健的患者有机会在传统的按服务项目收费（FFS）支付系统或新的人头支付系统“口腔保健促进健康”（DCH）之间进行选择。支付模式被认为会为患者和护理人员带来不同的激励机制。从理论上讲，不同的激励措施可能会导致与健康相关的结果存在差异，但研究结果尚无定论。本研究对常规牙科护理中的患者进行了为期 12 年的纵向前瞻性队列研究，分析了在这两种支付系统中，患者的教育水平与口腔健康发展和自我报告的口腔健康之间的关系，并与早期 6 年随访的结果进行了比较。
信息是通过问卷和来自瑞典西约塔兰地区公共牙科服务中 n = 5877 名个体的登记册获得的，这些个体在 12 年内保持了他们对支付模式的原始选择，其中 DCH 中有 1650 名患者，FFS 中有 4227 名患者。数据包括显性龋齿患病率、自我报告的口腔健康和教育水平以及牙科保健支付模式的选择。采用卡方检验和多变量回归分析进行分析。
6 年随访的结果在 12 年检查中基本保持不变，表明基线前龋齿患病率是影响较差口腔健康发展的最主要因素，表现为最终龋齿患病率较高。受教育程度（≥大学）在 12 年后对更高龋齿患病率的风险的影响增加，并在支付模式之间存在差异，与自我评估的口腔健康有关。
从 6 年到 12 年，支付模式之间的健康和健康影响特性差异持续存在。应考虑利用人头支付系统中的潜在补偿机制来提高口腔健康平等的策略。
