A New Payment Model in Swedish Dental Care

The Public Dental Service introduced a new way of paying for dental care in 2007 in Region Västra Götaland, and in 2009 in all of Sweden. The new system, ‘Dental Care for Health’ (DCH), was based on capitation rather than the traditional fee-for-service (FFS) system. The overarching aim of this thesis was to conduct an evaluation of this new payment system with regard to patient attitudes, dental care and oral health. The specific aims of the four included manuscripts were: (I) to describe potential differences in views on oral health and oral health behavior between the patients who chose the respective schemes; (II) to map the experiences and attitudes among the prepayment scheme patients with regard to the agreement, the dental care received, and the financial arrangements; (III) to compare the amount and type of dental care received by patients in the two payment schemes, respectively, and to conclude about the financial net of the prepayment scheme; and (IV) to measure over six years the development of oral health in terms of manifest caries incidence, in the two payment schemes. Study I showed that patients who chose DCH reported themselves as being healthier and more engaged in health-promoting behaviors than patients in FFS. According to the qualitative analysis of interviews from study II, the DCH patients were satisfied with their choice and appreciated feeling secure when having an agreement with the PDS. Study III reported that DCH patients had more preventive treatment and less restorative treatment than FFS patients. The outcome for oral health, as described by the incidence of manifest caries from six years adherence to either of the payment schemes, showed, in study IV, a 50% increase in the risk for caries in FFS compared with DCH, when important background factors were controlled for

Patients’ experiences of adverse symptoms, emotions, and coping strategies in connection to treatment of head and neck cancer - an interview study

Abstract Purpose This study aimed to increase the understanding of emotions and coping strategies used by head and neck cancer patients before cancer treatment, and to explore their emotions and coping strategies in relation to symptoms and side effects after treatment. Furthermore, we aimed to investigate the patients’ perceptions of received treatment and support. Methods Semi-structured in-depth interviews were conducted with 10 patients who had been treated for head and neck cancer, which included radiotherapy, at the Department of Oncology and the Department of Oral and Maxillofacial Surgery at Sahlgrenska University Hospital in Gothenburg. The interviews were analyzed in accordance with the method for Qualitative Content Analysis. Results The result picture revealed three head themes. The first theme “Management of simultaneously influencing mind-sets before cancer treatment” described the patients experiences of feeling “Scared and worried,” “Lonely and disappointed,” and “Relieved and confident”, and how they tried to handle the diagnosis and preparations for treatment by “Applying a positive mind-set”, “Searching for support,” and “Trusting the healthcare system”. The second theme “Experiences of becoming a pale shadow of oneself”, illustrated experiences of affecting post-treatment symptoms and side effects. To which, the last theme “Handling contextual influencing experiences after cancer treatment” displayed post-treatment emotions of being “Shocked and disappointed” and “Concerned and unsupported” but also “Grateful and forward-thinking”, where strategies such as “Appreciating Life”, “Networking socially,” and “Adapting to the new life” were used. Conclusions The results indicated the need for a more patient-centered care approach, with clearer structures and improved individual support both before and after treatment and in connection to rehabilitation. Patients’ cognitive changes after cancer treatment should be considered in the aftercare, which should also include adaptation to situation and strengthening of patients’ self-management as a goal