Concepts In Public Health

Chapter 2 Trends In Dental Public Health

What Is An Oral Health Disparity?

When certain populations or groups experience a higher level of oral diseases when compared to other groups. Non-Hispanic Blacks, American Indians, Hispanics, Alaska natives have the poorest oral health of all racial groups in U.S. Limited knowledge and access to preventive care contribute to disparity.

Demographics Used

Age Sex Race or ethnicity Socioeconomic status Primary language Geography Medical or disability status Behavior lifestyles

Correcting The Disparities

Healthy People 2000, 2010, 2020 Surgeon General National Call to Action Improve data collection Collect data/do research Put data and research into action (I said this)

Healthy People 2020

Oral health is a focus of this initiative 42 objectives Oral health linked with other areas (maternal and child health, cancer, diabetes, access and infrastructure)

National Call To Action

Framework for oral health action Strategies for collaboration to reduce disparities Strategies to improve oral health *Report calls for action in 5 areas. (See next slide)

Five Areas For Action

Change perception of oral health Overcome barriers/replicate effective programs and proven efforts Build science base/accelerate science transfer Increase oral health workforce, diversity, capacity and flexibility Increase collaboration

Improve Data Collection

Data collection methods need to be improved Data analysis methods need to be improved along with methods of comparison

Collect Data/Do Research

State health departments Local health departments Dental schools Dental hygiene schools *Research needs to be conducted by each of these entities in order to produce comparable data.

Demographic Shifts

Fastest growing segment of U.S. population is 85 years and older. (Good thing or bad?) By 2030, 20% of U.S. population will be 65 or older. Fewer than 5% of elderly live in nursing homes. About 20% of Americans have a disability with 10% having a severe disability.

Note

With people living longer there is more of a demand for oral care. HOWEVER! Graduate dental students who answered a survey stated they did not feel well prepared to work with the elderly, disabled, or those with HIV/AIDS.

Demographics Continued

1 in 4 Americans is Black, Hispanic, or Asian/other non-Hispanic. 1 in 10 U. S. residents is foreign born. Number of oral health professionals representing minority groups is disproportionate to the number of ethnic groups.

Note

According to your text, the field of dental hygiene is even less ethnically diverse than the dental field. Relatively few faculty members in dental or dental hygiene schools are ethnic minorities. Why? What do you think?

Think About This

Do you agree with the statement: Appropriate role models/mentors are lacking for students and graduates from ethnic minority groups who wish to work in dental public health settings? In other words, does a role model/mentor have to be ethnic if the student they are mentoring is ethnic?

Access To Care

Fact: More than 90% of active dentists and hygienists work in private practice. Fact: Many dentists do not participate in Medicaid or State Childrens Health Insurance Program.

Dental Health Professional Shortage Areas

What it is: Geographic areas, special population groups, or facilities designated by the government as having a shortage of oral health personnel. Examples: rural areas, low income or Medicaid populations, correctional institutions.

Safety Net Dental Clinics

No regular source for dental care/now this facility is chosen Sliding fee scale/Medicaid accepted Will not be turned away if they cannot afford treatment Clinic is close to home *Problem-not enough of these clinics

Mobile and Portable Services

Another solution to access problem Mobile vans, mobile trailers, portable dental equipment Provides services to underserved populations

Teledentistry

Addresses lack of dental specialty services in rural areas Uses electronic information and communications technology Provides consultation by a specialists electronically/saves travel time and expenses. Uses digital radiography, computer and video applications

Other Solutions

Allow dental hygienists to practice without supervision of a dentist Change law that limits licensure to only those practitioners who have successfully passed a state clinical board Change law that prevents third party payers from reimbursing dental hygienists directly

Medicare
1.

2.

Provides health insurance to those 65 and older, certain people with disability, and persons with kidney failure Does not provide coverage for oral health services

Medicaid

Jointly funded by federal and state Provides insurance for low income families Includes children, seniors, blind, disabled Oral health services mandatory for children Oral health services optional for adults

What Do You Think?

What message do you think Medicare and Medicaid send by providing the kinds of coverage they provide?

SCHIP

State Childrens Health Insurance Program Jointly funded-federal and state Health insurance for children to age 19 Incomes are generally less than 2x the poverty level/do not qualify for Medicaid Oral health coverage not a mandatory component All states have opted to include some oral health coverage

Community Based Programs

Community clinics School-based sealant programs Preschool fluoride supplement programs Nursing home oral health programs

Funding For Programs

Federal/state/local governments Corporate sponsors Foundations/philanthropic organizations Sliding fee schedule clinics Private donations

Insurance

15% of persons 18 and older have no medical insurance 45% (approx. 85 million) have no dental insurance

Insurance
Two types: 1. Indemnity plans-reimbursement plans/fee-for-service plans 2. Managed care plans

Managed Care Plans

Three Types: Health maintenance organization (HMO) Preferred provider organization (PPO) Point-of-service plans (POS)

Health Maintenance Organizations

HMO, DMO, DHMO Health care services are on a prepaid basis Were designed to reduce cost of health care Dentist receives monthly fee (capitation) Members must receive care from a network provider Example: Aetna DMO

Preferred Provider Organization

PPO Patients must use a network provider Provider agrees to discount their fees Patients can go out of network (higher deductibles and co-pay amounts)

Point-Of-Service Plans

POS DMO patient can go to out of network provider Benefits are usually lower than if patient stays in network

Capitation

Provider is paid a fixed amount for each patient enrolled in his/her office regardless of whether or the patient actually uses the services. Providers are paid in several ways: capitation, fee-for-service, or can be salaried by the plan.

Gatekeeper Function

Primary care provider controls referral to specialists Primary care providers include: Pediatricians, family doctors, general dentists, pediatric dentists.

Oral Health Infrastructure

Programs and people who assure the publics oral health Lack of personnel with oral health expertise-serious problem/results in decline in publics oral health Oral Health America-issued Oral Health Report Card for states/grade=C

Workforce
Text states: Recruiting members of underrepresented ethnic groups into oral health and allied health professions and therefore, into dental public health positions has been difficult. What can be done?

What Is The Problem?

Student debts Graduates repay student loans by practicing in Health Service Corps or Indian Health Services leave when loan is repaid Mean graduating debt for a dental student in 2002 was $107,503 Only about 145 dentists are board certified in dental public health

Oral Health Integration

Surgeon General called for integration of oral health and general Mouth should be thought of as integral part of the body/not separate entity Oral health can be integrated into: Nutrition, cancer, HIV/AIDS, osteoporosis, birth defects, diabetes, CD prevention, tobacco cessation, prenatal counseling, school readiness initiatives

Other Ways To Integrate

Teach general dentists to treat young children and recognize other childhood health problems Promote first dental visit by age one Assure each child has a medical and dental home Incorporate oral health screening/referral, education, and fluoride varnishes into primary care and well child visits Increasing inter-professional education and communication via the Internet

Technology

Good or bad? Information overload Is information reliable? Consumers expect health care professionals to know their stuff/causes clinicians to pay high malpractice premiums/develop defensive mind set

Health Communication Strategies

Social marketing-technique to increase public awareness of the relationship of behaviors to diseases and to influence people to take action. Media advocacy-use of various media outlets and formats to increase awareness and knowledge of issues.

Literacy
1.

2.
3. 4.

5.

45% of adults in U.S. read at 8th grade level or lower Health literacy importance: Learning oral health knowledge Purchasing oral health care products Promoting oral health to others Communicating with oral health care providers Navigating the oral health care system

Improving Health Literacy

Integrate health concepts and skills into adult education, GED programs, and ESL classes. Plain Language Movement-documents written in plain language help people find what they need, understand what they find, and act on that understanding

Evidence Based Practice

Goal-to facilitate timely translation of research findings into clinical and community practices Barriers that prevent evidence based practice: page 26 in text, box 2-3 Research shows that it takes at least 10 years for practitioners to adopt new materials or techniques. Cochrane Oral Health Group