The impact of payment methods on oral health promotion and prevention programmes: scoping review.

objectivesTo explore and assess the effect of payment schemes on oral health promotion and prevention programmes.

methodsA scoping review was conducted using the Arksey & O'Malley framework. MEDLINE (via PubMed), Embase (via Scopus), and The Cochrane Library were searched. Unpublished literature was also collected. Searching and screening were conducted until 31 July 2025. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All studies comparing payment methods for oral health prevention and promotion were included. A conceptual framework linking payment mechanism to provider incentive, service delivery behaviour, and preventive care outcomes was used to guide synthesis, with findings classified across three outcome levels: utilisation (Level 1), quality of preventive care processes (Level 2), and clinical oral health outcomes (Level 3). The studies were grouped according to the payment system, their impact on the service provider and receiver, and their advantages and disadvantages. After summarising the results, the data were analysed by consulting experts and compared with existing policies. Quality assessment was carried out using Joanna Brigg's Institute's Quality appraisal tools.

resultsOut of the 30 studies included, the review found that payment systems have various forms, with four main payment systems being Pay for performance (n = 3), Fee for service (n = 15), Capitation (n = 10), and Global Budget (n = 2). Other payment systems such as salary, treatment vouchers, or direct payment by the employer were also identified, and have been shown to increase preventive dental services and oral health promotion activities.

conclusionsFee-for-service payment is consistently associated with higher treatment volumes but lower rates of preventive care delivery, while capitation incentivises prevention but carries risks of patient selection and service reduction without adequate risk adjustment. Pay-for-performance and value-based payment approaches show promise for improving preventive care quality, though evidence remains limited. No single payment model reliably promotes oral health prevention across all contexts. A mixed payment model combining the activity incentives of fee-for-service, the cost-sharing principles of capitation, and the quality orientation of value-based payment offers the most promising framework for advancing oral health promotion. Policymakers should consider hybrid financing structures supported by quality monitoring, and further research is needed to evaluate their long-term effects on clinical oral health outcomes.