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 .