1. Local PH Flashcards
CLINICAL CARE \_\_\_\_ Sets Goals Focus on \_\_\_\_ Maximize Care Mainstream Patients \_\_\_\_ Practice For Profit
POPULATION HEALTH \_\_\_\_ Determined Goals Target Public at Large Maximize \_\_\_\_ Care Safety Net for Vulnerable \_\_\_\_ Team Practice Salaried
• Public health ○ Social perspective • Greatest care for greatest amount of people • Population health is a very different perspective
dentist
individual
independent
socially
baseline
collaborative
3 Phases Of Public Health
• \_\_\_\_ ○ Make sure things get done ○ Workforce ○ Enforce laws • \_\_\_\_ ○ Always looking to monitor health § Caries rates § CDC, monitoring outbreaks ○ Identify the problems • \_\_\_\_ ○ Mobilize community partnerships
• Maximize health from individual and \_\_\_\_ area
assurance
assessment
policy development
population
Social determinants of health
- agriculture and food production
- ____
- work enviornment
- ____
- unemployment
- ____
- health care services
- houses
Spans ____, Suburban, Rural, Local and Global
Addresses All ____, Genders & Socio-Economic Factors
• Socio-economic, cultural and environment conditions that are just as important as \_\_\_\_ components
agriculture and food production
living and working conditions
water and sanitation
urban
races
biologic
A profession in transition
• Where dentistry is going is an important \_\_\_\_
health policy issue
Dental expenditures
• In 2016 - $384 • Now starting to see \_\_\_\_ off ○ Nice growth until 2007-08 ○ In 2007-08: recession - affected the way we provided care • Now back to an \_\_\_\_ trend - economy is now improving ○ Recovering enough to provide and get dental care
leveling
upward
Dental expenditures
• Purple is private insurance ○ Is financed by \_\_\_\_ insurance a lot more than medical § Has now been decreasing over time; \_\_\_\_% is now • A lot of \_\_\_\_ as well for dentistry ○ 40 vs 11% ○ That's why it's \_\_\_\_ for a lot of patients • Orange - CMS ○ Only 12% vs 38% for medical ○ Medicaid and medicare § Medicaid is for low-income § Medicare is for older individuals ○ Mostly \_\_\_\_, very little \_\_\_\_ goes to older people for dentistry • Advocating for more medicare in dentistry, and more medicaid - a lot of low-income and elderly are paying out of pocket bc they're not getting anything from their employer
private 46 OOP medicaid medicare
• Two ways to look at who visits dentist:
○ ____ expenditures
§ Money that’s spent at the dentist
§ ____ visit dentists the most
□ Dental care for children is a requirement in the ____; medicaid is very generous for the children
□ Employer health plan has to include dental if it’s including the ____ based on the ACA
□ Every bill to reform the ACA cut out dentistry for children
§ Medicaid - dental insurance is ____
□ ____ have the lowest
□ ____ (medicare doesn’t include dentistry) is increasing
money
children
ACA
children
optional
adults
older adults
• Children with private insurance visited dentist more than those with ____ and more than those that are ____
• Why would only 41% of children on medicaid visit the dentist?
○ ____ to care - inability to transport; some dentists don’t even take medicaid; no pediatric dentists in the area
public
uninsured
barriers
- Adults (19-64)
* Only ____% with public insurance vist the dentist
22
- Very little public insurance for the older
* A lot of adults maintain dental insurance through ____ based, or under medicare you can buy ____ programs
employer
supplemental
Dental Workforce Issues Geographic \_\_\_\_ of Dentists Acceptance of \_\_\_\_ Trained Dentists Trends to Expand Care by \_\_\_\_ International Dental Therapy Model United States Versions: Alaska, Minnesota, Maine \_\_\_\_ Dental Hygiene \_\_\_\_ dental auxilliary (EFDA)
• Bad distribution of dentists in PA
distribution foreign non-physicians public health expanded function
- Cost as a barrier to receiving care
* A lot of non-finacnial barriers, not really ____!
cost
• Increase in use of the ER
○ Primarily ____ (21-34 y/o)
§ Doesn’t have insurance, while the older pop does
○ Will rarely get ____ (will get pain relief and antibiotics)
younger
dental care
• Another way of looking at who goes to the dentist
• When was your ____ dental visit?
○ 57% of men who are bt 18-64 said they visited dentist
○ 66% of women (18-64)
§ Generally, how many people visit the dentist? ____%; but the medical ____ do not match that
□ ____ plays a part
• Racial and ethnic disparities
○ Not seen as much for ____
○ Black: 55.9 (as opposed for 62.9 for white)
○ Older (black over 65): 42% (as opposed for 62.5 for white)
last 66 expenditures self-importance children
Improving Access to Care for Vulnerable and Underserved Populations, 2011
Topics include • \_\_\_\_ in Access to Dental Care • Expanding\_\_\_\_Workforce • Expanding Oral Health Care \_\_\_\_ • \_\_\_\_ Dental Care • Cultural \_\_\_\_ and Ethics
disparities dental settings financing competency
Utilization of Dental Services Financial + Non Financial Barriers
Most Frequent User n \_\_\_\_ n \_\_\_\_ n \_\_\_\_-educated n Higher \_\_\_\_ n Some health problems n \_\_\_\_ benefits
Less Frequent User n \_\_\_\_ and African American n \_\_\_\_ n Less \_\_\_\_ n Lower \_\_\_\_ n No \_\_\_\_ insurance n Age \_\_\_\_
Dental anxiety and fears, transportation, comfort
white female college income dental
hispanic male education income dental 19-34
Universal Oral Health Care
Mathur
, et al JDR 2015
3 Arguments
____ of Dental Disease
____ Costs
____ as Ethical Mandate
* Everyone has some dental need * High cost to people in society * Want to make sure we can provide coverage for as many \_\_\_\_ as possible; but make sure those who aren't covered will have coverage * Universal health care includes \_\_\_\_ * Right now, dentistry is a \_\_\_\_ rather than a right * Need more people and more services being covered
burden personal & societal beneficence services dentistry privelage
Profession of dentistry
- unique ____ valuable to society
- ____ & code of ethics
- ____ learning
- ____ & research organizations• Profession of dentistry
○ Self-regulation
• Occupation or just a profession? These are key
knowledge
self regulation
research and continued
service
American Dental Association
____% membership of all dentists
Promotes oral health to public
Powerful ____
Protect profession
Support selected programs
(Research, Public Health)
Provides member ____
Dissemination of scientific info (EBD web site)
Develops ____
CODA, Seal of Approval for products
70
advocacy
benefits
professional standards
Federal Health Agencies
Department of Health & Human Services
AHRQ, SAMSHA, CMS
CDC, HRSA, IHS
FDA, NIH, NIDCR
• Dentistry works closely with these • \_\_\_\_ - fluoride control • \_\_\_\_ - funded with dental activities • IHS - provides dental care • Research ○ \_\_\_\_ ○ NIH ○ \_\_\_\_ • AHRQ, SAMHSA, CMS ○ All components of public health that provides \_\_\_\_
CDC HRSA FDA NIDCR funding
Centers for Disease Control and Prevention (CDC)
Protect Public Health And Safety
• Control of ____and Pathogens
• Address ____ Diseases and Conditions
• Provide Assessment and ____ Data
• Ensure Best Practices for ____ Living and Prevention
• Monitor ____ and Ensure Best Practices for
Clinical Care
infectious diseases non-infectious surveillance healthy diseases
HRSA: Health Resources and Services Administration
- increase access to ____ (CHC, HPSA)
- funding for study of ____ systems
NHSC: national health service corps
- increase ____ workforce
- loan ____
- ____• HRSA gives out schollys and replayment
care oral health care primary care repayment scholarship
Indian health service
Principal ____ health care provider and health advocate for 1.8 million American Indian and Alaska Native people in 35 states
____ community prevention programs
Active ____ programs
AI/AN = ____
• Gives care to NA as a result of the treaties
federal
organized
clinical
US citizens
Health Agencies in State Government
Department of Health
____ & Surveillance
____ Development
____ & Treatment Programs
* Each state is different * Pennsylvania does not have a \_\_\_\_ that's under the state health department * Ohio has \_\_\_\_ programs that are active
epidemiology policy assurance dental director large
Health Agencies in State Government
Professional Licensing through State Dental Board
____ the Health & Safety of Public
Set ____ for Dental Practice
Control ____ of Practice & Respond to ____
Issue and ____ Licenses
• Assure quality of dentistry which is protected by state board • Set CE requirements to continue the quality of dentists ○ Assuring quality is important public health
protect standards quality complaints remove
Health Agencies in State Government
Medicaid Office
Medicaid Dental Insurance Programs for ____ Children and Adults
____, S-CHIP, Adult ____
Department of Education Policies
____ School Dental Examinations
Dental Treatment Programs
School ____
* Variation can result in inequality to care * \_\_\_\_ has state wide mandated fluoride supplies
low-income
EPSDT
basic
mandatory
fluoridation
kentucky
Health Agencies in Local Government
City Health Department
____ Policies
Government/NGO Health Clinics
____: Federally Qualified Health Clinics
____ Health Centers
• Government health clinics are located at local areas • Fluoridation is controlled by the \_\_\_\_ governemnt rather than state ○ Kentucky has \_\_\_\_-wide mandated fluoridated
fluoridation FQHC city community local state
Global Public Health
World Health Organization
Oral Health Priority Action Areas
____, nutrition and oral health, ____, Tobacco
____ children, Elderly, HIV disease
Oral Health Services & Information Technology
Government/NGO Health Programs
____ South American Initiative
____ support initiative
diet fluoride school PAHO fluoridation
