Abstract

BackgroundTo 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.MethodsA 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.ResultsMore 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%).ConclusionsYoung 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.

Highlights

  • 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

  • The Capitation payment (CP) model was introduced more than 10 years ago, few studies have been published on its effect on oral health and whether or not this is beneficial for the patients and/or the organisation [1, 2]

  • The patients in the FFS group had significantly more caries at baseline compared with the CP group (p < 0.05) and the mean 3-year increment was significantly higher, 1.6 vs. 0.8 Decayed filled surfaces (DFS)

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Summary

Introduction

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. At the age of 20 years, all patients that wish to remain in the Public Dental Service have the opportunity to choose one of two payment systems, a) a monthly fixed payment (capitation payment, CP) or, b) a traditional fee-for-service system (FFS) with payments for each treatment that is carried out. In the former payment model, Petersson and Twetman BMC Oral Health (2017) 17:40. The CP patients received more emergency and preventive treatments and were more frequently examined by dental hygienists than the FFS patients [5]

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