The Medical Necessity of Orthodontic Care: A Qualitative Study
Notice bibliographique
Résumé
INTRODUCTION: As global momentum builds for universal health coverage (UHC), it is unclear whether orthodontic care should be included in UHC packages. The concept of medically necessary orthodontic care (MNOC) and its criteria thus have far-reaching implications for priority setting and resource allocation in public and private oral health care programs. OBJECTIVE: To identify factors that contribute to the determination of MNOC based on perspectives from leaders of dental professional organizations, academics, clinicians, funders, patient advocates, and patients from 7 countries: Canada, United States, Germany, Greece, United Kingdom, Switzerland, and Australia. METHODS: A qualitative description design was used with semi-structured virtual interviews conducted via Zoom from November 2021 to August 2022. Interviews were transcribed verbatim, coded, and analyzed for themes. RESULTS: Sixteen interviews were conducted. Participants described their concept of MNOC through 4 interrelated categories: (1) dental factors including dental health, the goals of treatment, and methods of needs assessment; (2) medical factors including the meaning of medical necessity, systemic health considerations, and treatment of craniofacial anomalies; (3) psychosocial factors including societal standards of beauty, social functioning, and mental health; and (4) funding factors including resource allocation considerations and the goals of funding. CONCLUSION: The diversity of factors identified highlights the complex interplay between the dental profession, funders of care, society, and individual patients in understanding MNOC. Given this complexity, MNOC is arguably not amenable to a concise definition or list of criteria. Instead, a decision-making process that incorporates key actor perspectives can enhance transparency, fairness, and accountability in priority setting and resource allocation as related to MNOC and medically necessary oral health care more broadly. This approach would ensure coverage for those with demonstrated need in the context of health, well-being, and quality of life.Knowledge Transfer Statement:This study provides critical insights into the dental, medical, psychosocial, and funding factors that influence the meaning of medically necessary orthodontic care (MNOC) from the perspectives of key actors in 7 high-income countries. The findings reveal that MNOC cannot be defined by a simple set of criteria. Instead, determinations of MNOC should be made through a decision-making process that incorporates a wide array of viewpoints. This approach ensures transparent and fair resource allocation, improving access to essential orthodontic services, thereby enhancing patient health and well-being.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,015 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».