L6 - NZ Dental care system and use of dental services Flashcards
(17 cards)
how is oral health services publicly funded?
coverage depends on age
- children rom 0-8 are served by the community oral health service COHS. there are services provided by DHBs and are based in schools or mobile units
- adolescents from 13 to their 18th birthday access free, DHB-funded oral health services, primarily from private dental practices
- adult services are largely publicly funded, with limited government funding for emergency dental care of low income adults, hospital dental services and, in some locations, free or low cost care provided directly or through māori oral health service providers. work and income grants can contribute to the costs of urgent dental treatment.
what does the special needs grant for dental care ministry of social development provide
- Provides non-recoverable grant for dental treatment for people who meet income/asset criteria
- From 1 December 2022 , the Government increased the amount available per year from $300 to $1000 and made available for immediate and essential treatment
- Includes extractions/fills/root canal treatment (excluding molars except in special circumstances), infection, gum infection
- Excludes cosmetics, ortho, routine check ups and routine scale and polish, ACC
what are the changes in the first three months to WINZ SNG (table in slides)
- Debt owed to MSD has reduced by $12m in three months
- Number of people access the grant has doubled
- Almost $15m has been provided in non-
recoverable grants
what does the combined dental agreement state?
~900 oral health providers contracted
- adolescents from the start of high school until the day they turn 18 years old who receive Oral Health Services to Adolescents (OHSA)
- children referred by the community oral health service who receive special dental services (SDS).
contract recently reviewed, recent NZDA submissions on this
what role ACC play in accessing dental treatment?
No fault funding for injuries in NZ, including treatment injuries
Covers everyone, including visitors, who are injured in an accident in NZ, incl mass casualties
Will pay for dental injuries caused by:
- an accident
- sporting injury
- as a result of medical or dental treatment
Won’t pay for:
- damage to teeth or dentures due to normal wear and tear, eg. chewing or biting
- damage to teeth due to decay or gum disease
- damage to dentures while not wearing them
- treatment done by someone that’s not a registered dentist eg. a dental technician
- dentist arranges the claim
what is publicly funded?
- children and adolescents up to 18th birthday (COHS and CDA)
- emergency dental treatment is funded by health NZ districts for relief of pain and treatment of infection for eligible low-income adults with CSC, with user part-charges
- hospital dental services provide specialist-level oral health care, and dental services for people of all ages with disabilities, medical complications or behavioural problems
- work and income provides special needs grants for immediate/essential dental treatment for eligable people on low incomes
what are the four aspects of Bradshaw’s taxonomy of need
normative need:
- what the expert or health professional, administrator or social scientist defines as ‘need’ in any given situation
- can very according to which expert is used (eg. two dentists will often disagree)
- equivalent to diagnosed treatment need
perceived (‘felt’) need:
- felt need roughly equivalent to want
- limited only by the perceptions of the individual
- measurement? ASK the patient
expressed need (demand, or utilisation):
- equivalent to felt need turned into action
- the person turns up and asks for treatment
- also called utillisation
- can measure by: practice ‘busyness’, waiting lists, day book totals, etc.
comparative need:
- a relative concept
- can apply to individuals or groups
- if population A has service X, but population B (who have the same characteristics as pop. A) doesn’t, then population B can be considered to be in comparative need of service X
- more difficult to measure - usually involves a value judgement
what are the ways people can use dentistry and how do these differences have consequences
visit regularly for check-ups (usually on a recall system)
- tend to have better oral health (fewer missing teeth, more filled teeth, better periodontal health, less plaque)
visit only when a problem arises (toothache, broken tooth, infection etc.)
- tend to have poorer oral health (more missing teeth, more decayed surfaces, poorer periodontal health, more plaque)
why do routine attenders have better oral health?
- preventative dental care
- interceptive dental treatment
- the ‘healthy user’ effect (routine attenders have better self-care, eat better, are less likely to smoke, have better health behaviours anyway)
what are the contextual factors involved in accessing dental care?
predisposing factors:
- is good oral health valued in that society?
- is there a predominant belief that tooth loss with ageing is inevitable?
Enabling factors:
- is it a rich society, or one where the struggles of day-to-day life take precedence?
- what is the degree of socialisation of health care provision?
Need factors:
- population health indices (is it a population with high caries prevalence?)
what are the individual factors involved with accessing dental care?
Predisposing factors:
- largely sociodemographic, but also dental anxiety and such like
- shape the attitudes and beliefs underpinning the use of services
Enabling factors:
- barriers and aids to access eg. charging policies, income, indurance etc.
Need factors:
- perceived and/or diagnosed conditions which motivate care-seeking - eg. toothache, or a prior label of ‘high risk’
describe the Dunedin study
- prospective observational study of a complete birth cohort
- prospective cohort study
- strictly observational
- set up to investigate the nature, prevalence, associations, implications and consequences of problems of health and development
- now superbly positioned to become a study of ageing
describe the findings of the journal of dental research
- this is the first longitudinal investigation of the effects of dental visiting
- showed that routine attendance with age decreased
- showed that routine attendance by sex was females attended more
- showed that routine attendance with age by childhood SES. those with higher SES attended more than those with low SES
descibe the findings of NZOHS 2009
- only 39% of adults 18+ reported that their usual reason for visiting was for a check-up (which means that 61% were periodic users)
- 41% of females, 36% of males
describe the findings fo the ICIHRP study
RCT of motivational interviewing effects on early childhood caries
Dental visiting by the mothers:
- dental vist made in pervious year by 38%
- unable to see a dentist in previous year due to cost 60%
- need to see a dentist now 79%
- usually visit for check-ups 39%
- believe it is important to visit the dentist 85%
describe the findings of the DMHDS research (graphs in slides helpful)
- the most comprehensive look at oral health to date
- used structural equation modelling to work our causal pathways using longitudinal data (underlined the important of beliefs and dental visiting)
what are the predictors of poor utilisation
- male sex
- membership of an ethnic minority
- rurality
- less education
- lower income
- lower occupational status
- lack of dental insurance (not NZ…)
