Ohcs Final Exam

Front 1

Winslow definition of Public Health:

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“The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort…”

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Institute of Medicine definition of Public Health:

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“…fulfilling society’s interest in assuring conditions in which people can be healthy.”

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3 major dimensions in public health or public health system:

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1. Building capacity (inputs)

2. Establishing processes (practices and outputs)

3. Assessing outcomes (results)

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Unique features of public health

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- Basis in social justice philosophy
- Inherently political nature
- Dynamic agenda
- Partners with government
- Grounding in the sciences
- Primary and secondary prevention as prime strategies
- Uncommon culture and bond

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Core public health functions

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Assessment

Policy development

Assurance

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Burt and Eklund’s criteria to Identifying a public health problem

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A condition that is a widespread actual or potential cause of morbidity or mortality

There is a perception on the part of the public, government, or public health authorities that the condition is a public health problem

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Assessment in dental public health:

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ASS SAD

Acquire data
Survey
Surveillance

Summarize data
Analysis
Description

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ASTDD 7-Step Model for assessment

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I Don't Pick CORES

1. Identify partners and form advisory committee(s)

2. Determine goals and resources

3. Plan data collection program
a. Identify primary and secondary data sources
b. Determine need for primary data collection
c. Identify resources
d. Select methods
e. Develop work plan

4. Collect data

5. Organize and analyze data

6. Report findings and utilize data for program planning, advocacy, education, and policy

7. Evaluate needs assessment and return to Step 1 (as necessary)

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Assurance in dental public health

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Build linkages and partnerships
Build community capacity
Integrate oral health communications
Promote access to care and other health system interventions
Evaluate outcomes
Manage quality

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Private care tends to maximize _____ _______, while Public care tends to minimize _____ _____

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best outcome; worst outcome

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Two best Dental public health journals

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1. Journal of Public Health Dentistry (United States)

2. Community Dentistry and Oral Epidemiology (Europe)

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Fastest growing cities, US, 2010

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Mostly the sun belt

Fort Worth, Texas
New York City, New York
Phoenix, Arizona
McKinney, Texas
Gilbert, Arizona
North Las Vegas, Nevada
San Antonio, Texas

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2 types of need:
1 type of demand:

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1. Perceived need - Assessed by the individual
2. Normative need - Assessed by professionals

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Need =

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unmet need
OR
Lack of dental visits

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What part of the country utilizes dental services the most:

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Midwest

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Key factors affecting demand for dental care:

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Consumer knowledge

Consumer attitudes

Level of disease

Financial mechanisms

Economy

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Health Belief Model

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Behavioral model of health services utilization

Based on an individuals’ perspective

Originally designed to explain why people did not participate in programs to prevent or detect diseases.

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3 Key components of Health Belief Model:

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PEN

1. Predisposing factors

2. Enabling factors

3. Need factors

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Perceived saliance

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doing something has value – is worthwhile

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Enabling Factors

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determines how care is used

financial ability to pay

community ‘s capacity to provide care.

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the most prevalent public health issue of children in this area

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Dental caries

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Percent of children in this region who have tooth decay

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60%

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Dental Discount Programs

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Not regulated
Low cost
No assurance of discount
Bait and switch common

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Three essential elements of Direct Reimbursement:

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1) they are self-funded by the employer;
2) they allow freedom to choose any dentist; and
3) they reimburse patients based on dollars spent on dental treatment,

Front 25

United Kingdom Human Resources:

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Dentists (General Dentists, Specialists, Consultants)

Dental Hygienists

Dental Therapists

Dental Nurses (Dental Assistants)

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United Kingdom Education for dentists:

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Directly follows secondary education

5-year curriculum, followed by 1 year of vocational training in general practice

Dental degree awarded is Bachelor of Dental Surgery (BDS)

addressed as "Dr."

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United Kingdom Patient Care:

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Most dental care provided free or at modest co-payment under provisions of National Health Service

In recent years, an increasing number of patients seek fee-for-service care from the private sector of practicing dentists

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China Human Resources:

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Dental Health Worker - provides “basic” dental care to villages and communes


Dental Technician-a level in sophistication of training and skill above that of Dental Health Worker (not a laboratory technician)


Stomatologist-a physician with specialized training in dentistry (usually administrators, faculty, or specialists-most like US dentists)


Dental Nurses (Dental Assistants)

No Dental Hygienists

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China Education for dentists:

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Dental Technicians - trained in 6 month to one-year programs in “dental schools”

Stomatologists - trained as physicians with specialized training in dentistry in a five year university-based program

Front 30

New Zealand Human Resources

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Dentists (General Dentists, Specialists, Consultants) - similar to the United Kingdom

N. Z. Dental Nurses - expanded function dental auxiliaries providing free care in the school system

Dental Nurses (dental assistants)

Dental Hygienists - few but increasing

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New Zealand Education:

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Dentists - educated in 5-year university program directly following secondary education (similar to United Kingdom)

New Zealand Dental Nurses - educated in 2 year programs emphasizing preventive and clinical care for application in school system

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New Zealand Patient Care:

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All dental care is provided on a fee-for-service basis for persons beyond 16 years of age, with the exception of those who are 16-18 and are dependent upon parents for support; all school children to age 13 can receive free dental care in school

National oral health status is good to age 18, then is followed by dramatic drop to a high rate of edentulism in older persons

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Germany Human Resources:

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Dentists - General Dentists, Specialists

Doctor of Dental Medicine (“Dr. Med. Dent.”) - largely an academician

Dental Hygienists

Dental Assistants

Dental Laboratory Technologists

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Germany Education:

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Dentist - education is free in state (federal) dental schools which offer a 6 year curriculum directly following secondary school and compulsory military service; entry is highly competitive

Dr. Med. Dent. - entry level requirement for a career in academia; 2 and 1/2 years of study, research, and thesis completion

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German Patient Care

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Virtually all Germans (approximately 97%) have dental insurance, to which they contribute in general collections for all social and health insurances (10-12% of income)

Insurance pays for all but periodontal, prosthodontic and orthodontic services, for which there is a co-payment of 15-20%

Front 36

Japan Human Resources

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Dentists - General Dentist, Specialist

Dental Hygienists

Dental Assistants

Dental Laboratory Technologists

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Japan Education

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Dentist - 2 years of pre-dental education at university level (state or private institution), followed by 4 years of dental specific education at university level (state or private institution); 2-4 year programs of specialty education in all traditional specialties

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Japan Patient Care

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Dental care provided by both public and private dental practices

Most care provided by private practices

Reimbursement of providers by both direct payment (patient) and indirect (social benefit) payment

Free care provided for patients over 70, the indigent, and the handicapped

Dental care fees for more than 98% of population covered by health insurance

Front 39

Canada Human Resources

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Dentists – General Dentists, Specialists

Denturists

Dental Hygienists

Dental Assistants

Dental Laboratory Technologists

Front 40

Canada Education

Back 40

Dentists - 4 years of pre-dental university education followed by 4 years in Dental School/Faculty of Dentistry; eligible for licensure in any of Canada’s ten provinces within 5 years of graduation; additional 2-5 year programs for specialty qualification
Denturists – Dental Laboratory Technologists specially trained and qualified to provided denture services
Dental Hygienists - 2 year certificate and 4 year Bachelor of Science degree programs

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Canada Patient Care

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Unlike medical care, which by-in-large, is provided free of major cost to the patient by a national health service plan, dental care is provided the majority of Canadians in private practices by a fee-for-service system
Dental care is provided to select underserved, underprivileged, or remote populations by low-cost to no-cost governmentally subsidized programs
The array, sophistication, and quality of dental services in Canada parallels those of the United States

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Global Maryland (Collegial Relationships)

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Poland (Medical University of Lodz)
Mexico ( Universidad Intercontinental)
Vietnam (Medical University of Hanoi)
Korea (Kyung-Hee University)
Peru (Universidad Peruana Cayetana Heredia)
Canada (University of British Columbia)
Australia (University of Sydney)
Japan (Osaka University)

Front 43

GOAL of Public Policy =

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promote public welfare

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Quasi-governmental organization

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an organization that is enforced by the government but is managed privately.

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Equity

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Promote a desirable distribution of goods and services among members of society

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3 Factors of Market Failures:

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1. Market Power
2. Imperfect Information
3. Externalities

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Externality

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something that is the cause of your business that is transmitted to the rest of the society (e.g. factory producing pollution)

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One of the factors of Public Policy is to look at what people NEED in MASS. Those are:

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o Police
o Defense (army)
o Education
o Roads

Front 49

The three sets of people who are involved in Public Policy:

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1. The Government
2. Lobbyists
3. Voters

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The foundations of POLICY are:

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o Political Science
o Sociology
o Economics

Front 51

two ways the government can regulate us as dentists

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1. make legislation
2. create regulatory agencies

Front 52

Where does the federal government get its authority to regulate healthcare?

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The constitution of the United States: “the government has the right to….promote the general welfare of…”

Front 53

Social Security Act of 1935

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Created a compulsory system based on employee-employer
contributions to provide income maintenance for the elderly.
Amended 30 years later to include the financing of physician and hospital services

The Social Security Act had nothing to do with healthcare initially, but it was later amended in 1965 by adding Medicare and Medicaid.

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Title XVIII – Medicare

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• 1965 amendment to the basic Social Security Act legislation
• Created a compulsory basic “insurance” plan for the aged, for hospital and related care, and a voluntary plan for medical and health services. Participation in hospital plan is compulsory, benefits are entitlement (those aged 65 and older), not by need. It is financed by its own payroll deduction.

Medicare is for old people,

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. Title XIX – Medicaid

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1965 amendment to the basic Social Security Act legislation.

More relevant to dentistry than Medicare.

Medicaid is for poor people, mostly kids.

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Occupational Health and Safety Act of 1970

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Provides job safety and health protection for workers by promoting safe and healthful working conditions throughout the nation.

- The Act created the Occupational Safety and Health Administration (OSHA), an agency of the Department of Labor .OSHA is a FEDERAL safety administration. MOSHA is the Maryland STATE agency

Front 57

Section 504 of the 1973 Rehabilitation Act

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Established to promote non-discrimination against the
handicapped.


illegal to discriminate against HIV positive patients.

Front 58

Health Maintenance Act – 1973

Back 58

The purpose of this act was to increase consumer access to pre-paid health plans. This law provided development funds for HMOs and established provisions that overrode restrictive State laws for
any HMO that would become federally certified.

It also required an employer of 25 or more persons to offer employees the option of
joining a certified HMO or medical care foundation if conventional health insurance is provided as a fringe benefit.

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the government considered fee for service as more costly than...

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pre-payment

Front 60

Professional Standards Review Organization (PSROs)

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PSRO program was established by Public Law 92-603, the Social Security Amendments of 1972, to evaluate health care services provided under Social Secrity programs, primarily Medicare and Medicaid

first piece of legislation when quality of healthcare is being reviewed by the government.

Front 61

The Health Care Quality Improvement Act of 1986

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This act established the National Practitioner Data Bank, and information clearing house, to collect and release certain information related to the professional competence and conduct of physicians, dentists, and in some cases, other health care practitioners

formal complaints against practitioners are filed in the National Practitioner Data Bank

Front 62

Americans with Disabilities Act (ADA), 1990

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ADA is applicable to private sector employers with more than 15 employees, places of public accommodation and all recipients of federal funds.

prohibits discrimination based on association with a
person with a disability. “Disability” under this Act includes those with HIV infection, making it crystal clear that discrimination against
an HIV infected patient in a dental education clinic is illegal as is discrimination against students who are “disabled.”


Dental offices are included in this Act as places of public accommodation

Front 63

State Children’s Health Insurance Program (SCHIP)

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The Federal Balanced Budget Act of 1997 created a new children’s health insurance program under which States are able to initiate and expand health insurance coverage for uninsured children.

Allocations are based on the number of uninsured children at or below 200% of the Federal poverty level.

Front 64

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

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Regulates Privacy

Health insurers, certain health care providers (including dentists),
and health care clearinghouses must establish procedures and
mechanisms to protect the confidentiality, integrity, and availability
of electronic protected health information.

Front 65

Health Professions Educational Assistance Act of 1976

Back 65

A. Purpose
B. Capitation grants
C. Area Health Education Centers (AHEC)
D. National Health Service Corps

Front 66

State Board of Dental Examiners have 3 functions:

Back 66

1. they are a state regulatory agency
2. they grant licenses
3. they oversee the practice of dentistry in the state