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1.  Heavy consumption of dental services; a longitudinal cohort study among Finnish adults 
BMC Oral Health  2013;13:18.
Background
A reform to Dental Care legislation in 2002 abolished age limits restricting adults’ use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants.
Methods
A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009.
Results
Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).
A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.
The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001).
Conclusions
Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.
doi:10.1186/1472-6831-13-18
PMCID: PMC3659074  PMID: 23617730
Health services research; Dental services; Longitudinal register study; Public dental service; Adult and elderly population; Complicated treatment needs; Heavy users of oral health services
2.  Willingness and ability to pay for unexpected dental expenses by Finnish adults 
BMC Oral Health  2012;12:35.
Background
Since 2002, adults have been able to choose oral health care services in the public sector or in the private sector in Finland. Though various subsidies for care exist in both sectors, the Public Dental Service (PDS) is a cheaper option for the patient but, on the other hand, there are no waiting lists for private care. The aim of this study was to assess middle-aged adults' use of dental services, willingness to pay (WTP) and ability to pay (ATP) for unexpected, urgent dental treatment.
Methods
Postal questionnaires on use of dental services were sent to a random sample of 1500 47-59 year old adults living in three large municipalities in the Helsinki region. The initial response rate was 65.8%. Two hypothetical scenarios were presented: "What would be the highest price you would be prepared to pay to have a lost filling replaced immediately, or, at the latest, the day after losing the filling?" and " How much could you pay for unexpected dental expenses at two weeks notice, if you suddenly needed more comprehensive treatment?" Logistic regression analysis was used to analyse factors related to WTP and ATP.
Results
Most respondents (89.6%) had visited a dentist recently and a majority (76.1%) had used private services. For immediate replacement of a lost filling, almost all respondents (93.2%) were willing to pay the lower price charged in the PDS and 46.2% were willing to pay the private fee. High income and no subjective need for dental treatment were positively associated with the probability of paying a higher price. Most respondents (93.0%) were able to pay a low fee, EUR 50 and almost half (41.6%) at least EUR 300 for unexpected treatment at short notice. High income and male sex were associated with high ATP.
Conclusion
There was a strong and statistically significant relationship between income and WTP and ATP for urgent dental care, indicating that access to publicly provided services improved equity for persons with low income.
doi:10.1186/1472-6831-12-35
PMCID: PMC3497879  PMID: 22935077
Utilization of dental services; Willingness to pay (WTP); Ability to pay (ATP); Public sector; Private sector
3.  Association of Examination Rates with Children’s National Caries Indices in Finland 
The objective was to assess the effect of examination rates on national caries indices of 5, 12 and 17-year-old children/adolescents in Finland. The data were gathered from patient records of the Public Dental Service (PDS) units (n=205, 73%) and from a national register. The data included PDS-specific total numbers of examined children/adolescents and means of decayed (d/D) teeth, dmft/DMFT-values and proportions of caries-free. For analytical purposes, the PDS-specific mean values weighted by the PDS population were calculated to imply the traditionally calculated figures. New PDS-specific examination-rate-adjusted mean values were calculated by using the predicted outcome values at 100% examination rates. The results showed that low examination rates were associated with slightly poorer oral health. The examination-rate-adjusted mean d/D- values indicated better oral health than the traditional indices. The adjustment slightly worsened oral health in proportions of caries-free, and had almost no effect on dmft/DMFT-value. Overall, the influence was modest. The high proportions of healthy children that are examined (against recommendation) and the relatively small number of those having extensive disease (frequently examined as recommended) probably mask the influence of examination rates on the indices in Finland. We conclude that in international comparisons, traditionally calculated indices seem to be sufficiently valid.
doi:10.2174/1874210600903010059
PMCID: PMC2697058  PMID: 19543545
4.  Oral Health Care Reform in Finland – aiming to reduce inequity in care provision 
BMC Oral Health  2008;8:3.
Background
In Finland, dental services are provided by a public (PDS) and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS). A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period.
Methods
National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform) and in 2004 (after the reform) were compared.
Results
In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees.
The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5%) and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private) increased by 21% during the study period. Private patients who had previously not been entitled to reimbursements seemed to gain most from the reform.
Conclusion
The results of this study indicate that implementation of a substantial reform, that changes the traditionally defined tasks of the public and private sectors in an established oral health care provision system, proceeds slowly, is expensive and probably requires more stringent steering than was the case in Finland 2001 – 2004. However, the equity and fairness of the oral health care provision system improved and access to services and cost-sharing improved slightly.
doi:10.1186/1472-6831-8-3
PMCID: PMC2268684  PMID: 18226197

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