Download - Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”
![Page 1: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/1.jpg)
1
Are Publicly Financed Dental Care Programs in Ontario
Delivering the “Best Bang for their Buck?”
E. Cardoso, V. Pilly, C. Quiñonez
![Page 2: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/2.jpg)
2
Outline• Current situation• Strategies abroad• Conceptual framework • Multi-Criteria Decision Analysis (MCDA) tool• Strengths & Weaknesses• Conclusion
![Page 3: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/3.jpg)
3
Current situation• Imbalance between financial
resources and challenges– Increasing demand–Higher costs–Ethical dilemmas (Xie et al., 2011)
• Sustainability of dental care programs • Recent call to increase access
![Page 4: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/4.jpg)
4
Current situation
• Challenge = Opportunity– Chase the “best bang for their buck”– Enhance process effectiveness & health outcomes
• Mantra of “no new dollars”– Scrutinize the basket of dental care services– Resource allocation optimization (Elshaug et al., 2009)
– Evidence and best practices
![Page 5: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/5.jpg)
5
Strategies abroad
Identify interventions with questionable outcomes (Garner & Littlejohns , 2011)Identify unsafe or ineffective services
(Elshaug et al., 2012)
Ethical principles for resource allocation(WHO,2004)
![Page 6: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/6.jpg)
6
Conceptual framework
• Decision support tool– Multi-Criteria Decision Analysis (MCDA)– Health Technology Assessment (HTA)
• Evaluate existing or future practices • Evaluation phase or planning phase • Help decision action toward program
objectives
![Page 7: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/7.jpg)
Yes
No
Yes
No
No
Yes
No
Procedure
Program Objectives Analysis
Are program objectives
met?
Do not fund
Analysis against need
Is procedure needed?
Analysis against effectiveness
Is procedure effective?
Analysis against appropriateness
Is procedureappropriate?
Is it the only option?
Fund
Yes
Yes
Is it cost effective?
Cost-effective analysis
Yes No
Analysis deferred?
NoNo
YesProfessionalor Patient
preference?
Procedure analysis
YesNo
7
![Page 8: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/8.jpg)
8
Building the proposed MCDA
• Various criteria listed and arranged in a hierarchical, priority-setting manner
• Dental procedure must satisfy all listed decision criteria to be funded– Fails to meet criterion definition flagged not
to be funded– Lacks evidence considered for evidence-
based review
![Page 9: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/9.jpg)
Yes
No
Yes
No
No
Yes
No
Procedure
Program Objectives Analysis
Are program objectives met?
Analysis against need
Is procedure needed?
Analysis against effectiveness
Is procedure effective?
Analysis against appropriateness
Is procedureappropriate?
Yes
9
![Page 10: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/10.jpg)
10
Program Objective Analysis• Procedure should:– Reflect on the founding principles of
the program – Support the ultimate goals or
programs objectives– Preserve the sustainability of the
program
![Page 11: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/11.jpg)
11
Need Analysis
• Instrumental aspect of “need”• Not linked to ill health• “Minimum amount of resources required
to exhaust capacity to benefit” (Culyer and Wagstaff, 1993)
• Some needs ought to go unmet to be equitable (Culyer , 1998)
![Page 12: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/12.jpg)
12
Effectiveness Analysis• Achieved its outcome in real life setting
(Guindo, 2012)
• Strength of evidence for evidenced-based decision (Schanschieff , 1986)
• How much improvement after the procedure is provided (Lavis, 1996)
• Basis for ‘Approppriateness’ (Lavis, 1996)
![Page 13: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/13.jpg)
13
Appropriateness Analysis • Effective for a particular patient or
population• No efforts are made to balance benefits
and costs yet (Lavis, 1996)
![Page 14: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/14.jpg)
14
Cost-effectiveness Analysis
• Identify worth financing services from other options (Johnson et al., 2009)
• Simplest criterion• Last in the hierarchy (Musgrove, 1999)
• Other options for public funding (Musgrove, 1999)
![Page 15: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/15.jpg)
15
Professional / patient preferences Analysis
• Further analysis to avoid resource overutilization
• Individual welfare is not for the scope of social responsibility (Wikler, 2002)
![Page 16: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/16.jpg)
Yes
No
Yes
No
No
Yes
No
Procedure
Program Objectives Analysis
Are program objectives met?
Analysis against need
Is procedure needed?
Analysis against effectiveness
Is procedure effective?
Analysis against appropriateness
Is procedureappropriate?
Yes
16
![Page 17: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/17.jpg)
Yes
Do not fund
Fund
YesCost
effective ?
Cost-effective analysis
Yes No
Analysis deferred?
No
No
YesProfessional or Patient
preference?Procedure
analysis
Yes
No
Only option ?
17
![Page 18: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/18.jpg)
18
Strengths
• Systematic and evidence-informed tool• Rational and transparent decision-making
process• Identifies intrinsic values of each procedure• Drives program performance according to
issues of sustainability
![Page 19: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/19.jpg)
19
Weaknesses
• Resistance from service providers • Resistance from funders• Centralized administration
![Page 20: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/20.jpg)
20
Conclusion• Inequality in access to dental care as a public
health issue• Sustainability of dental public health programs• Maximize health benefits as an ethical objective of
the health care system • Proposed systematic tool
– Evaluate current public oral health programs against their strategic goals
– Push towards a stronger policy which includes vulnerable populations other than children
![Page 21: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/21.jpg)
21
Thank You!
![Page 22: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/22.jpg)
22
References• Culyer AJ. The morality of efficiency in health care — some
uncomfortable implications. Health Econ 1992; 1: 7-18.• Culyer, A. Need-is a consensus possible? J. Med. Ethics 24, 77-80
(1998)• Elshaug, A., Moss, J.R., Littlejohns, P., Karnon, J., Merlin, T.L.& Hiller,
J.E. (2009) Identifying existing health care services that do not provide value for money. MJA 190, 5: 269-73.
• Elshaug, A. G., Watt, A. M., Mundy, L. & Willis, C. D. Over 150 potentially low-value health care practices: an Australian study. Med. J. Aust. 197, 556-560 (2012)
• Garner, S. & Littlejohns, P. Disinvestment from low value clinical interventions: NICEly done? BMJ 343, d4519 (2011)
![Page 23: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/23.jpg)
23
References• Guindo, L. A. et al. From efficacy to equity: Literature review of decision criteria for
resource allocation and healthcare decisionmaking. Cost. Eff. Resour. Alloc 10, 9-7547-10-9 (2012)
• Johnson, A. P. et al. Health technology assessment: a comprehensive framework for evidence-based recommendations in Ontario. Int. J. Technol. Assess. Health Care 25, 141-150 (2009)
• Lavis, J. N. & Anderson, G. M. Appropriateness in health care delivery: definitions, measurement and policy implications. CMAJ 154, 321-328 (1996)
• Musgrove, P. Public spending on health care: how are different criteria related? Health
Policy 47, 207-223 (1999) • Ontario Association of Public Health Dentistry (2005) Preparing for change, Retreat April 27 - 29, 2005.
Barrie: Vision Management Services, Ontario Association of Public Health Dentistry.
• Quiñonez C, Sherret L, Grootendorst P, Shim MS, Azarpazhooh A, Locker D. An environmental scan of provincial/territorial dental public health programs. Office of the Chief Dental Officer, Health Canada. (2007) http://www.fptdwg.ca/English/e- environmental.html
![Page 24: Are Publicly Financed Dental Care Programs in Ontario Delivering the “Best Bang for their Buck? ”](https://reader033.vdocument.in/reader033/viewer/2022051421/56816197550346895dd14423/html5/thumbnails/24.jpg)
24
References• Schanschieff S. Report of the committee of enquiry into unnecessary
dental treatment, H M Stationery Office, Great Britain Department of Health and Social Security, England, 1986
• Wikler, D. Personal and social responsibility for health. Ethics Int. Aff. 16, 47-55 (2002)
• World Health Organization (2004): Guidance on ethics and equitable access to HIV treatment and care. http://www.who.int/ethics/Guidance%20on%20Ethics% 20and%20HIV.pdf.
• Xie, F. et al. Using health technology assessment to support evidence-based decision-making in Canada: an academic perspective. Expert
Rev. Pharmacoecon Outcomes Res. 11, 513-521 (2011).