False hope: Effects of social class and health policy on oral health inequalities for migrant farmworker families
False hope: Effects of social class and health policy on oral health inequalities for migrant farmworker families
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DOI：
10.1016/j.socscimed.2010.09.024
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发表时间：
2010-12-01
影响因子：
5.4
通讯作者：
Tyson, Dinorah Martinez
中科院分区：
文献类型：
--
作者：
Castaneda, Heide;Carrion, Iraida V.;Tyson, Dinorah Martinez
很少有研究从人种学的角度探讨与牙科保健政策相关的社会阶层和获取问题。美国佛罗里达州是全国为低收入儿童提供牙科护理记录最差的州之一，尤其是为参加医疗补助的儿童提供的牙科护理记录较差。在本文中，我们讨论了农民工家庭中儿童未得到满足的牙齿健康需求。尽管是最边缘化的人群之一，但大多数人都有资格享受医疗补助，因此可以享受牙科服务。然而，严重的差异与缺乏公共保险体系有关。这项研究是通过 2009 年在牙科诊所和移民启蒙中心进行的参与者观察以及对牙科保健提供者 (n = 19) 和农民工父母 (n = 48) 的访谈得出的。我们的结果表明，与不良口腔健康结果相关的一些典型因素，例如牙齿健康素养较低，可能不适用于这一人群。相反，我们认为结构特征和无效政策导致了口腔保健差异。牙科医疗补助计划长期资金不足，导致报销率低、提供者参与度低以及贫困社区内牙医分配严重短缺。我们将佛罗里达州家庭的情况描述为“虚假的希望”之一，因为承诺提供的服务既没有足够的资源，也没有紧迫性。由此产生的慈善医疗体系导致牙医提供无偿医疗而不是接受医疗补助，这只会进一步加剧持续的不平等。我们提供了几项建议，包括针对移民的具体努力，例如密封剂和新妈妈计划；通过消除牙医治疗低收入儿童的障碍来改进现行系统；和创新模式，提供全面的护理并增加提供者的数量。 (C) 2010 Elsevier Ltd. 保留所有权利。
Few studies have engaged issues of social class and access related to dental health care policy from an ethnographic perspective. The state of Florida in the US has one of the poorest records in the nation for providing dental care for low-income children, falling especially short for Medicaid-enrolled children. In this paper, we discuss unmet dental health needs of children in migrant farmworker families. Although one of the most marginalized populations, most are eligible for Medicaid and are thus covered for dental services. However, serious disparities have been linked to the lack of access through the public insurance system. This study was informed by participant observation at dental clinics and a Migrant Head Start Center and interviews with dental health providers (n = 19) and migrant farmworker parents (n = 48) during 2009. Our results indicate that some typical factors associated with poor oral health outcomes, such as low dental health literacy, may not apply disproportionately to this population. Instead, we argue that structural features and ineffective policies contribute to oral health care disparities. Dental Medicaid programs are chronically underfunded, resulting in low reimbursement rates, low provider participation, and a severe distribution shortage of dentists within poor communities. We characterize the situation for families in Florida as one of "false hope" because of the promise of services with neither adequate resources nor the urgency to provide them. The resulting system of charity care, which leads dentists to provide pro bono care instead of accepting Medicaid, serves to only further persistent inequalities. We provide several recommendations, including migrant-specific efforts such as programs for sealants and new mothers; improvements to the current system by removing obstacles for dentists to treat low-income children; and innovative models to provide comprehensive care and increase the number of providers. (C) 2010 Elsevier Ltd. All rights reserved.