Patients' choice of payment system in the Swedish Public Dental Service--views on dental care and oral health.

Abstract

The aim of this study was to generate new knowledge of considerations and factors having impacted the patients' choice of payment system and their views on oral health. Moreover, their later attitudes to the prepaid risk-related payment system, having been enrolled or not, were explored. A qualitative design was chosen and data was collected through semi-structured interviews.Twenty patients in the Public Dental Service (PDS) in western Sweden were strategically sampled with reference to gender, age (older/younger adults), residence (rural/urban), and choice of payment system:fee-for-service or capitation plan.The interview guide covered areas concerning the payment systems, patient considerations before choosing system, views of their own oral health and experiences of received dental care within the chosen system.The analysis was performed according to basic principles of qualitative content analysis. The results revealed two themes expressing the latent content. In the theme "The individual's relation to the PDS", expectations of the care, feelings of safety and aspects of responsibility emerged.The theme"Health-related attitudes and perceptions" revealed that views on health and self-assessment of oral health influenced the patients' considerations. Moreover, the perceived influence on oral health and risk thinking emerged as important factors in this theme. The conclusion was that the individual's relation to the PDS together with his/her health-related attitudes and perceptions were the main factors impacting the choice of payment system in the PDS. A health promotion perspective should be applied, empowering the patients to develop their risk awareness and their own resources.