Who chooses prepaid dental care? A baseline report of a prospective observational study

An optional capitation prepayment system has been implemented in Swedish dental care, supplementary to the traditional fee-for-service scheme within the Public Dental Service. The implementation of a new system may have a variety of preferred and adverse effects, arguably dependent on the individual patient's attitudes, health beliefs and course of action.The aim of this study was to describe potential differences regarding socioeconomic and lifestyle factors, perceived oral health and attitudes towards oral health between patients in the two payment systems.

Questionnaire data were consecutively collected from 13,719 patients, who regularly attended 20 strategically selected clinics within the PDS in Region Västra Götaland, before they were offered the choice between the traditional and the new payment system.

Capitation patients were more often female and well educated. They had healthier habits, were more motivated to follow self-care advice, more often judged their oral health to be very good and considered oral health to be very significant for their wellbeing. The results were statistically significant and described a gradient.

The more explicitly affirmative the answer, the more likely the patient was to choose the prepayment scheme. There appears to be a pattern of differences with respect to important individual views on oral health between patients choosing a capitation system or a fee-for-service system. These differences may be important when assessing outcomes in the new payment system and in public dental care.