Objectives

A health care reform will replace the health care and social services centred on public provision with a market-oriented system and enhanced competition between public and private sectors. The aim was to ascertain Public Dental Services (PDS) changes personnel anticipated and how dental services in the new “public” undertakings could be made more cost-efficient.

Materials and methods

An electronic questionnaire was sent to the Chief Dentists of a random sample of 12 PDS units in southern and northern Finland for distribution to their personnel; 71.0% responded.

Results

Most respondents (64.3%) believed that their PDS unit would not change. However, 45.4% foresaw a merger with another unit. More dentists (51.2%) were aware of market- and competition-oriented organisational forms to be introduced in the public sector than dental hygienists (35.0%) and dental assistants (27.3%; p < 0.01). Only 12.4% thought of moving to the private sector. To increase cost-efficiency in the new system, a majority suggested improvement in preventive care (79.8%) and increased use of dental hygienists (75.7%). A smaller proportion suggested longer opening hours (23.1%), higher patient fees (17.9%) or more paying patients (12.4%).

Discussion

Public sector employees had little knowledge and understanding of the coming reform and were badly prepared for competition with the private sector.

中文翻译：

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芬兰公共牙科服务人员面临重大医疗改革

目标

医疗改革将以市场为导向的体制取代以公共提供为中心的医疗保健和社会服务，加强公共和私营部门之间的竞争。目的是确定公共牙科服务 (PDS) 人员预期的变化，以及如何使新的“公共”事业中的牙科服务更具成本效益。

材料和方法

向芬兰南部和北部 12 个 PDS 单位的随机抽样的首席牙医发送了一份电子问卷，以分发给他们的人员；71.0% 回应。

结果

大多数受访者 (64.3%) 认为他们的 PDS 单位不会改变。然而，45.4% 的人预计会与另一个部门合并。与牙科保健员 (35.0%) 和牙科助理 (27.3%; p  < 0.01) 相比，更多牙医 (51.2%) 意识到将在公共部门引入以市场和竞争为导向的组织形式。只有 12.4% 的人考虑转向私营部门。为了提高新系统的成本效益，大多数人建议改进预防保健（79.8%）并增加使用牙科保健员（75.7%）。较小的比例表示开放时间更长（23.1%）、患者费用更高（17.9%）或付费患者更多（12.4%）。

讨论

公共部门雇员对即将到来的改革知之甚少，对与私营部门竞争的准备不足。