DOCSLIB.ORG

The Experience of Families Whose Children Access Dental Care Under

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Experience of Families Whose Children Access Dental Care Under 13-11-20 Experiences of Parents Whose Children Access Dental Care Under the Healthy Kids Dental Program by Sharon Melanson, Dip(DH), BSc(DH), MSc Canadian Institutes of Health Research Western Regional Training Centre University of British Columbia Why this topic? • Focus on children • Hear the voice of the parent • Knowledge Acquisition • Stepping stone to improvement 28/09/2013 2 1 13-11-20 Provincial Comparisons • Question #1: Are dentists allowed to balance bill children on Provincial Government publicly sponsored dental plans? • Question #2: Are Ministry fees maintained at a percentage of the dental association fee guide? • Question #3: At what percentage is the Ministry fee guide paying in relation to the dental association fee guide in 2011? 28/09/2013 3 Balance Billing Alberta, Manitoba, Ontario, Quebec, New Brunswick, Nfld/Labrador, Nova Scotia, PEI NO Saskatchewan: Yes and No British Columbia: YES 28/09/2013 4 2 13-11-20 Methodology • Method: Qualitative Description • Sample: purposeful sample, maximum variation • Data Collection: semi-structured interviews, review of documents • Data Analysis: content analysis, quasi- statistical analysis is supplemental • Results: low inference description 28/09/2013 5 Results • Demographics • Beliefs • Dental Care Pathways • Healthy Kids Program Experiences 28/09/2013 6 3 13-11-20 Results Demographics: • 16 parents interviewed (14 mothers, 2 fathers) • 15/16 families live on adjusted net income of $22,000 or less 28/09/2013 7 Results Beliefs • Most parents related positive childhood experiences with dentist (12/16) “I’m not afraid of the dentist” (P-15), “never had any bad experiences” (P6). • Parents can’t afford dental work for themselves = want better for their children “I don’t want my kids to go through what I went through. No, definitely not!” (P1). 28/09/2013 8 4 13-11-20 Q: What are some reasons people might not take their children to the dentist? 1. Finances: given by every respondent “even with 100% coverage...there’s extra costs...I guess it would depend on whether they wanted to pay the dentist or whether or not they wanted to eat that month” (P12) 2. Fear 3. Don’t think it is important 28/09/2013 9 Dental Care Pathways The Dental Care Process flowchart 28/09/2013 10 5 13-11-20 Dental Care Pathways Individual flowchart Dental Care Pathways (N=20) Exits From Pathway (N=37) 28/09/2013 11 28/09/2013 12 6 13-11-20 Dental Care Pathways Family cannot afford the Family pays balance bill (or other billing balance bill and practices) to obtain treatment receives treatment (N=16) (N=4) Child not Family found Charitable scheduled dentist who funding for treatment did not organization (N=5) balance bill paid the (N=3) balance bill (N=8) 28/09/2013 13 28/09/2013 14 7 13-11-20 Pathway Exits Referral to have treatment in hospital or under sedation (N=12) Family cannot pay the balance bill or other billing procedure (N=20) Child refuses to attend due to fear (N=4) Discharge with tx. not complete (N=1) 28/09/2013 15 Healthy Kids Program Experiences The BC Healthy Kids program helps low income families with the costs of basic dental care. 1. Enrollment 2. Is program meeting your needs? 3. How can program be improved? “I don’t know what they could do better other than paying more ...that’s the only way to say that” (P15). “Try to put a cap on dentist and what they can charge people who have their kids on the HK program” (P5). “The fee guide is behind the times, it’s a matter of being current with the fees” (P9). 28/09/2013 16 8 13-11-20 Themes 1. HK program: a success and a failure 2. Use of Advocates 3. Resignation “And I said, ‘No, let me correct you on that one, I didn’t neglect her teeth; I can’t afford to fix her teeth’”(P5) 28/09/2013 17 Limitations Overrepresentation of: 1. Children requiring services of hospital privileged dentist. 2. Use of charitable organizations Lack of recall 28/09/2013 18 9 13-11-20 Further Research • Why is Healthy Kids utilization at 40%? • Dentist’s opinions on balance billing. • Address sampling issues. – Larger representative sample – Several geographic areas • Knowledge Translation 28/09/2013 19 Questions 28/09/2013 20 10 .
Load more

Recommended publications
  • CMS-9909- Surprise Billing Disclaimer
    Notice: This HHS-approved document has been submitted to the Office of the Federal Register (OFR) for publication and has not yet been placed on public display or published in the Federal Register. The document may vary slightly from the published document if minor editorial changes have been made during the OFR review process. The document published in the Federal Register is the official HHS-approved document. [Billing Codes: 6523-63-P; 4830-01-P; 4510-29-P; 4120-01-P] OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 890 [RIN 3206-AO30] DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 54 [TD9951] RIN 1545-BQ04 DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Parts 2510 and 2590 [RIN 1210-AB99] DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 144, 147, 149, and 156 CMS-9909-IFC [RIN 0938-AU63] Requirements Related to Surprise Billing; Part I CMS-9909-IFC 2 AGENCY: Office of Personnel Management; Internal Revenue Service, Department of the Treasury; Employee Benefits Security Administration, Department of Labor; Centers for Medicare & Medicaid Services, Department of Health and Human Services. ACTION: Interim final rules with request for comments. SUMMARY: This document sets forth interim final rules implementing certain provisions of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). These interim final rules amend and add provisions to existing rules under the Internal Revenue Code, the Employee Retirement Income Security Act, the Public Health Service Act, and the Federal Employees Health Benefits Act. These interim final rules implement provisions of the No Surprises Act that protect participants, beneficiaries, and enrollees in group health plans and group and individual health insurance coverage from surprise medical bills when they receive emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance services from nonparticipating providers of air ambulance services, under certain circumstances.
    [Show full text]
  • The BCMA, Then and Now a Selected History from 1965 to Doctors of BC
    The BCMA, Then and Now A Selected History from 1965 to Doctors of BC Dr Brad Fritz THE BCMA, THEN AND NOW: A SELECTED HISTORY FROM 1965 TO DOCTORS OF BC 1 Contents Timeline ................................................................................... 3 1993—Utilization and co-management ............................ 62 Introduction ............................................................................ 4 1993–1998—Reduced activity days and the end of prorationing .......................................................................... 65 1965—The BCMA of 1965 .................................................... 6 1994—Fee disparities and the Relative Value Guide ....... 69 1968–1972—Reform Group–Establishment conflict, referenda, and a Negotiating Committee .......................... 10 1997—The Northern Doctors’ Dispute, the Rural Agreement, and MOCAP .................................................... 74 1968–1979 —A decade of turmoil ...................................... 16 2002—Bill 9 and arbitration ................................................ 77 1972–1980—A professional negotiator ............................. 19 2002—The General Practice Services Committee ........... 81 1973–1995—Public health advocacy: Working for the people of BC .......................................................................... 23 2002–2003—The Bonita Thompson report and a change in the society appointments ................................ 84 1974–2010—Benefits ........................................................... 33 2013 —Doctors
    [Show full text]
  • Medical Practice Service Agreement
    Medical Practice Service Agreement Unshuttered and anucleate Dewitt redissolves, but Christos apogeotropically stork's-bill her prunt. Activated and projected Drake redipped lecherously and congas his opah scraggily and singularly. Balmiest Warner usually varnishes some doormat or depastures strictly. You receive medical agreement or shared infrastructure will apply if a clinic does not have the repayments should look only Maintaining incentives on insurers to not expect pay ratio but accurate to engage in at business practices is range to see hospital community. Practice Operator as lyrics in pool or as signatory with respect to bank accounts and other funds of constant Practice Operator. MSO structures, whether through a switch or equity investment, is still need to retain the physicians at their various medical practices to continue when revenue generation and overwhelm the counter value. Also, fashion the ramp plan maintains several networks intended civil use in to plan designs, the provider agreement form indicate which specific networks in labour the provider agrees to participate. Some billing services include reporting requirements and frequency. Provision of Professional Services. Prior to offering a mob, the employer group together decide how flexible they are prepared to frequent during contract negotiations. Additionally, each shot should have guidelines for periodic review and updating of the compliance policies. Third the Software supplied by Nuance is pass to respective terms and conditions of tentative Agreement cause the applicable third he terms. Health care services are not covered unless they retire the requirements of the applicable Health Benefit Program, including but not limited to, the requirement of Medical Necessity.
    [Show full text]
  • Examining Surprise Billing: Protecting Patients from Financial Pain Hearing
    EXAMINING SURPRISE BILLING: PROTECTING PATIENTS FROM FINANCIAL PAIN HEARING BEFORE THE SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS COMMITTEE ON EDUCATION AND LABOR U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTEENTH CONGRESS FIRST SESSION HEARING HELD IN WASHINGTON, DC, APRIL 2, 2019 Serial No. 116–14 Printed for the use of the Committee on Education and Labor ( Available via the World Wide Web: www.govinfo.gov or Committee address: https://edlabor.house.gov U.S. GOVERNMENT PUBLISHING OFFICE 36–589PDF WASHINGTON : 2019 VerDate Mar 15 2010 11:59 Nov 19, 2019 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 C:\USERS\NWILLIAMS\ONEDRIVE - US HOUSE OF REPRESENTATIVES\DESKTOP\3658 EDL-011-D with DISTILLER COMMITTEE ON EDUCATION AND LABOR ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia, Chairman Susan A. Davis, California Virginia Foxx, North Carolina, Rau´ l M. Grijalva, Arizona Ranking Member Joe Courtney, Connecticut David P. Roe, Tennessee Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan Northern Mariana Islands Brett Guthrie, Kentucky Frederica S. Wilson, Florida Bradley Byrne, Alabama Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin Mark Takano, California Elise M. Stefanik, New York Alma S. Adams, North Carolina Rick W. Allen, Georgia Mark DeSaulnier, California Francis Rooney, Florida Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania Pramila Jayapal, Washington Jim Banks, Indiana Joseph D. Morelle, New York Mark Walker, North Carolina Susan Wild, Pennsylvania James Comer, Kentucky Josh Harder, California Ben Cline, Virginia Lucy McBath, Georgia Russ Fulcher, Idaho Kim Schrier, Washington Van Taylor, Texas Lauren Underwood, Illinois Steve Watkins, Kansas Jahana Hayes, Connecticut Ron Wright, Texas Donna E.
    [Show full text]
  • Pharmacy Manual [PDF]
    Pharmacy Manual The information contained in this Pharmacy Manual does not apply to pharmacy providers from the province of Quebec. Table of Contents Section 1 - General Information About TELUS Health 6 Communicating With Cardholders: The Insurer’s Prerogative 7 Section 2 - The Telus Assure Claims Card Sample Assure Claims Card 9 The Cardholder Identification Number 9 Carrier Number 10 The Cardholder Name Line 10 The Second Name Line 10 Other Text 10 Relationship Code and Date of Birth 11 Section 3 - TELUS Health Assure Claims Pharmacy Support Centre Contact Information and Hours of Operation 13 Holiday Schedule 13 Section 4 - General Policies and Procedures Procedures 15 Validation of Electronic Claims 15 Paper Claims 15 Incorrect Date of Birth 15 Claim Void 16 Claim Retransmission Requests 16 Balancing transactions 16 Pharmacy Payment Options 17 Pricing 17 Determination of Prescription Pricing 17 Keeping a Level Playing Field 18 What Can Be Charged to Cardholders 18 Deferred Payment Plans 19 Government Programs WorkSafe BC (WSBC) 19 Ontario Workplace Safety and Insurance Board (WSIB) 19 Pharmacy Manual 2 Section 4 - General Policies and Procedures (continued) Documentation Requirements 19 Authorization for Prescriptions 19 Verbal Refill Authorizations and Verbal Prescriptions 20 Pharmacist Prescribing/Adaptation 20 Continued Care Prescription (CCP)/Prescription Adaptation by a Pharmacist 20 Changing an Authorized Prescription 20 Dispensing Reduced Quantities 21 Documentation Retention 21 No Substitution 21 Pharmacist’s Signature/Initials
    [Show full text]
  • Universal Health Care: Concerns for American Physicians, Using the Canadian Experience As a Model
    Universal Health Care: Concerns For American Physicians, Using The Canadian Experience as a Model "Social, political and economic myths prevent us from learning from other countries' experiences in financing health care. Perhaps the only advantage of being the last industrial democracy without universal health insurance is that we can learn from the experience of others. We will learn little, however, if we credit the many myths about foreign experience regularly repeated by critics of national health insurance. If ever there was an obvious American opportunity for cross- national learning, it is Canada's path to and experience with universal health insurance."' I. INTRODUCTION The health care problems facing America today are at a critical point. One out of four people, or approximately sixty-three million people, will lose health insurance coverage for some period during the next two years.2 Thirty-seven million Americans have no insurance and another twenty-two million lack adequate coverage. 3 Polls suggest that a majority of Americans are insecure about their health care coverage and are discouraged about the soaring cost of health care, which rose from $250 billion in 1980 to more than $900 billion in 1993.4 Health care costs have been expanding at a rate of ten percent a year, faster than the nation's overall economic growth. 5 As a percentage of gross domestic product, health care costs will grow from fourteen percent to nineteen percent during the next decade if left unchecked.6 1. Testimony Prepared For The Senate Committee on Finance, Health Care: The In- ternational Perspective, FEDERAL NEWS SERVICE, October 14, 1993, available in LEXIS, NEWS Library.
    [Show full text]
  • Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States Paul J
    Boston College International and Comparative Law Review Volume 21 | Issue 2 Article 3 8-1-1998 Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States Paul J. Donahue Follow this and additional works at: http://lawdigitalcommons.bc.edu/iclr Part of the Comparative and Foreign Law Commons, and the Health Law and Policy Commons Recommended Citation Paul J. Donahue, Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States, 21 B.C. Int'l & Comp. L. Rev. 385 (1998), http://lawdigitalcommons.bc.edu/iclr/vol21/iss2/3 This Article is brought to you for free and open access by the Law Journals at Digital Commons @ Boston College Law School. It has been accepted for inclusion in Boston College International and Comparative Law Review by an authorized editor of Digital Commons @ Boston College Law School. For more information, please contact [email protected]. Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States Paul J Donahue" I. INTRODUCTION Among the myriad of variables which health care reform in the United States must address is how reform should, at the level of the theoretical ideal, and must, at the level of pragmatic politics, take into account the federal organization of the government. As the research which underlies this article has again reminded the author, the Ameri­ can situation is unique. The lessons foreign models teach may not be relevant to the United States, and if relevant, may not be easy to apply.
    [Show full text]
  • What Are the Billing Procedures Under Medicare?
    What are the billing procedures under medicare? PATRICIA TESKEY Medical care legislation, coming specifically to the difference be- ernment about how much the pa- under provincial jurisdiction in tween what the government plan al- tient was billed directly for the serv- Canada, varies from province to lowed and the individual practi- ice so plan officials have complete province. Physicians planning to re- tioner chose to charge for a given information as to what insured res- locate in another province, there- service'. But Bill 16 also terminated idents are actually paying for med- fore, face the challenge of inter- this "balance billing" provision. ical care. preting that province's medical care The law states that in areas of Any physician-patient disputes system, the benefits allowed for the province where laboratory, ra- over the amount charged are ar- services and the individual physi- diologic or qlectrodiagnostic facil- bitrated by an assessment commit- cian's options for billing patients. ities don't receive a license, the pa- tee set up by legislation and admin- Of course, the provincial medical tient pays for the service directly istered by the College of Physicians associations or societies as well as and can't recoup the money from and Surgeons of Alberta. individual colleagues will offer ex- the plan; however, when it comes cellent advice when it comes time to to practical application, there are Saskatchewan choose whether to be "opted in" hardly any unlicensed facilities in Government body: Medical Care (participating) or "opted out" (non- the province. Insurance Commission (MCIC) participating); but to make the ini- Legislation: Medical Care Insurance tial research easier for the physician Alberta Act on the move, we have put together a Government Saskatchewan physicians don't face province-by-province summary of body: Alberta Health an ".all in" or "all out" choice.
    [Show full text]
  • Price Setting and Price Regulation in Health Care Lessons for Advancing Universal Health Coverage
    Price setting and price regulation in health care Lessons for advancing Universal Health Coverage Sarah L Barber, Luca Lorenzoni and Paul Ong Price setting and price regulation in health care ii Price setting and price regulation in health care Price setting and price regulation in health care Lessons for advancing Universal Health Coverage Sarah L Barber, Luca Lorenzoni and Paul Ong Price setting and price regulation in health care: lessons for advancing Universal Health Coverage Sarah L Barber, Luca Lorenzoni, Paul Ong ISBN 978-92-4-151592-4 (WHO) WHO/WKC-OECD/K18014 © World Health Organization and the Organisation for Economic Co-operation and Development, 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) endorse any specific organization, products or services. The use of the WHO or OECD logo is not permitted. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD). WHO and OECD are not responsible for the content or accuracy of this translation.
    [Show full text]
  • Physician Fee Levels: Medicare Versus Canada
    Physician Fee Levels: Medicare Versus Canada W. Pete Welch, Ph.D., Steven J. Katz, M.D., Stephen Zuckerman, Ph.D. Adjusted for differences in purchasing fee levels and how they are adjusted over power and practice expenses, Canadian time that is likely to be the single most Im­ physician fees are, on average, 59 percent portant issue faced under the Medicare of Medicare fees. The general perception fee schedule. that Medicare fees are low is the result of Thus far, assessment of the appropri­ comparison with U.S. private fees, not to ateness of Medicare payment rates has the much lower Canadian fees. In the con­ been confined to comparisons with rates text of the current U.S. health care sys· paid by private insurers in the United tem, lowering Medicare fees to Canadian States (Physician Payment Review Com­ levels could jeopardize access to care by mission, 1992c). Because private rates are Medicare beneficiaries. However, if all higher, the comparison raises concerns payers used the same fee schedule, fees that the elderly's access to care could be that differed substantially from those cur· impaired if physicians prefer to treat pa­ rently used by private insurers might be tients covered by private insurance rather viable. than Medicare enrollees. The experience of the Medicaid program, whose rates are INTRODUCTION substantially lower than private insurance The new Medicare fee schedule, a ma­ rates, is an example of how low physician jor reform of physician payment in the fees can restrict access to care within the United States, has accomplished two U.S.
    [Show full text]
  • Perspectives and Lessons from the Canadian Healthcare System
    Perspectives and Lessons from the Canadian Healthcare System Gautam Gowrisankaran University of Arizona, HEC Montr´eal,and NBER October 22, 2020 International Health Systems Conference Gilbert Center, University of California, Berkeley Thanks to Sebastian Fleitas, Josh Gottlieb, Kelli Marquardt, and Erin Strumpf for helpful discussions. Gowrisankaran Canadian Healthcare System October 22, 2020 1 / 12 Why should we care about the Canadian healthcare system? Canada is the closest country to the U.S. in many ways But, our history of health insurance has diverged In 1966, the minority Liberal Pearson government passed the Medical Care Act, with support from the New Democratic (Labor) Party This led to the creation of a series of provincial / territorial health authorities Since that time, the Canadian healthcare system has been largely single payer Canadian market cannot be thought of in isolation Many spillovers to larger U.S. market, such as with physician labor supply, drug prices, etc. During the years since this time, U.S. health spending has exploded And, Canadian life expectancy has increased! Health Spending Trends Gowrisankaran Canadian Healthcare System October 22, 2020 2 / 12 How does Canadian system work? Each of the 13 provinces / territories has its own system Biggest are Ontario Health Insurance Plan and R´egiede l'assurance maladie du Qu´ebec Canada Health Act of 1984 codifies requirements such as no balance billing But, services such as dental care, eye care, drugs, out-of-country care are not covered Employer-based private
    [Show full text]
  • An Environmental Scan of Publicly Financed Dental Care in Canada: 2015 Update
    Environmental Scan 2015 An environmental scan of publicly financed dental care in Canada: 2015 update Jodi L. Shaw, CD, DMD, MSc, FRCD(C) and Julie W. Farmer, RDH, MSc Environmental Scan 2015 This report was prepared under the direction of Dr. Peter Cooney, Chief Dental Officer Public Health Agency of Canada. It does not represent a policy statement by the federal government. This serves as a descriptor of public dental care activities at the time of the scan and includes changes that have occurred since the previous scan with information provided by provincial, territorial, and federal representatives. For a thorough understanding of dental public health activities for each jurisdiction, the corresponding dental directors/departments should be contacted. ii Environmental Scan 2015 Acknowledgments This report was made possible by the efforts and cooperation of many people. Below is a list of those that we would like to thank. Federally Citizenship and Immigration Canada Nurlan Karybekov Correctional Services Canada Angela Wright, Ghalib Dhalla Royal Canadian Mounted Police Dragana Pantic, Janyne Williams Veterans Affairs Canada Brian Barrett, Laurie LeClair Health Canada Lisette Dufour, Marc Plante, Andrea Doiron, Julie Côté Provincially Alberta Deb Warner Saskatchewan Janet Gray Manitoba Khalida Hai-Santiago Ontario Sandra Bennett New Brunswick Suzanne Clair Nova Scotia Helen Pitman, Angela Arsenault, Dean Hirtle, Beverley Corbin iii Environmental Scan 2015 Prince Edward Island Albert Adegbembo, Rhea Jenkins, Chris Mooney Newfoundland and Labrador Ed Williams Nunavut Ron Kelly, Maureen Connors Northwest Territories Victorine Lafferty, Denise Canuel We would also like to acknowledge Dr. Carlos Quiñonez whose work on the original Environmental Scan of Publicly Financed Dental Care in Canada that was completed in 2005 provided a solid foundation for this report.
    [Show full text]