Longitudinal register study of attendance frequencies in public and private dental services in Finland.

OBJECTIVE: The Public Dental Service (PDS) in Finland was recently opened to all adults. According to annual statistics, 75% of children and 51% of adults made dental attendances in 2008. This study aimed to survey the frequency of dental attendance across three years and compared attendance frequencies between age groups and treatment sectors. METHODS: Data from municipal databases and the reimbursement register of the Social Insurance Institution were collected on all who had attended the PDS (733,000) or the private sector (473,000) in 2008 and they were retrospectively followed from 2008 to 2006. RESULTS: Most children had attended the PDS in each year (57.4%) or in two of the three years (32.2%). Most working aged (57.3%) and elderly (69.1%) were annual attenders in the private sector. In addition, 27.1% of the former and 19.8% of the latter had attended in two of the three years. Attending in one year only was unusual. In the PDS, adult annual attendance was uncommon (31.9%), and adult attenders were fairly evenly distributed over the three categories, attending in one, two or all three years. CONCLUSIONS: Annual or biannual attendances seemed to be the norm among children in the PDS and adults in the private sector. Adults in the PDS showed irregular attendance patterns probably partly due to scarcity of resources for recall patients in the PDS.

Industry structures in private dental markets in Finland.

OBJECTIVE: To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. DESIGN: Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. RESULTS: Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. CONCLUSIONS: Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

Pricing and competition in the private dental market in Finland.

OBJECTIVE: To investigate how the prices were set in private dental care, which factors determined prices and whether the recent National Dental Care Reform had increased competition in the dental care market in Finland. DESIGN: A questionnaire to all full time private dentists (n = 1,121) in the ten largest cities. Characteristics of the practice, prices charged, price setting, perceived competition and expectations for the practices were requested. The response rate was 59.6%. Correlation analysis (Pearson's) was used to study relationships between the prices of different treatment items. Linear regression analysis was used to study determinants of the price of a one surface filling. RESULTS: Most dentists' fee schedules were based on the price of a one surface filling and updated annually. Changes in practice costs calculated by the dentists' professional association and information on average prices charged on dental treatments in the country influenced pricing. High price levels were associated with specialisation, working in a group practice, working close to many other practices or in a town with a dental school. Less than half of the respondents had faced competition in dental services and price competition was insignificant. CONCLUSIONS: Price setting followed traditional patterns and private markets in dental services were not found to be very competitive.