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Financial systems' impact on dental care; a review of fee-for-service and capitation systems
V Johansson1, B Axtelius, B Söderfeldt
1Department of Oral Public Health, Malmö University, Sweden. veronica.johansson@od.mah.se
Objective:
This review covers the impact of financial systems on dental care.
Background:
Remuneration in fee-for-service (FFS) is done per service provided and in capitation (CAP) per patient enrolled. It may be expected that dentists' incentive in CAP is to keep the number of services provided at a minimum, while in FFS it is to keep the number of services at a maximum. This should lead to a different impact on care, with the dentists in CAP focusing more on prevention and dentists in FFS more on restorative treatment. Six questions were put: Does CAP increase or decrease caries incidence? Does CAP increase or decrease restorative treatments? Does CAP increase preventive care? Does CAP increase or decrease productivity? Does CAP increase or decrease the dentist's satisfaction with his/her work? Does CAP increase or decrease the patients' satisfaction with the oral care provided?
Methods:
Literature was obtained through searches in databases. A format was developed to define the literature of interest.
Results:
CAP decreases restorative treatment and there is a tendency of decreased caries incidence. "Supervised neglect" cannot be established. CAP increases preventive care. A conclusion regarding productivity was not possible. The results on dentist's satisfaction with work were inconclusive, as were the results regarding patient satisfaction.
Conclusions:
CAP has a different impact on provided care than FFS. More research is needed in this area and focus on efficiency is of importance.
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