Considerations on Swedish Dental Care : from leadership to patient satisfaction

Sammanfattning: The thesis consists of two papers which are based on a researchproject called ‘Considerations on Swedish Dental Care’. The aimsof the project were to analyse the characteristics of leadership in thepublic dental service (PDS) in Sweden (Paper I) and to study anddescribe patients’ opinions of dental care provided by the PDS andin private dentistry (Paper II).The aim of the first study was to investigate how experienced chiefdental officers (CDOs) in the PDS managed to maintain a marketposition at a time of social change and increased competition froma changing private sector. The CDOs, who have held a leading positionfor at least five years, were asked to participate in the study. Anempirical study with a qualitative design was conducted. Data from16 CDOs were collected in September-October 2014, with a 75%response rate. The aim of the second study was to investigate adults’ experiencesand opinions of the dental care they have received over time frombeing 50 years old to 70 years old. Patients’ dental visiting patterns,satisfaction with care and oral health measured as numbers of teethwere compared between the two care-provision sectors, public andprivate. In addition, a follow-up was conducted among those whoclaimed to have visited only the public sector or the private sectorand those who claimed to have used both sectors during the wholestudy period. Both studies may be of wider interest when examining Swedishdentistry:a) there are no studies of the characteristics of the top leadershipin the Swedish PDS. The PDS in Sweden differs a great dealfrom the PDS in other countries, as it covers much more of themarket and accounts for almost 45% of the total oral healthcaremarket in Sweden;b) there are no previous studies in Sweden, where a comparison ofpatients’ opinions of care in the two sectors of care providers inSweden is made in this way. The findings in Paper I underscore the fact that CDOs in the PDSexert a great deal of effort to consolidate the actual market position.The PDS is also “open” to patients of all kinds, not only to children,adolescents and special needs groups, and it also offers specialist care,which is unusual in many other countries.Paper II shows that patients who visited the PDS had a slightly poorerdental status, compared with the private patients. Both groups lostteeth during a 20-year period and almost at the same level. AlthoughCDOs in the first study focused on maintaining a strong marketposition, the patients in the second study reported greater satisfactionand a more frequent visiting pattern in private dental care comparedwith the PDS. To summarise, this thesis aims to illustrate the spirit of the top managementin the Swedish PDS and to explore adult patients’ opinionsand experience of care in the two provider sectors in Swedish oralhealth care.