Factors affecting dental services accessibility
a qualitative study
DOI:
https://doi.org/10.14528/snr.2019.53.4.2984Keywords:
dentistry, accessibility, focus group, system stakeholdersAbstract
Introduction: Access to dental services is a basic right included in the compulsory health insurance for patients and thus an important part of the healthcare system in Slovenia. The purpose of this research was to identify and explore the factors that have the greatest impact on the accessibility of dental services from the perspective of the system stakeholders in Slovenia.
Methods: A qualitative study was conducted based on the focus group method. The focus group consisted of relevant system stakeholders, namely two representatives of the regulator, provider and payer, a total of six participants. A thematic analysis was carried out in order to identify the patterns and themes within thequalitative data obtained.
Results: The results of the focus group revealed the views of system stakeholder on the accessibility of dental services in Slovenia. According to the system stakeholders' perspective, accessibility of dental services in Slovenia is not optimal and significant changes in terms of financing and organisation are required.
Discussion and conclusion: We found that the lack of adequate human resources, insufficient health insurance and payment for services are the crucial factors in providing adequate access to dental health in Slovenia. In order to increase its accessibility, the dental programme needs to be expanded and the number of teams for its implementation increased.
Downloads
Metrics
References
Albreht, T., Pribakovic, R.B., Josar, D., Poldrugovac, M., Kostnapfel, T., Zaletel, M., et al., 2016. Slovenia: health system review. Health systems in transition, 18(3), pp. 1–207.
Bersell, C.H., 2017. Access to oral health care: a national crisis and call for reform. American Dental Hygienists' Association, 91(1), pp. 6–14. PMid:29118145
Bintabara, D., Nakamura, K., & Seino, K., 2018. Improving access to health care for women in Tanzania by addressing socioeconomic determinants and health insurance: a population based cross-sectional survey. BMJ Open, 8(9), art. ID e023013. https://doi.org/10.1136/bmjopen-2018-023013 PMid:30209158; PMCid:PMC6144413
Braun V., & Clarke V., 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), pp. 77–101. https://doi.org/10.1191/1478088706qp063oa
Business Dictionary, 2017. Accessibility. Available at: http://www.businessdictionary.com/definition/accessibility.html [10. 9. 2017].
de Gutierrez, G.M., Diniz, M.B., Lima, B.F.A., dos Santos, K.K., & Santos, M.T.B.R., 2018. Barriers to access to dental treatment for people with physical disabilities in a Brazilian metropolis. Pesquisa Brasileiraem Odontopediatria e Clinica Integrada, 18(1), pp. 1–8. https://doi.org/10.4034/PBOCI.2018.181.95
Eslamipour, F., Heydari, K., Ghaiour, M., & Salehi, H., 2019. Access to dental care among 15–64-year-old people. Journal of education and health promotion, 7(46). https://doi.org/10.4103/jehp.jehp_99_17 PMid:29693027; PMCid:PMC5903154
Evans, D.B., Hsu, J., & Boerma, T., 2013. Universal health coverage and universal access. World Health Organization, 91, pp. 546–546A. https://doi.org/10.2471/BLT.13.125450 PMid:23940398; PMCid:PMC3738317
Heima, M., Ferretti, M., Qureshi, M., & Ferretti, G., 2017. The effect of social, geographic factors on the untreated tooth decay among head start children. Journal of clinical and experimental dentistry, 9(10), pp. e1224-e1229. https://doi.org/10.4317/jced.54228 PMid:29167713; PMCid:PMC5694152
Joseph, A.E. & Phillips, D.R., 1984. Accessibility and utilization: geographical perspectives on health care delivery. London: Harper & Row.
Kiauta, M., Poldrugovac, M., Rems, M., Robida, A., & Simčič, B, 2010. Nacionalna strategija kakovosti in varnosti v zdravstvu (2010–2015). Ljubljana: Ministry of Health, pp. 3-24. https://core.ac.uk/download/pdf/52484025.pdf
Kodeks etike v zdravstveni negi in oskrbi Slovenije, 2014. Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije Lima Carreiro, D., Oliveira, Rodrigues, R.F., Mineiro Coutinho, W.L., de Barros Lima Martins, A.M.E, & Haikal, D.S.A., 2018.
Evaluation of satisfaction with dental care from the standpoint of adult Brazilian users: a multilevel analysis. Science and Collective Health, 23(12), pp. 4339–4349. https://doi.org/10.1590/1413-812320182312.32792016 PMid:30540017
Maguire, M., & Delahunt, B., 2017. Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars. The All Ireland Journal of Teaching and Learning in Higher Education, 9(3), pp. 33501–33514.
Masadeh, M.A., 2012. Focus group: reviews and practices. The Journal of Applied Science and Technology, 2(10), pp. 63–68.
McKernan, S.C., Reynolds, J.C., Ingleshwar, A., Pooley, M., Kuthy, R.A.,& Damiano, P.C., 2018. Transportation barriers and use of dental services among medicaid-insured adults. JDR Clinical & Translational Research, 3(1), pp. 101–108. https://doi.org/10.1177/2380084417714795 PMid:30938652
Mitts, L., & Hernández-Cancio, S., 2016. Dental therapists can improve access to dental carefor underserved communities. Available at: https://familiesusa.org/resources/dental-therapists-can-improve-access-to-dental-care-forunderserved-communities/ [10. 9. 2017].
Mosadeghrad, A.M., 2013. Health care service quality: towards a broad definition. International journal of health care quality assurance, 26(3), pp. 203–219. https://doi.org/10.1108/09526861311311409 PMid:23729125
Moseley, M.J., 1979. Accessibility: the rural challenge. London: Methuen.
Nacionalni program zdravstvenega varstva Republike Slovenije: zdravje za vse do leta 2004 (NPZV), 2000. Uradni list Republike Slovenije, št. 49.
Nagle, B., & Williams, N., 2013. Methodology brief: introduction to focus groups. [S.l.]: Center for Assessment, Planning and Accountability, pp. 1–12.
Pravila obveznega zdravstvenega zavarovanja, 1994. Uradni list Republike Slovenije, št.79.
Pravilnik pripravništva in strokovnega izpita za poklic zobozdravnik zobozdravnica, 2018. Uradni list Republike Slovenije, št. 47.
Prevolnik Rupel, V., 2016. ESPN Thematic Report on inequalities in access to healthcare: Slovenia. Brussels: European Commission, pp. 1-20.
Rabiee, F., 2004. Focus-group interview and data analysis. Proceedings of the nutrition society, 63(4), pp. 655–660. https://doi.org/10.1079/PNS2004399 PMid:15831139
Resolucija o nacionalnem planu zdravstvenega varstva 2016–2025, Skupaj za družbo zdravja (ReNPZV16–25), 2016. Uradni list Republike Slovenije, št. 25.
Robinson, A., 2006. Phenomenology. In: E. Cluett & R. Bluff, eds. Principles and practice of research in midwifery. 2nd ed. Edinburgh: Churchill Livingstone Elsevier, pp. 187−219.
Rosing, K., Leggett, H., Csikar, J., Vinall-Collier, K., Christensen, L.B., Whelton, H., et al., 2019. Barriers and facilitators for prevention in Danish dental care. Acta Odontologica Scandinavica, 77(6), pp. 439–451. https://doi.org/10.1080/00016357.2019.1587503 PMid:30905244
Salminen, H., Piispanen, P., & Toth-Pal, E. 2019. Primary care physicians' views on osteoporosis management: a qualitative study. Archives of osteoporosis, 14(1), pp. 40–48. https://doi.org/10.1007/s11657-019-0599-9 PMid:31028556; PMCid:PMC6486622
Starfield, B., Shi, L., & Macinko, J., 2005. Contribution of primary care to health systems and health. The milbank quarterly, 83(3), pp. 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x PMid:16202000; PMCid:PMC2690145
Taiwo, O.O., & Panas, R., 2018. Roles of community pharmacists in improving oral health awareness in Plateau State, Northern Nigeria. International dental journal, 68(4), pp. 287–294. https://doi.org/10.1111/idj.12383 PMid:29446064
Verheire, F., De Visschere, L., Fernandez, C., Lambert, M. & Marks, L., 2018. Accessibility to oral healthcare for people on social assistance: a survey of social service providers from Public Welfare Centers in Flanders. International dental journal, 68(6), pp. 393–404. https://doi.org/10.1111/idj.12395 PMid:29744868
Ware, V.A., 2013. Improving the accessibility of health services in urban and regional settings for Indigenous people. Canberra: Australian Institute of Health and Welfare.
World health organization, 2012. Health consumer Index: report. Available at: https://healthpowerhouse.com/files/Report-EHCI-2012.pdf [20. 6. 2019].
Yuen, A., Martins Rocha, C., Kruger, E., & Tennant, M., 2018a. Does public transportation improve the accessibility of primary dental care in São Paulo, Brazil. Community dentistry and oral epidemiology, 46(3), pp. 265–269. https://doi.org/10.1111/cdoe.12360 PMid:29377218
Yuen, A., Rocha, C.M., Kruger, E., & Tennant, M., 2018b. The equity of access to primary dental care in São Paulo, Brazil: a geospatial analysis. International dental journal, 68(3), pp. 171–175. https://doi.org/10.1111/idj.12336 PMid:28913887
Zakon o Zdravniški službi (ZZdrS), 2006. Uradni list Republike Slovenije, št.72.
Zakon o zdravstvenem varstvu in zdravstvenem zavarovanju (ZZVZZ), 2006. Uradni list Republike Slovenije, št. 72.
Zakon o zdravstveni dejavnosti - 1 (ZZDej-1), 2005. Uradni list Republike Slovenije, št. 23.
Zavod za zdravstveno zavarovanje Slovenije (ZZZS), n. d. Available at: https://zavarovanec.zzzs.si/wps/portal/portali/azos/pravice_ozz_ioz/obseg_pravic/!ut/p/z1/04_Sj9CPykssy0xPLMnM [5. 5. 2019].
Zdravniška zbornica (Medical Chamber), 2018. V zobozdravstvu manjka do 500 programov otroškega in odraslega zobozdravstva. Available at: https://www.zdravniskazbornica.si/informacijepublikacije-in-analize/obvestila/2018/07/12/v-zobozdravstvumanjka-do-500-programov-otro%C5%A1kega-in-odraslegazobozdravstva [4. 10. 2019].
Zdravstvena skupnost Slovenije zavod SRS za zdravstveno varstvo, 1982. Enotni seznam zdravstvenih storitev in samoupravni sporazum o njegovi uporabi v svobodni menjavi dela. Ljubljana: Zavod SR Slovenije za zdravstveno varstvo.
Zver, E.H. & Srakar, A., 2018. Finančna dostopnost do zdravstva v Sloveniji in njen vpliv na neenakosti v zdravju. In: T. Lesnik, M. Gabrijelčič Blenkuš, A. Hočevar Grom, T. Kofol Bric & M. Zaletel., eds. Neenakosti v zdravju v Sloveniji v času ekonomske krize. Ljubljana: National Institute of Public Health,
pp. 127–136.
World Medical Association, 2013. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310(20), pp. 2191–2194. https://doi.org/10.1001/jama.2013.281053 PMid:24141714
Downloads
Published
How to Cite
Issue
Section
License
As the author undersigned hereby, I transfer, assign, or otherwise convey the following authorship rights as comprised in the Copyright and Related Rights Act (CRRA) to the Slovenian Nursing Review, Ob železnici 30A, 1000 Ljubljana: the right of reproduction - the exclusive right to fix the work in a material medium or in another copy directly or indirectly, temporarily or permanently, by any means and in any digital form, in whole or in part (CRRA, Article 23); the right of distribution (CRRA, Article 24); the right of making a work available and accessible through the internet (CRRA, Article 32a); the right of transformation, especially the exclusive right to translate a pre-existing work (CRRA, Article 33). The transfer of author rights applies to the article in its entirety, including pictorial and/or graphic works and possible supplements. The transfer of rights is exclusive and unlimited in duration or territory.