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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

Why this topic?

• Focus on children • Hear the voice of the parent • Knowledge Acquisition • Stepping stone to improvement

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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?

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Balance Billing

Alberta, Manitoba, , , , Nfld/Labrador, Nova Scotia, PEI NO Saskatchewan: Yes and No

British Columbia: YES

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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

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Results

• Demographics • Beliefs

• Dental Care Pathways • Healthy Kids Program Experiences

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Results

Demographics: • 16 parents interviewed (14 mothers, 2 fathers) • 15/16 families live on adjusted net income of $22,000 or less

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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).

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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

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Dental Care Pathways The Dental Care Process flowchart

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Dental Care Pathways

Individual flowchart

Dental Care Pathways (N=20)

Exits From Pathway (N=37)

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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)

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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)

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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).

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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)

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Limitations Overrepresentation of: 1. Children requiring services of hospital privileged dentist. 2. Use of charitable organizations Lack of recall

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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

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Questions

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