Patients' health in contract and fee-for-service care – a descriptive analysis

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Patients' health in contract and fee-for-service care – a descriptive analysis

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Publication Conference Paper, peer reviewed
Title Patients' health in contract and fee-for-service care – a descriptive analysis
Author(s) Johansson, Veronica ; Axtelius, Björn ; Söderfeldt, Björn ; Sampogna, Francesca ; Paulander, Jörgen
Date 2006
English abstract
AIM Fee-for-service, paying afterwards for services provided, is the traditional patient financial system in dentistry in Sweden. The public dental health service (PDHS) in Värmland has since 1999 also an alternative system: contract care, where a fixed sum of money is paid annually for dental care, which is then received without additional cost. This study describes demographic as well as general and oral health-related characteristics among patients in a service study comparing the two patient financial systems, fee-for-service and contract care, in the PDHS in Värmland. METHODS A questionnaire was answered by 1,324 patients (response rate 57%). Of the respondents, 52% were in contract care and 48% in fee-for-service. A non-response analysis and a special study of the non-respondents were undertaken. General health was studied with SF-36, measuring health in eight dimensions: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Oral health was studied with OHIP-14, measuring oral health in seven dimensions (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap) and as an index. The demographic factors included gender, age, birth country, marital status, education, and social affinity with neighbourhood and housing area. The data were analysed with contingency tables, Chi-square tests, t-tests, Mann-Whitney non-parametric tests and logistic regression analyses. RESULTS The non-response analysis revealed that the likelihood for answering the questionnaire was higher for women (OR=1.27), for respondents in contract care (OR=1.43) and for each year of life (OR=1.02). A short telephone interview with 40 non-respondents in each financial system indicated that the non-respondents had better oral health than the respondents. The non-respondents had experienced less pain in the mouth, less difficulties doing their usual jobs and had found life more satisfying than the respondents. There were no significant differences in gender or age. In the study population, differences in health were observed between the financial systems. Respondents in contract care had better oral health than those in fee-for-service (p=0.019). They had also better general health in half of the dimensions of SF-36 (physical functioning: p<0.001; role-physical: p=0.002; general health: p<0.001; social functioning: p=0.045), were younger (p<0.001), better educated (p< 0.001), were born in Sweden more often (p<0.001) and were more often married/living with somebody (p=0.011) than were the fee-for-service respondents. The fee-for-service respondents experienced higher social affinity with their housing area (p=0.049). CONCLUSION There was bias in nonresponse. Contract care patients had better general and oral health than patients in fee-for-service. Acknowledgement: The study was financed by the Swedish Research Council.
Host/Issue Community Dental Health;3
Volume 23
ISSN 0265-539X
Pages 187-188
Language eng (iso)
Subject(s) Humanities/Social Sciences
Note The 11th Annual Conference of The European Association of Dental Public Health (EADPH), 7-9 September, 2006, Praque, Czech Republic
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