Administrative barriers to care of government-funded orthodontic coverage for Indigenous youth in Canada
Bibliographic record
Abstract
Objectives: The European colonization of Canada has resulted in generations of oppression and transgenerational trauma for Indigenous people. The long-term consequences of colonization include well-documented worse health outcomes, including poorer oral health and increased severity and occurrence of malocclusion for Indigenous people. The Canadian government has treaty obligations to provide medical coverage to Indigenous people. Through the Canadian government’s Non-Insured Health Benefits program (or the First Nations Health Authority in British Columbia), tier-three medical benefits are covered, including dental treatments and orthodontics. However, the criteria for being approved for orthodontic coverage under this program are extremely stringent and require a complicated pre- determination process. The purpose is to evaluate the extent to which the predetermination process is a barrier to Indigenous youth in Canada obtaining government funding for orthodontic treatment. Methods: Interviews were conducted to explore the perspectives of office managers of orthodontic offices, orthodontists, administrators of orthodontic-related associations including the CAO and the FNHA. International orthodontists were also interviewed to compare government-funding orthodontics around the world to Canada's model. The interviews used a topic-guided, standardized, open-ended interview format. The transcribed interviews were analyzed for general themes. Results: Eight themes emerged from 13 interviews: 1. Excessive use of staff, 2. Administrative barriers, 3. Issues with Jordan’s Principle, 4. Family expectations, 5. Qualifying issues, 6. Problems with phase 1, 7. Transparency and accountability, and 8. Focus on expense. Conclusions: This study suggests that there are significant administrative barriers associated with the orthodontic predetermination process encountered by Indigenous Canadian youth seeking funding for care through the Non-Insured Health Benefits Program, or the First Nations Health Authority in British Columbia. Some recommendations for reducing these barriers are enumerated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.023 | 0.005 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".