Inequity in oral health care for elderly canadians: part 2. Causes and ethical considerations (original) (raw)

2014, Journal

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Abstract

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This paper examines the inequities in oral health care for elderly Canadians, identifying financial, behavioral, and physical barriers as primary obstacles. The authors argue for a government-administered universal dental plan alongside additional strategies such as promoting awareness of oral health care, establishing care standards, educational advancements in dental geriatrics, and revising dental program admissions criteria to better serve the aging population.

Canadian Dentists' Opinions on Publicly Financed Dental Care

Journal of Public Health Dentistry, 2009

Objective: The aim of this study was to inform policy leaders of the opinions of Canada's major dental care service provider regarding publicly financed dental care. Methods: Using provincial/territorial dental regulatory authority listings, a 26-item questionnaire was sent to a representative sample of Canadian dentists (n = 2219, response rate = 45.8 percent). Descriptive statistics were produced, and bivariate and multivariate logistic regressions were conducted to assess what predicts dentists' responses. Results: Canadian dentists support governmental involvement in dental care, preferring investments in prevention to direct delivery. The majority of dentists have less than 10 percent of their practice represented by publicly insured patients, with a small minority having greater than 50 percent. The majority would accept new publicly insured patients, preferring fee for service remuneration. Dentists generally appear dissatisfied with public forms of third-party financing. Conclusions: Dentists prefer a targeted effort at meeting public needs and are influenced in their opinions largely in relation to ideology. In order to move forward, policy leaders will need to devote some attention to the influence and complexity of public and private tensions in dentistry. At the very least, public and private practitioners must come to appreciate each other's challenges and balance public and private expectations in public programming.

Toward a Universal Dental Care Plan: Policy Options for Canada

IRPP INSIGHT No. 46, 2023

Canada is a laggard when it comes to providing public funding for dental care, ranking close to the bottom of OECD countries. However, the federal government's proposed $13-billion Canadian Dental Care Plan could change that. This paper calls the plan a major step forward in reforming dental care but argues that the "payer of last resort model" the government has chosen to implement falls short. It identifies four broad policy goals that should guide future reform of dental care and six possible options for achieving them. It calls for the government to move toward implementing universal dental care coverage for a limited core of essential dental services and argues that the best way to achieve it is through the creation of a federally funded arm's-length agency.

Public preferences for seeking publicly financed dental care and professional preferences for structuring it

Community Dentistry and Oral Epidemiology, 2010

Quiñonez C, Figueiredo R, Azarpazhooh A, Locker D. Public preferences for seeking publicly financed dental care and professional preferences for structuring it. Community Dent Oral Epidemiol 2010. © 2010 John Wiley & Sons A/SAbstract – Objectives: To test the hypotheses that socially marginalised Canadians are more likely to prefer seeking dental care in a public rather than private setting, and that Canadian dentists are more likely to prefer public dental care plans that approximate private insurance processes.Methods: Data on public opinion were collected through a weekly national omnibus survey based on random digit dialling and telephone interview technology (n = 1005, >18 years). Data on professional opinion were collected through a national mail-out survey of a random selection of Canadian dentists (n = 2219, response rate = 45.8%). Dental and socio-demographic data were collected for the public, as were professional demographic data for dentists. Descriptive and basic regression analyses were undertaken.Results: The majority of Canadians surveyed, 66.4%, prefer to seek dental care in a private setting, 19% in a community clinic, and 7.6% in a dental school; those that are younger and of lowest incomes are most likely to prefer seeking dental care in a public setting. Most Canadian dentists, 80.9%, believe that governments should be involved in dental care, yet only 46% believe this role should include direct delivery. A third of dentists have also reduced the amount of publicly insured patients in their practice. Canadian dentists are more likely to prefer those public plans that most closely reflect private insurance mechanisms.Conclusion: There appears to be a policy disconnect between the preferences of those populations where governmental involvement is most warranted, and the current mechanisms for financing and delivering dental care in Canada. By concentrating almost exclusively on third-party-type financing and indirect delivery, public dental care policy may not be adequately responding to those most in need, especially in an environment where dentists are largely dissatisfied with public plans.

Breaking down barriers: towards the development of a low-cost community dental clinic in Prince George, British Columbia

2014

Access to dental care for all population groups in Canada is inequitable. While the overall dental health of Canadians is very good, there are disparities that primarily affect the financially disadvantaged in society. Current methods for delivering dental care demonstrate an economic gradient favoring more affluent members of society. An examination of the methods for financing dental care, both public and private, will be conducted to better understand the challenges to solving this dilemma. The role of government and dental professionals in providing access to dental care will be explored. The existing gaps in dental care delivery will be illustrated, and the current methods for providing dental care in northern British Columbia will be identified. While continued government support for disadvantaged groups is necessary, an investigation of alternative models of low-cost dental care delivery will be undertaken to determine the feasibility of these models in Prince George, British...

Sorry Doctor, I Can’t Afford the Root Canal, I Have a Job: Canadian Dental Care Policy and the Working Poor

Canadian Journal of Public Health, 2010

C anada's national system of health insurance does not include dental care. Governments pay for only 4-6% of all dental care expenditures. 1 Dental care is delivered in the private sector, financed by out-of-pocket expenditures (43%) and by employment-based insurance (53%). 1 This method of structuring dental care has developed in relation to social need and employment status, meaning governments finance care for groups receiving social transfers (e.g., welfare), while employment-based insurance plays the dominant role in the private sector. This level of public financing has led to a social discourse on access to dental care, and increased attention is being paid to the challenges experienced by low-income Canadians, in particular the working poor (WP). 2-4 The WP, or individuals who maintain regular employment but remain in relative poverty, 5 do not qualify for welfare insurance that covers some dental care, yet they rarely enjoy employment-based dental benefits. In 2001, approximately 75% of Canadians living in non-poor families reported having access to dental insurance, whereas only 26% of the WP reported such access. 5 That same year, there were 650,000 WP persons in Canada, and including dependants this totalled 1.5 million Canadians, approximately 4-5% of the national population. 5 From the point of view of dental care policy, social concerns are not unfounded. National population estimates demonstrate that those with no income report more dental visits than those making $15-30,000 a year, pointing to the role of public insurance and the importance of insurance generally. 6 The WP highlight a gap in how METHODS Historical review The development of Canadian dental care policy was detailed through a series of document reviews. All current volumes of the

Demand and Burden of Dental Care in Canadian Households

International Journal of Economics and Finance, 2014

This paper examines factors associated with dental care spending in Canada employing through three models; the first model estimates the income elasticity of demand for dental care and the other two models estimate the share of total household income spent on dental care. The income elasticity of Canadian households in 2009 with respect to out-of-pocket dental care spending was 0.146 (p-value<0.001). The lowest income quintile had the highest odds for spending $0 on dental care, which could indicate not using dental care or having full coverage. However, when these households did spend on dental care, they were most likely to have a higher burden of dental expenditure as a share of household income. Having private health insurance is associated with an increase in the demand for dental care but it also reduces the likelihood of the households having a higher burden of dental expenditures as a share of household income. Older adults (65 years or older), compared to young adults (aged 29 years or less) are most likely to spend on dental care and most likely to be in the higher burden category (RRR 2.55 compared to lower burden category, p-value < 0.001). This study found significant interprovincial variation; Yukon, Northwest Territories, Nunavut and Alberta households were found to spend the most on dental care when compared to the rest of the provinces.

Providing dental insurance can positively impact oral health outcomes in Ontario

BMC Health Services Research

Background Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. Methods We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013–2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada’s most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. Results Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5). Compared to the highes...

Cost as a barrier to accessing dental care: findings from a Canadian population-based study

Journal of Public Health Dentistry, 2014

Objective: The aim of this study is to determine the demographic and socioeconomic characteristics of Canadians who report cost barriers to dental care. Methods: An analysis of data collected from the 2007/09 Canadian Health Measures Survey was undertaken from a sample of 5,586 Canadian participants aged 6-79. Cost barriers to dental care were operationalized through two questions: "In the past 12 months, have you avoided going to a dental professional because of the cost of dental care?" and "In the past 12 months, have you avoided having all the dental treatment that was recommended because of the cost?" Logistic regressions were conducted to identify relationships between covariates and positive responses to these questions. Results: Approximately 17.3 percent of respondents had avoided a dental professional because of cost within the previous year, and 16.5 percent had declined recommended dental treatment because of cost. Adjusted estimates demonstrate that respondents with lower incomes and without dental insurance were over four times more likely to avoid a dental professional because of cost and approximately two and a half times more likely to decline recommended dental treatment because of cost. Conclusions: Nearly one out of five Canadians surveyed reported cost barriers to dental care. This study provides valuable baseline information for future studies to assess whether financial barriers to dental care are getting better or worse for Canadians.

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References (75)

  1. Yao CS, MacEntee MI. Inequity in oral health care for elderly Canadians: Part 1. Oral health status. J Can Dent Assoc. 2013;79:d114.
  2. Statistics Canada. Projected population by age group according to three projection scenarios for 2006, 2011, 2016, 2021, 2026, 2031 and 2036, at July 1, CANSIM, table 052-0005 and Catalogue no. 91-520-X. 2010. [accessed 2012 Jul 17].
  3. Yao CS, MacEntee MI. Inequity in oral health care for elderly Canadians: Part 2. Causes and ethical considerations. J Can Dent Assoc. 2013;79:d127.
  4. Lavigne SE. The state of oral health in personal care homes: a public health issue? J Can Dent Assoc. 2008;74(10):899-901.
  5. Leake J, Birch S. Public policy and the market for dental ser- vices. Comm Dent Epidemiol. 2008;36(4):287-95.
  6. Canadian Dental Association. CDA position on Access to oral healthcare for Canadians. May 2010. Available: http:// www.cda-adc.ca/files/position\_statements/accessToCare.pdf [accessed 2013 Jul 24.
  7. Quiñonez C, Grootendorst P. Equity in dental care among Canadian households. Int J Equity Health. 2011;10(1):14.
  8. Quiñonez CR, Figueiredo R, Locker D. Canadian dentists' opinions on publicly financed dental care. J Public Health Dent. 2009;69(2):64-73.
  9. Birch S, Anderson R. Financing and delivering oral health care: what can we learn from other countries? J Can Dent Assoc. 2005;71(4):243, 243a-243d.
  10. Hawkins RJ. The organization, financing and delivery of dental care for older adults in Canada: an assessment from a social sciences perspective. Can J Community Dent. 1998;13:10-24.
  11. Landon S, McMillan ML, Muralidharan V, Parsons M. Does health-care spending crowd out other provincial government expenditures? Canadian Public Policy. 2006;32(2):121-141.
  12. Canadian Institute for Health Information. National Health Expenditure Trends, 1975 to 2011. Spending and Health Workforce, 2011. [accessed 2012 Jul 26]. Available: https://secure. cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1671.
  13. Mathauer I, Nicolle E. A global overview of health insurance administrative costs: what are the reasons for variations found? Health Policy. 2011;102(2-3):235-46.
  14. Province of Ontario. Breaking the cycle. The third prog- ress report: Ontario's poverty reduction strategy, 2011 anuual report. Ontario. [accessed 2012 Jul 26]. Available: http://www. children.gov.on.ca/htdocs/English/documents/breakingthecycle/ 2011AnnualReport.pdf.
  15. Government of New Brunswick. Overcoming poverty together: The New Brunswick economic and social inclusion plan. New Brunswick: Government of New Brunswick. 2010. [accessed 2012 Jul 26]. Available: http://www2.gnb.ca/content/ dam/gnb/Departments/esic/pdf/Booklet-e.pdf.
  16. Government of Québec. Régie de l'assurance maladie Québec. Dental services. [accessed 2012 Jul 26]. Available: http://www.ramq.gouv.qc.ca/en/citizens/health-insurance/ healthcare/Pages/dental-services.aspx.
  17. Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med. 2003;349(8):768-75.
  18. Organisation for Economic Co-operation and Development. Health at a Glance 2011: OECD Indicators, OECD Publishing. [accessed 2012 Jul 26]. Available: http://dx.doi.org/10.1787/ health_glance-2011-en
  19. Morgan RO, Virnig BA, DeVito CA, Persily NA. The Medicare-HMO revolving door--the healthy go in and the sick go out. N Engl J Med. 1997;337(3):169-75.
  20. Rodríguez M, Stoyanova A. The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain. Health Econ. 2004;13(7):689-703.
  21. Gechert S. Supplementary Private Health Insurance in selected countries: Lessons for EU Governments? CESifo Economics Studies. 2010;56(3):444-64.
  22. Butler JR. Policy change and private health insurance: did the cheapest policy do the trick? Aust Health Rev. 2002;25(6):33-41.
  23. Hurley J, Guindon GE. 2008. Centre for Health Economics and Policy Analysis (CHEPA) Working Paper Series -Paper 08-04 -Private Health Insurance in Canada. [accessed 3 Sep 2011]. Available: http://www.chepa.org/research-products/ working-papers/08-04.
  24. Canadian Dental Association. C.D.A. Answers Royal Commission on Health Services [Special Report]. J Can Dent Assoc. 1965;31(7):462-3.
  25. Health Canada. Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007-2009 (Technical Report). [accessed 27 Aug 2013]. Available: http:// www.fptdwg.ca/English/e-documents.html
  26. Hussey P, Anderson GF. A comparison of single-and multi- payer health insurance systems and options for reform. Health Policy. 2003;66(3):215-28.
  27. Grignon M, Hurley J, Wang L, Allin S. Inequity in a market- based health system: Evidence from Canada's dental sector. Health Policy. 2010;98(1):81-90.
  28. Wallace BB, MacEntee MI. Access to dental care for low- income adults: perceptions of affordability, availability and acceptability. J Community Health. 2012;37(1):32-9.
  29. Quiñonez C, Ieraci L, Guttmann A. Potentially preventable hospital use for dental conditions: implications for expanding dental coverage for low income populations. J Health Care Poor Underserved. 2011;22(3):1048-58.
  30. Kiyak HA, Reichmuth M. Barriers to and enablers of older adults' use of dental services. J Dent Educ. 2005;69(9):975-86.
  31. WHO. Achieving universal health coverage: developing the health financing system. Geneva, World Health Organization, Department of Health Systems Financing. 2005. [accessed 9 Mar 2011]. Available: http://www.who.int/health\_financing/ pb_1.pdf
  32. Moeller JF, Chen H, Manski RJ. Investing in preventive dental care for the Medicare population: a preliminary analysis. Am J Public Health. 2010;100(11):2262-9.
  33. Brekke KR, Sørgard L. Public versus private health care in a national health service. Health Econ. 2007;16(6):579-601.
  34. García-Prado A, González P. Whom do physicians work for? An analysis of dual practice in the health sector. J Health Polit Policy Law. 2011;36(2):265-94.
  35. Flood CM, Haugan A. Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. Health Econ Policy Law. 2010;5(3):319-41.
  36. Oliver A. The Veterans Health Administration: an American success story? Milbank Q. 2007;85(1):5-35.
  37. MacEntee MI, Kazanjian A, Kozak JF, Hornby K, Thorne S, Kettratad-Pruksapong M. A scoping review and research syn- thesis on financing and regulating oral care in long-term care facilities. Gerodontology. 2012;29(2):e41-52.
  38. Dharamsi S, MacEntee MI. Dentistry and distributive justice. Soc Sci Med. 2002;55(2):323-9
  39. Dharamsi S, Pratt DD, MacEntee MI. How dentists account for social responsibility: economic imperatives and professional obligations. J Dent Educ. 2007;71(12):1583-92.
  40. Research in Focus on Research. What the census can tell us about Canada's dental workforce? 2008. Sudbury (ON): Centre for Rural and Northern Health Research. [accessed 26 Jul 2012]. Available http://www.cranhr.ca/focus.html.
  41. Skillman SM, Doescher MP, Mouradian WE, Brunson DK. The challenge to delivering oral health services in rural America. J Public Health Dent. 2010;70 Suppl 1:S49-57.
  42. Ahn S, Burdine JN, Smith ML, Ory MG, Phillips CD. Residential rurality and oral health disparities: influences of contextual and individual factors. J Prim Prev. 2011;32(1):29-41.
  43. Galan D, Holtzman JM. Dentistry for the homebound and institutionalized: the University of Manitoba's Home Dental Care Program. J Can Dent Assoc. 1990;56(7):585-91.
  44. Morreale JP, Dimitry S, Morreale M, Fattore I. Setting up a mobile dental practice within your present office structure. J Can Dent Assoc. 2005;71(2):91.
  45. McDonagh P. McGill's commitment to dentistry outreach: transforming delivery of oral health care in Quebec. J Can Dent Assoc. 2008;74(7):605-7.
  46. Carr BR, Isong U, Weintraub JA. Identification and descrip- tion of mobile dental programs -a brief communication. J Public Health Dent. 2008;68(4):234-7.
  47. Rawls. A theory of justice. In: President and Fellows of Harvard College, editors. The Rationality of the parties. Oxford: Oxfod University Press.; 1999. p. 127.
  48. Tomar SL. There is weak evidence that a single, universal dental recall interval schedule reduces caries incidence. J Evid Based Dent Pract. 2011;11(2):89-91.
  49. Watt RG, Marinho VC. Does oral health promotion improve oral hygiene and gingival health? Periodontol 2000. 2005;37:35-47.
  50. Kvale G, Berggren U, Milgrom P. Dental fear in adults: a meta-analysis behavioral interventions. Community Dent Oral Epidemiol. 2004;32(4):250-64.
  51. Yoon MN, Steele CM. Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech- language pathologists and dental hygienists. Gerodontology. 2012;29(2):e525-35.
  52. Kayser-Jones J, Bird WF, Redford M, Schell ES, Einhorn SH. Strategies for conducting dental examinations among cog- nitively impaired nursing home residents. Spec Care Dentist. 1996;16(2):46-52.
  53. MacEntee MI. Muted dental voices on interprofessional healthcare teams. J Dent. 2011;39 Suppl 2:S34-40.
  54. Frenkel H, Harvey I, Newcombe RG. Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial. Community Dent Oral Epidemiol. 2001;29(4):289-97.
  55. Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50(3):430-3.
  56. Terpenning M, Shay K. Oral health is cost-effective to main- tain but costly to ignore. J Am Geriatr Soc. 2002;50(3):584-5.
  57. MacEntee MI, Wyatt CC, Beattie BL, Paterson B, Levy- Milne R, McCandless L, et al. Provision of mouth-care in long- term care facilities: an educational trial. Community Dent Oral Epidemiol. 2007;35(1):25-34.
  58. Pruksapong M, MacEntee MI. Quality of oral health ser- vices in residential care: towards an evaluation framework. Gerodontology. 2007;24(4):224-30.
  59. Dharamsi S, Jivani K, Dean C, Wyatt C. Oral care for frail elders: knowledge, attitudes, and practices of long-term care staff. J Dent Educ. 2009;73(5):581-8
  60. Yoon MN, Lowe M, Budgell M, Steele CM. An exploratory investigation using appreciative inquiry to promote nursing oral care. Geriatr Nurs. 2011;32(5):326-40.
  61. Fallon T, Buikstra E, Cameron M, Hegney D, Mackenzie D, March J, et al. Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city. Int J Evid Based Healthc. 2006;4(3):162-79.
  62. MacEntee MI. Missing links in oral health care for frail elderly people. J Can Dent Assoc. 2006;72(5):421-5.
  63. McNally ME, Dharamsi S, Bryant SR, MacEntee MI. Ethical considerations for the oral healthcare of frail elders. In: MacEntee MI, ed. Oral Healthcare and the frail elder: A clinical per- spective. Iowa: Wiley-Blackwell Publishers; 2010. p. 13-30.
  64. Hawkins RJ. The organization, financing and delivery of dental care for older adults in Canada: an assessment from a social sciences perspective. Can J Community Dent. 1998;13:10-24.
  65. Nitschke I, Ilgner A, Müller F. Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death. Gerodontology. 2005;22(3):123-9.
  66. MacEntee MI, Mathu-Muju KR. Uncertainty in oral health- care for older people. Gerodontology. 2013 (in press).
  67. MacEntee MI. The educational challenge of dental geriatrics. J Dent Educ. 2010;74(1):13-9.
  68. Mohammad AR, Preshaw PM, Ettinger RL. Current status of predoctoral geriatric education in U.S. dental schools. J Dent Educ. 2003;67(5):509-14.
  69. De Visschere L, Van der Putten GJ, de Baat C, Schols J, Vanobbergen J. The impact of undergraduate geriatric dental education on the attitudes of recently graduated den- tists towards institutionalised elderly people. Eur J Dent Educ. 2009;13(3):154-61.
  70. Moreira AN, Rocha ES, Popoff DA, Vilaça EL, Castilho LS, de Magalhães CS. Knowledge and attitudes of dentists regarding ageing and the elderly. Gerodontology. 2012;29(2):e624-31.
  71. MacEntee MI, Weiss RT, Waxler-Morrison NE, Morrison BJ. Opinions of dentists on the treatment of elderly patients in long-term care facilities. J Public Health Dent. 1992;52(4):239-44.
  72. Chowdhry N, Aleksejuniene J, Wyatt C, Bryant R. Dentists' perceptions of providing care in long-term care facilities. J Can Dent Assoc. 2011;77:b21.
  73. Klineberg I, Massey W, Thomas M, Cockrell D. A new era of dental education at the University of Sydney, Australia. Aust Dent J. 2002;47(3):194-201.
  74. Baumeister SE, Davidson PL, Carreon DC, Nakazono TT, Gutierrez JJ, Andersen RM. What influences dental students to serve special care patients? Spec Care Dentist. 2007;27(1):15-22.
  75. Loignon C Allison P, Landry A, Richard L, Brodeur JM, Bedos C. Providing humanistic care: dentists' experience in deprived areas. J Dent Res. 2010;89(9):991-5.

Canadian Opinions on Publicly Financed Dental Care

Canadian Journal of Public Health, 2007

Background: Inequalities in oral health and care are long recognized in Canada, with public health environments increasingly focusing on issues of equity and access to care. How does Canada publicly insure for diseases that are largely preventable, minimally experienced by the majority, but that still cause tremendous suffering among the socially marginalized? We consider this dynamic by asking Canadians their opinions on publicly financed dental care. Methods: Data were collected from 1,006 Canadian adults through a telephone interview survey using random digit dialling and computer-assisted telephone interview technology. Simple descriptive and bivariate analyses were undertaken to assess relationships among variables, with logistic regression odds ratios calculated for significant relations. Results: Canadians support the idea of universal coverage for dental care, also recognizing the need for care to specific groups. Generally preferring to access public care through the private sector, Canadians support the idea of opting out, and expect those who access such care to financially contribute at point of service. Conclusion: Support for publicly financed dental care is indicative of a general support for a basic right to health care. Within the limits of economy, the distribution of oral disease, and Canadian values on health, the challenge remains to define what we think is equitable within this sector of the health care system. This question is ultimately unanswerable through any survey or statistical means, and must, to become relevant, be openly promoted and debated in the social arena, engaging Canadians and their sense of individual and social responsibility. MeSH terms: Dental care delivery; public opinion; access to health care; policy La traduction du résumé se trouve à la fin de l'article.

Dental insurance, income and the use of dental care in Canada

Journal (Canadian Dental Association), 2007

Using recent Canadian health survey data, we investigated the effect of socioeconomic status on patients' use of dental services and dental insurance coverage. Our results point to an important socioeconomic gradient in the use of dental services. The probability of receiving any dental care over the course of a year increases markedly with dental insurance, household income, and level of education. Among those receiving at least some dental care, however, a person's general oral health--not financial factors--largely determined visit frequency. The insurance effect appears to operate through a reduction in price paid at point of service, not decisions by those with high anticipated need for dental care to selectively purchase insurance. Indeed, those with poorer self-assessed oral health, as well as those from Quebec (where dental benefits are subject to personal income tax) and those over 65 years of age (who have likely lost employer provided coverage) were less likely to...

Grootendorst P: Dental insurance, income and the use of dental care in Canada

2020

Using recent Canadian health survey data, we investigate the effect of individuals' socio-economic status on their use of dental services and dental insurance coverage. Our results point to an important socio-economic gradient in the use of dental services. The probability of receiving any dental care over the course of a year increases markedly with dental insurance, household income, and ones level of educational attainment. Conditional on receiving some dental care, however, ones general oral health -not financial factors -largely determines visit frequency. The insurance effect appears to operate through a reduction in price paid at point of service, not the decision of those with high anticipated need for dental care to selectively purchase insurance. Indeed, those with poorer self assessed oral health, as well as those from Quebec (where dental benefits are subject to personal income tax), and those 65+ (who have likely lost employer-provided coverage) are less likely to ...

Equity in dental care among Canadian households

International Journal for Equity in Health, 2011

Background: Changes in third party financing, whether public or private, are linked to a household's ability to access dental care. By removing costs at point of purchase, changes in financing influence the need to reach into one's pocket, thus facilitating or limiting access. This study asks: How have historical changes in dental care financing influenced household out-of-pocket expenditures for dental care in Canada? Methods: This is a mixed methods study, comprised of an historical review of Canada's dental care market and an econometric analysis of household out-of-pocket expenditures for dental care. Results: We demonstrate that changes in financing have important implications for out-of-pocket expenditures: with more financing come drops in the amount a household has to spend, and with less financing come increases. Low-and middle-income households appear to be most sensitive to changes in financing. Conclusions: Alleviating the price barrier to care is a fundamental part of improving equity in dental care in Canada. How people have historically spent money on dental care highlights important gaps in Canadian dental care policy.

Access to Basic Dental Care and the Heavy Hand of History in Canada (pp. 20-22)

Putting our Money where our Mouth is: The Future of Dental Care in Canada, 2011

A review of the policy legacies caused by the dismantlement of the Saskatchewan Children's Dental Plan and the inadequate coverage of presentation and basic treatment services for at-risk rural, remote and Indigenous populations in Canada.

Trends in self-reported cost barriers to dental care in Ontario

BackgroundThe affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket.Objectives1) To explore trends in self-reported cost barriers to dental care in Ontario; 2) To determine the socio-economic and demographic characteristics of Ontarians reporting cost barriers to dental care; and 3) To identify what predicts reporting cost barriers to dental care in Ontario.MethodsA secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson reg...

Oral health care in Canada--a view from the trenches

Journal, 2006

PURPOSE Concern is increasing over the effect of lack of access to oral health care on the oral health, and hence general health, of disadvantaged groups. In preparation for a national symposium on this issue, key informants across Canada were canvassed for their perceptions of oral health services and their recommendations for improving oral health care delivery. This paper reports the results of that survey. METHOD A questionnaire was constructed to address problems facing agencies with responsibility for meeting the oral health care needs of people receiving government assistance, the underhoused and the working poor. The survey was sent to 200 agencies, government and professional organizations. Data from the returned questionnaires were entered into a Statistical Package for the Social Sciences database and analyzed. Responses from Ontario were compared with those from the rest of Canada, those from government organizations were compared with others and results were examined by...

Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges

BMC Health Services Research, 2014

Background: Dentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance. Methods: We conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists' experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation.