In 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, implemented contract care alongside the traditional patient financial system of fee-for-service care. In contract care, the patient pays a fixed sum annually for dental care and then receives basic dental care without additional costs. Aim The aim was to study the relation between patient financial system and oral health-related quality of life (OHRQoL). Methods In 2003, a questionnaire was sent to 2,400 consecutively selected patients in the PDHS in Värmland, 1,200 from each patient financial system. The questionnaire was answered by 1,324 participants (57% of those who could be reached). The questionnaire contained questions about willingness to pay for dental care, how much one had paid for dental care the previous year, OHRQoL (measured with the OHIP-14), dental anxiety, humanism of caregiver, general health (measured with the SF-36), multidimensional health locus of control, sense of coherence, self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The data were analysed with a block method of multiple linear regression, adding blocks of variables in six steps: financial system, economic factors, individual factors, social factors, psychological factors and health factors. The threshold for statistical significance was set at p≤0.05. Results OHRQoL was affected by the financial system of the respondent: those in fee-for-service care had a worse OHRQoL than those in contract care. OHRQoL was also affected by health, sense of coherence and to some extent by psychological and economical factors. Of the social variables, only being foreign born had a significant effect on OHRQoL. Conclusions OHRQoL was found to be affected by patient financial system. Acknowledgements The study was financed by the Swedish Research Council.