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01-02-2012 | Original Paper

Access to Dental care for Low-Income Adults: Perceptions of Affordability, Availability and Acceptability

Authors: Bruce B. Wallace, Michael I. MacEntee

Published in: Journal of Community Health | Issue 1/2012

Abstract

The objective of this study was to explore access to dental care for low-income communities from the perspectives of low-income people, dentists and related health and social service-providers. The case study included 60 interviews involving, low-income adults (N = 41), dentists (N = 6) and health and social service-providers (N = 13). The analysis explores perceptions of need, evidence of unmet needs, and three dimensions of access—affordability, availability and acceptability. The study describes the sometimes poor fit between private dental practice and the public oral health needs of low-income individuals. Dentists and low-income patients alike explained how the current model of private dental practice and fee-for-service payments do not work well because of patients’ concerns about the cost of dentistry, dentists’ reluctance to treat this population, and the cultural incompatibility of most private practices to the needs of low-income communities. There is a poor fit between private practice dentistry, public dental benefits and the oral health needs of low-income communities, and other responses are needed to address the multiple dimensions of access to dentistry, including community dental clinics sensitive to the special needs of low-income people.

Bryant, T., Leaver, C., & Dunn, J. (2009). Unmet healthcare need, gender, and health inequalities in Canada. Health Policy, 91(1), 24–32.PubMedCrossRef

Grignon, M., Hurley, J., Wang, L., & Allin, S. (2010). Inequity in a market-based health system: Evidence from Canada’s dental sector. Health Policy, 98(1), 81–90.PubMedCrossRef

Lawrence, H. P., & Leake, J. L. (2001). The US surgeon general’s report on oral health in America: A Canadian perspective. Journal of Canadian Dental Association, 67(10), 587.

Locker, D. (2000). Deprivation and oral health: A review. Commissioned Review, 28(3), 161–169.

Raphael, D. (2007). Poverty and policy in Canada: Implications for health and quality of life. Toronto: Canadian Scholars Press.

Health Canada. (2010). Report on the findings of the oral health component of the Canadian health measures survey 2001–2009. Ottawa: Health Canada.

Loignon, C., Haggerty, J., Fortin, M., Bedos, C., Allen, D., & Barbeau, D. (2010). Physicians’ social competence in the provision of care to persons living in poverty: Research protocol. BMC Health Services Research, 10(1), 79.PubMedCrossRef

MacEntee, M. (2006). An existential model of oral health from evolving views on health, function and disability. Community Dental Health, 23(1), 5–14.PubMed

MacEntee, M. I., & Harrison, R. (2011). Dimensions of dental need and the adequacy of our response: Forum proceedings. Journal Canadian Dental Association, 77, b12.PubMed

10.

Quiñonez, C., Figueiredo, R., Azarpazhooh, A., & Locker, D. (2010). Public preferences for seeking publicly financed dental care and professional preferences for structuring it. Community Dentistry and Oral Epidemiology, 38(2), 152–158.PubMedCrossRef

11.

Birch, S., & Anderson, R. (2005). Financing and delivering oral healthcare: What can we learn from other countries. Journal of Canadian Dental Association, 71(4), 243.

12.

Dharamsi, S., Pratt, D. D., & MacEntee, M. I. (2007). How dentists account for social responsibility: Economic imperatives and professional obligations. Journal of Dental Education, 71(12), 1583–1592.PubMed

13.

Pegon‐Machat, E., Tubert‐Jeannin, S., Loignon, C., Landry, A., & Bedos, C. (2009). Dentists’ experience with low‐income patients benefiting from a public insurance program. European Journal of Oral Sciences, 117(4), 398–406.PubMedCrossRef

14.

Andersen, R. (1968). A behavioral model of families’ use of health services. Chicago: University of Chicago, Center for Health Administration Studies.

15.

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.PubMedCrossRef

16.

Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1301.PubMed

17.

Davidson, P. L., Andersen, R. M., Wyn, R., & Brown, E. R. (2004). A framework for evaluating safety-net and other community-level factors on access for low-income populations. Inquiry, 41(1), 21–38.PubMedCrossRef

18.

Karikari-Martin, P. (2011). Use of health care access models to inform the patient protection and affordable care act. Policy, Politics, & Nursing Practice, 11(4), 286–293.CrossRef

19.

Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19(2), 127–140.PubMedCrossRef

20.

McIntyre, D., Thiede, M., & Birch, S. (2009). Access as a policy-relevant concept in low-and middle-income countries. Health Economics Policy and Law, 4(02), 179–193.CrossRef

21.

Chen, J., & Hou, F. (2002). Unmet needs for healthcare. Health Reports, 13(2), 23–34.PubMed

22.

Nelson, C. H., & Park, J. (2006). The nature and correlates of unmet healthcare needs in Ontario, Canada. Social Science and Medicine, 62(9), 2291–2300.PubMedCrossRef

23.

McCarthy, J. F., & Blow, F. C. (2004). Older patients with serious mental illness: Sensitivity to distance barriers for outpatient care. Medical Care, 42(11), 1073–1080.PubMedCrossRef

24.

Ricketts, T. C., & Goldsmith, L. J. (2005). Access in health services research: The battle of the frameworks. Nursing Outlook, 53(6), 274–280.PubMedCrossRef

25.

Newton, J. T., & Bower, E. J. (2005). The social determinants of oral health: New approaches to conceptualizing and researching complex causal networks. Community Dentistry and Oral Epidemiology, 33(1), 25–34.PubMedCrossRef

26.

Pauly, B. M., MacKinnon, K., & Varcoe, C. (2009). Revisiting “who gets care?”: Health equity as an arena for nursing action. Advances in Nursing Science, 32(2), 118–127.PubMed

27.

Stevens, P. E. (1992). Who gets care? Access to healthcare as an arena for nursing action. Scholarly Inquiry for Nursing Practice, 6(3), 185–200.PubMed

28.

Allin, S., Grignon, M., & Le Grand, J. (2010). Subjective unmet need and utilization of healthcare services in Canada: What are the equity implications? Social Science and Medicine, 70(3), 465–472.PubMedCrossRef

29.

Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 509–535). Thousand Oaks, CA: Sage.

30.

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.

31.

Millar, W. J., & Locker, D. (1999). Dental insurance and use of dental services. Health Reports, 11(1), 55–67.PubMed

32.

Chi, D., & Milgrom, P. (2008). The oral health of homeless adolescents and young adults and determinants of oral health: Preliminary findings. Special Care in Dentistry, 28(6), 237–242.PubMedCrossRef

33.

Cohen, L. A., Bonito, A. J., Akin, D. R., Manski, R. J., Macek, M. D., Edwards, R. R., et al. (2009). Toothache pain: Behavioral impact and self-care strategies. Special Care in Dentistry, 29(2), 85–95.PubMedCrossRef

34.

Quinonez, C., Gibson, D., Jokovic, A., & Locker, D. (2009). Emergency department visits for dental care of nontraumatic origin. Community Dentistry and Oral Epidemiology, 37(4), 366–371.PubMedCrossRef

35.

Bedos, C., Brodeur, J., Boucheron, L., Richard, L., Benigeri, M., Olivier, M., et al. (2003). The dental care pathway of welfare recipients in quebec. Social Science and Medicine, 57(11), 2089–2099.PubMedCrossRef

36.

Bedos, C., Brodeur, J., Levine, A., Richard, L., Boucheron, L., & Mereus, W. (2005). Perception of dental illness among persons receiving public assistance in Montréal. American Journal of Public Health, 95(8), 1340–1344.PubMedCrossRef

37.

Muirhead, V., Quiñonez, C., Figueiredo, R., & Locker, D. (2009). Oral health disparities and food insecurity in working poor Canadians. Community Dentistry and Oral Epidemiology, 37(4), 294–304.PubMedCrossRef

38.

Reid, K. W., Vittinghoff, E., & Kushel, M. B. (2008). Association between the level of housing instability, economic standing and healthcare access: A meta-regression. Journal of Healthcare for the Poor and Underserved, 19(4), 1212–1228.CrossRef

39.

Daiski, I. (2007). Perspectives of homeless people on their health and health needs priorities. Journal of Advanced Nursing, 58(3), 273–281.PubMedCrossRef

40.

De Palma, P., & Nordenram, G. (2005). The perceptions of homeless people in Stockholm concerning oral health and consequences of dental treatment: A qualitative study. Special Care in Dentistry, 25(6), 289–295.PubMedCrossRef

41.

Gelberg, L., Lin, L. S., & Rosenberg, D. J. (2008). Dental health of homeless adults. Special Care in Dentistry, 8(4), 167–172.CrossRef

42.

Williamson, D. L., Stewart, M. J., Hayward, K., Letourneau, N., Makwarimba, E., Masuda, J., et al. (2006). Low-income Canadian’s experiences with health-related services: Implications for health care reform. Health Policy, 76(1), 106–121.PubMedCrossRef

43.

Greenberg, B. J. S., Kumar, J. V., & Stevenson, H. (2008). Dental case management: Increasing access to oral healthcare for families and children with low incomes. Journal of the American Dental Association, 139(8), 1114–1121.PubMed

44.

Patrick, D., Lee, R., Nucci, M., Grembowski, D., Jolles, C., & Milgrom, P. (2006). Reducing oral health disparities: A focus on social and cultural determinants. BMC Oral Health, 6(Suppl 1), S4.PubMedCrossRef

45.

Quiñonez, C. R., Figueiredo, R., & Locker, D. (2009). Canadian dentists’ opinions on publicly financed dental care. Journal of Public Health Dentistry, 69(2), 64–73.PubMedCrossRef

46.

Levesque, M. C., Dupere, S., Loignon, C., Levine, A., Laurin, I., Charbonneau, A., et al. (2009). Bridging the poverty gap in dental education: How can people living in poverty help us? Journal of Dental Education, 73(9), 1043–1054.PubMed

47.

British Dental Association. (2003). Dental care for homeless people. London: British Dental Association.

48.

Collins, J., & Freeman, R. (2007). Homeless in north and west Belfast: An oral health needs assessment. British Dental Journal, 202(12), E31.PubMedCrossRef

49.

Frankish, C. J., Hwang, S. W., & Quantz, D. (2005). Homelessness and health in canada. Canadian Journal of Public Health, 96, 23–29.

50.

Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164(2), 229.PubMed

51.

Hwang, S. W. (2002). Is homelessness hazardous to your health? obstacles to the demonstration of a causal relationship. Canadian Journal of Public Health, 93(6), 407–410.

52.

Moore, G., Gerdtz, M., & Manias, E. (2007). Homelessness, health status and emergency department use: An integrated review of the literature. Australasian Emergency Nursing Journal, 10(4), 178–185.CrossRef

53.

Dharamsi, S., & MacEntee, M. I. (2002). Dentistry and distributive justice. Social Science and Medicine, 55(2), 323–329.PubMedCrossRef

54.

Muirhead, V., Quinonez, C., Figueiredo, R., & Locker, D. (2009). Predictors of dental care utilization among working poor Canadians. Community Dentistry and Oral Epidemiology, 37(3), 199–208.PubMedCrossRef

Title: Access to Dental care for Low-Income Adults: Perceptions of Affordability, Availability and Acceptability
Authors: Bruce B. Wallace
Michael I. MacEntee
Publication date: 01-02-2012
Publisher: Springer US
Published in: Journal of Community Health / Issue 1/2012
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI: https://doi.org/10.1007/s10900-011-9412-4

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Access to Dental care for Low-Income Adults: Perceptions of Affordability, Availability and Acceptability

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