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Implementing Change in Oral Health Policy: Lessons Learned. Stephen Beetstra, DDS Arkansas Children’s Hospital. Implementing Change in Oral Health Policy. Change occurs when a problem has been identified and public opinion demands a solution.

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implementing change in oral health policy lessons learned

Implementing Change in Oral Health Policy:Lessons Learned

Stephen Beetstra, DDS

Arkansas Children’s Hospital

implementing change in oral health policy
Implementing Change in Oral Health Policy
  • Change occurs when a problem has been identified and public opinion demands a solution.
  • Most successful policy changes begin locally and move up through the state and federal systems.
implementing change in oral health policy3
Implementing Change in Oral Health Policy
  • Do your research. Come across as an expert and a resource for the policy makers.
  • Think broadly about who the policy change will effect.
  • Develop collaborative relationships with other organizations before pushing for a policy change.
implementing change in oral health policy4
Implementing Change in Oral Health Policy
  • Inquire with local, state, and federal leaders if change is possible under the current political environment.
  • When meeting with policy makers, discuss the problem, but also possible (multiple) solutions
  • Come with cost estimates.
  • A cost benefit analysis will determine if changes in policy will occur.
implementing change in oral health policy5
Implementing Change in Oral Health Policy
  • Strike when the iron is hot. Use current events to help strengthen your position.
    • Demonte Driver
  • Be prepared to defend your position intelligently when adversity strikes.
    • North Little Rock Toddler
access issues
Access Issues
  • Dental Medicaid Fee Increases
    • Pro
      • Federal Match
      • Increase in non traditional practices
      • Initial support from the dental community
      • Increase in Access
      • Assists in support for safety net system
      • Medicaid programs can manipulate quantity of services by fee schedules
access issues7
Access Issues
  • Cons
    • Sometimes not supported by other Health professionals
    • Viewed as a quick fix by many lawmakers
    • Increase in non traditional practices
    • Becomes a perceived threat to traditional dental practices because of corporate involvement
    • Allegations of cherry picking and patient dumping between providers and practices
    • Fee schedules determine what services will be provided
access issues8
Access Issues
  • Bottom Line with Medicaid Fee Increases
  • Significant increases in preventive services for patients
  • Strengthens already established safety net providers
  • Slight increase in restorative and emergency services
  • If already established traditional practice, chances are they will not participate even with fee increase.
access issues9
Access Issues
  • Bottom Line with Medicaid Fee Increases
  • Corporate practices will develop quickly due to fee increases
  • Cost of program will increase significantly for the State
  • Mobile dental practices begin to appear
  • Due to competition for staff, pay rates increase for assistants, hygienists, and staff dentists
case studies

Case Studies

Problem One: No Access For Anyone

hidalgo county demographics
Hidalgo County Demographics
  • County Population – 7500
  • Home of the Gray Ranch
  • Sixty miles from anywhere
  • Hospital Closed in the 1970’s (Hill-Burton)
  • Home to two prisoner of war camps in WWII
  • Current major employer is the Public Schools
hidalgo medical services
Hidalgo Medical Services
  • Started in 1994 after no medical providers were in the county for more than 10 years.
  • State and Federal Support were necessary to get program started.
  • Initial mission was to provide health care to an underserved population.
  • Mission drastically changed when Phelps-Dodge closed the smelter at Playas in 1998.
hidalgo medical services13
Hidalgo Medical Services
  • Community survival and economic development became the major focus of the organization.
  • Primary Goal became economic development.
  • Second largest employer in the county.
  • Largest construction project in 20 years.
  • Used local taxes to pay for improvements
hidalgo medical services14
Hidalgo Medical Services
  • Results
    • Largest primary care provider in Southwest New Mexico
    • Currently 4 dentists, 4 hygienists, 10 assistants, and part time orthodontist
    • May re-open the hospital for an acute care inpatient facility
    • Expanded services to four other communities
    • Was able to persuade Department of Homeland Security to open training site
case studies15

Case Studies

Problem Two: No Access for Medicaid Recipients

background
Background
  • In 2000, a community leader from the Barrio complained to Senator Bingaman about lack of dental care for children.
  • No pediatric dentists in Eastern New Mexico.
  • Two dentists accept Medicaid. One 60 miles away, the other 100.
  • Met with local dentists about issues.
background17
Background
  • Dentist Concerns
    • Practices at capacity
    • Lack of support staff
    • High missed appointment rates
    • Unable to refer patients to specialists for complex cases
    • Unable to recruit dentists to community
roswell dental project
Roswell Dental Project
  • Collaboration between Eastern New Mexico University-Roswell, University of New Mexico, NM Department of Health,Chaves County, and City of Roswell
  • Roswell used the project to make it an All American City
  • Used creation of dental education programs at all levels to increase access to underserved populations
roswell dental project19
Roswell Dental Project
  • Create access and training to and from specialists for local providers.
  • Create hospital program
  • The Dental Van Project
  • New Facility in 2008
  • Residency expansion in 2009
  • Three new dentists in the community since projected started
roswell dental project20
Roswell Dental Project
  • Major Funding of the project came from Federal and State Governments, and W.K. Kellogg Foundation, Community Voices Project
  • Barriers during project
    • Dentist
    • Other Community College
    • Staffing
case studies21

Case Studies

Problem Three: Community Water Fluoridation

henderson county statistics
Henderson County Statistics
  • Population – 70,000
  • Hendersonville City Water System – 47,000
  • Known as the “City of Four Seasons”
  • Population either affluent or poor, very small middle class
fluoridation
Fluoridation
  • Largest water system not fluoridated in North Carolina
  • Failed in the early 60’s, 70’s, and 80’s.
  • Caries rates 40% higher in low income population than the rest of the state
fluoridation battle of 1996
Fluoridation Battle of 1996
  • Talked with Parents and Providers about what I was seeing in clinic
  • Talked to Community Partners to see if they would support the initiative
  • Called State Dental Director and Dean of the Dental School for Assistance
  • Obtained Cost information for fluoridation equipment
fluoridation battle of 199625
Fluoridation Battle of 1996
  • Obtained grant information for City Officials
  • Met with the Mayor, and each city council person individually
  • Was able to have issue placed on council agenda
fluoridation battle of 199626
Pro

Dental Association

Medical Association

School Board

Board of Health

Head Start

Council on Aging

State Agencies

Local Newspaper

Churches

Industries

Chamber of Commerce

Civic Organizations

Fluoridation Battle of 1996
fluoridation battle of 199627
Fluoridation Battle of 1996
  • Anti
    • Henderson County Coalition to Prevent Water Fluoridation
    • One Chiropractor
fluoridation battle of 199628
Fluoridation Battle of 1996
  • Initial City Council Meeting
  • Public Hearing in Armory
  • Anti-fluoridation Summit
  • Meeting with City Councilmen
  • Protests
    • Harassments
    • Picketing
  • Vote
  • Lawsuit
fluoridation battle of 199629
Fluoridation Battle of 1996
  • Aftermath
    • Coalition membership
    • Ice storm
    • Sealant Program
stephen beetstra dds

Stephen Beetstra, DDS

Arkansas Children’s Hospital

beetstrasm@archildrens.org