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Wolf E, Ziesemer K, Van der Hijden E. Policy interventions to improve the accessibility and affordability of Dutch dental care. A scoping review of effective interventions. Heliyon 2024; 10:e28886. [PMID: 38707350 PMCID: PMC11066141 DOI: 10.1016/j.heliyon.2024.e28886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Caries and periodontitis remain prevalent in the Netherlands. Given the assumption that increasing the accessibility and affordability of dental care can improve oral health outcomes, policy interventions aimed at improving these aspects may contribute to better oral health. To identify possible solutions, this scoping review firstly identifies policy interventions from around the world that have effectively improved the accessibility or affordability of dental care. Secondly, this review discusses the potential of the policy interventions identified that are applicable to the Dutch healthcare sector specifically. A literature search was performed in four databases. Two reviewers independently screened all potentially relevant titles and abstracts before doing the same for the full texts. Only studies that had quantitatively evaluated the effectiveness of policy interventions aimed at improving the accessibility or affordability of dental care were included. 61 of the 1288 retrieved studies were included. Interventions were grouped into four categories. Capacity interventions (n = 5) mainly focused on task delegation. Coverage interventions (n = 25) involved the expansion of covered dental treatments or the group eligible for coverage. Managed care interventions (n = 20) were frequently implemented in school or community settings. Payment model interventions (n = 11) focused on dental reimbursement rates or capitation. 199 indicators were identified throughout the 61 included studies. Indicators were grouped into three categories: accessibility (n = 137), affordability (n = 21), and oral health status (n = 41). Based on the included studies, increasing managed care interventions for children and adding dental coverage to the basic health insurance plan for adults could improve access to dental care in the Netherlands. Due to possible spillover effects, it is advisable to investigate a combination of these policy interventions. Further research will be necessary for the development of effective policy interventions in practice.
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Affiliation(s)
- E.H. Wolf
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - K.A. Ziesemer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - E.J.E. Van der Hijden
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
- Zilveren Kruis Health Insurance, Handelsweg 2, 3707 NH Zeist, Utrecht, the Netherlands
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de Sam Lazaro SL, Karger TR, Despres BR, McPherson RC, Minor EJ. An approach to developing oral health knowledge for allied health students. J Dent Educ 2021; 86:581-591. [PMID: 34850391 DOI: 10.1002/jdd.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/31/2021] [Accepted: 11/12/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Oral health competency-based education approaches have been proposed as a mechanism to address oral health outcomes and equity issues. Recommendations for oral health education for allied health professional students include practices to increase team members' knowledge and skills in the integration of oral health and primary care practice (IOHPCP) initiative's oral health clinical competencies for primary care providers. AIMS This study aimed to examine changes in self-reported knowledge of occupational students in the topics of oral health, the dental profession, and dental healthcare systems following participation in a series of webinars and a community-engaged learning project. MATERIALS AND METHODS This study utilized an oral health education program through webinars and a community-engaged learning project for occupational therapy students. Program evaluation measures were utilized to assess the oral health education activities through self-reported knowledge in oral health topics aligned with IOHPCP domains along with topics identified by the community partner organization. RESULTS Findings demonstrate that asynchronous webinars can increase self-reported knowledge in occupational therapy students. DISCUSSION Recommendations for inclusion of oral health education for allied health students related to knowledge of oral health, the dental profession, and dental healthcare systems are shared. CONCLUSIONS Asynchronous webinars have the potential to increase self-reported oral health knowledge for allied health professionals.
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Affiliation(s)
| | - Taylor R Karger
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
| | - Brittanee R Despres
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
| | - Rachel C McPherson
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
| | - Ellen J Minor
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
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Khouja T, Burgette JM, Donohue JM, Roberts ET. Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services. Health Serv Res 2020; 55:642-650. [PMID: 32700423 PMCID: PMC7518821 DOI: 10.1111/1475-6773.13324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid. DATA SOURCES Medical Expenditure Panel Survey (2011-2016), Area Health Resources File, and Medicaid adult dental coverage policies. STUDY DESIGN We conducted a quasi-experimental analysis using linked parent-child dyads in low-income families (≤125 percent of the Federal Poverty Level). We assessed whether expansions of Medicaid to low-income adults under the Affordable Care Act were associated with increases in the use of preventive dental services among low-income children when state Medicaid programs did vs did not cover these services for adults. PRINCIPAL FINDINGS Over the study period, 37.8 percent of low-income children received at least one annual preventive dental visit. We found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered (1.26 percentage points; 95% CI: -3.74 to 6.27) vs did not cover preventive dental services for adults (3.03 percentage points; 95% CI: -2.76 to 8.81). (differential change: -1.76 percentage points; 95% CI: -8.09, 4.56). However, our estimates are imprecise, with wide confidential intervals that are unable to rule out sizable effects in either direction. CONCLUSION We did not find an association between Medicaid expansions with concurrent coverage of preventive dental services for adults and children's use of these services. Factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.
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Affiliation(s)
- Tumader Khouja
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Jacqueline M. Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental MedicineUniversity of PittsburghPittsburghPennsylvania
| | - Julie M. Donohue
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Eric T. Roberts
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
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Kranz A, Rozier R, Stein B, Dick A. Do Oral Health Services in Medical Offices Replace Pediatric Dental Visits? J Dent Res 2020; 99:891-897. [PMID: 32325007 PMCID: PMC7346745 DOI: 10.1177/0022034520916161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the United States, state Medicaid programs pay for medical and dental care for children from low-income families and support nondental primary care providers delivering preventive oral health services (POHS) to young children in medical offices ("medical POHS"). Despite the potential of these policies to expand access to care, there is concern that they may replace dental visits with medical POHS. Using Medicaid claims from 38 states from 2006 to 2014, we conducted a repeated cross-sectional study and used linear probability regression to estimate the association between the annual proportion of children in a county receiving medical POHS and the probability that a child received 1) dental POHS and 2) a dental visit in a given year. Models included county and year fixed effects and controlled for child- and county-level factors, and standard errors were clustered at the state level. In a weighted population of 45.1 million child-years (age, 6 mo to <6 y), we found no significant nor substantively important association between the proportion of children in a county receiving medical POHS and the probability that a child received dental POHS or a dental visit. Additionally, we found an almost zero probability (<0.001) that the reduction in dental POHS was at least as large as the expansion in medical POHS (full substitution) and a 0.50 probability that increased medical POHS was associated with an increase in dental POHS of at least 6.6% of the expansion of medical POHS. Results were similar when receipt of dental visits was examined. This study failed to find evidence that medical POHS replaced dental visits for young children enrolled in Medicaid and, in fact, offers evidence that increased medical POHS was associated with increased utilization of dental care. Given lower-than-desired rates of dental visits for this population, delivery of medical POHS should be expanded.
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Affiliation(s)
| | - R.G. Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Kranz AM, Duffy E, Dick AW, Sorbero M, Rozier RG, Stein BD. Impact of Medicaid Policy on the Oral Health of Publicly Insured Children. Matern Child Health J 2019; 23:100-108. [PMID: 30032444 PMCID: PMC6324972 DOI: 10.1007/s10995-018-2599-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective Fluoride varnish (FV) applications among non-dentist primary care providers has increased due to state Medicaid policies. In this study we examine the impact of FV policies on the oral health of publicly insured children aged 2-6 years old. Methods Using three waves of the National Survey of Children's Health (2003, 2007, 2011/12), we used a logistic regression model with state and year fixed effects, adjusting for relevant child characteristics, to examine the association between years since a state implemented a FV policy and the odds of a publicly insured child having very good or excellent teeth. We compared children with public insurance in states with FV policies to children with public insurance in states without FV policies, controlling for the same difference among children with private insurance who were unlikely to be affected by Medicaid FV policies. Results Among 68,890 children aged 2-6 years, 38% had public insurance. Compared to privately insured children, publicly insured children had significantly lower odds of having very good or excellent teeth [odds ratio (OR) 0.70, 95% CI 0.62-0.81]. Publicly insured children in states with FV policies implemented for four or more years had significantly greater odds of having very good or excellent teeth (OR 1.28, 95% CI 1.03-1.60) compared to publicly insured children in states without FV policies. Conclusions for Practice State policies supporting non-dental primary care providers application of FV were associated with improvements in oral health for young children with public insurance.
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Affiliation(s)
| | - Erin Duffy
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Andrew W Dick
- RAND, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA
| | - Mark Sorbero
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Richard Gary Rozier
- University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Bradley D Stein
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Burgette JM, Preisser JS, Rozier RG. Access to preventive services after the integration of oral health care into early childhood education and medical care. J Am Dent Assoc 2018; 149:1024-1031.e2. [PMID: 30243426 DOI: 10.1016/j.adaj.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/12/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effect of Early Head Start (EHS) on receipt of preventive oral health services (POHS) from both oral and medical health care providers is not known. METHODS The authors compared children enrolled in North Carolina EHS programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates. RESULTS Primary caregivers of children enrolled in EHS (n = 479) and Medicaid (n = 699) were interviewed when children were approximately 10 and 36 months of age. An average of 81% of EHS and non-EHS children received POHS from an oral or medical health care provider at follow-up. EHS children had greater odds of receiving an oral health assessment (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.74 to 3.13) and fluoride (OR, 1.53; 95% CI, 1.16 to 2.03) from an oral health care provider than children not enrolled. EHS children had decreased odds (OR, 0.73; 95% CI, 0.54 to 0.99) of receiving fluoride from a medical health care provider. CONCLUSIONS Both children enrolled in EHS and community control participants had high rates of POHS, but the source of services differed. EHS children had greater odds of receiving POHS from oral health care providers than non-EHS children. EHS and non-EHS children had equal rates for fluoride overall because of the greater percentage of non-EHS children with medical fluoride visits. PRACTICAL IMPLICATIONS The integration of POHS in early education and Medicaid medical benefits combined with existing dental resources in the community greatly improves access to POHS.
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AlHumaid J, Salloot Z, Al-Ansari A, El Tantawi M, AlYousef Y, Al-Harbi F. Contribution of preventive methods in controlling caries among Saudi primary schoolchildren: a population-based cross-sectional study. Acta Odontol Scand 2018; 76:422-426. [PMID: 29320886 DOI: 10.1080/00016357.2018.1425899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study assessed the association between caries preventive measures including regular dental checkups, twice a day tooth brushing using fluoridated toothpaste and pit and fissure sealants on one side and the presence of caries among primary schoolchildren in the Eastern Province of Saudi Arabia. MATERIALS AND METHODS A cross-sectional study was conducted in 2016 including 1198, 6-12-year-old children from 13 randomly selected schools. The outcome variable was caries presence. The explanatory variables were brushing twice a day using fluoridated toothpaste, the presence of sealant and regular dental checkups. Multivariable logistic regression model was conducted to assess the associations controlling for confounders (age, gender, ability to get treatment, being health insured and school) using SPSS version 20.0. RESULTS Data of 921 participants (83.8%) were available. The prevalence of caries was 63.5%, whereas 67.6% brushed their teeth twice a day, 28.3% visited the dentist for regular checkups and 7.6% had sealant. In multivariable regression, out of the three main explanatory variables, only having regular checkups was significantly associated with caries presence (OR = 0.65, 95% CI = 0.48, 0.88). CONCLUSIONS Lower odds of caries presence were associated with regular dental checkups but not with regular brushing or having sealant.
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Affiliation(s)
- Jehan AlHumaid
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainah Salloot
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Asim Al-Ansari
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maha El Tantawi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yousef AlYousef
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahad Al-Harbi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Mertz E, Spetz J, Moore J. Pediatric Workforce Issues. Dent Clin North Am 2017; 61:577-588. [PMID: 28577638 DOI: 10.1016/j.cden.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Untreated dental disease remains one of the most prevalent health conditions for children, driven in part by disparities in access to care. This article examines evidence-based workforce strategies being used to facilitate better access to pediatric health services and to improve oral health status and outcomes for children. The workforce strategies described in this article include promising new models in the dental field, with new and existing providers as well as emerging workforce models outside of the dental field. Case studies for some of these workforce strategies are also presented. Future directions and health policy implications are considered.
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Affiliation(s)
- Elizabeth Mertz
- Preventive and Restorative Dental Sciences, Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 410, San Francisco, CA 94143, USA.
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143, USA
| | - Jean Moore
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, 1 University Place, Suite 220, Rensselaer, NY 12144, USA
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