Mark Corson

By E. Eusebio. The Mayo Foundation.

These data do not While "no dental problem" "no teeth discount tricor 160mg otc," and "cost" account for other services children receive outside of account for the vast majority of the reasons for not vis- Medicaid - such as free care donated by the dentist purchase 160 mg tricor otc. The iting a dentist safe 160mg tricor, the category of "access problem" was amount of dental care that dentists provide free of rarely cited. Their usage for its children substantially above the rate for conditions make it additionally difficult to access higher income pre-school children. Although the economically disadvantaged also identify a number of other barriers as important, may face similar barriers to care as the general pop- though clearly of secondary importance compared to ulation, these barriers force much starker tradeoffs inadequate reimbursement. Dentists do not participate in Medicaid, pri- For economically disadvantaged people, the cost of care marily, because of low program reimbursement rates. Long-term solutions to improving their access the opportunity cost of serving a Medicaid client is far to care are the same that will improve their economic sta- higher than the Medicaid reimbursement rate (Barnett tus––such as better education, better job skills, safer neigh- and Brown, 2000). More is needed in the way of public support for The data suggest that for low-income persons, the dental care for disadvantaged adults. To date, Medicaid major barriers to care appear to be perception of and Head Start have provided limited care for disadvan- need and cost. The Healthy Kids Dental Program is administered by private dental benefits Some observers have identified individual factors companies with rules, regulations and reimbursement that create barriers to care. While these factors may influence pared to the same 4 months in the previous year utilization and expenditures, evidence of their quan- (Michigan Department of Community Health, 2000). People who live in areas where there are few, if any, Other states looking to secure marketplace access dentists nearby must overcome circumstances to receive for patients enrolled in their programs should look regular dental care, but there are no comprehensive carefully at this example. The skills persons who have coverage for dental services, the and experience required to treat some of these indi- major one is finding dentists to treat them. The costs involved also may be live in areas where dental providers are generally in beyond the means of the affected families. Dentistry has years, these individuals do not utilize dental services clearly benefited from the robust economy over the to the extent of the general population. Greater wealth has resulted in Americans with special problems, such as individu- large increases in dental services utilization and total als with disabilities, those with congenital conditions, national expenditures. Dentists are more likely to refuse funding, the efforts by the dental profession and assignment of benefits and, therefore, more of the others to provide the poor adequate access to dental burden of dealing with the insurance company will care will continue to fall short. Annual max- tors which are likely to influence demand are: 1) imums, which have not changed appreciably in the more affluent, educated and growing population, 2) last 15 to 20 years, should increase with a moderate new diagnostic and treatment technologies, and 3) increase in premiums of 5% or less. If medical costs some underserved populations will gain financial continue to increase as they have during the past access to care and use services (e. In the more pronounced as younger cohorts with less longer run, events and trends in the financing and caries experience replace the so-called baby boom organization of medical care may have substantial generation. The unpredictabil- new technologies must be factored into the situation ity of medical costs and the response by employers before any final conclusions can be reached. This The proportion of dental expenditures funded is because the next generation of elderly (the current directly by patients, private prepayment and public 55-65 year-olds) is large in number and these programs will remain essentially the same for the individuals are already high users of dental care. Major increases in public funding of They will, therefore, be the most affluent elderly dental care for the poor or medically disabled are generation thus far and their current dentitions will not expected, with the exception of modest increas- require high levels of maintenance. In the longer Also, there will be some increase in direct reim- term, as the generation following the baby boomers bursement and there will be more interest in begins to retire, demand among the elderly may Medical Saving Accounts as a market-based system decline because these future generations will be to control medical care costs. There is no reason to Physical and mental disability, whether associat- expect that within the next 5 to 10 years large ed with advanced age, illness, congenital condition, numbers of dentists will establish practices in rural or injury, is a significant barrier to access. Government tion to low-income and other health problems that programs to encourage dentists to locate in under- are associated with disabilities, the fact is that most served areas are valuable in specific locations when dental practices are organized with fully ambulato- they succeed, but so far, the number of dentists ry patients as the primary, if not exclusive, focus. Disability and special needs will continue to be a This is unlikely to improve in the next decade and significant barrier to access. Therefore, in the long term, fees Americans, regardless of their financial, geographic, should be indexed accordingly. More than three addition, priority should be given to covering chil- out of four people from non-poor families report at dren first. Private carriers, who would be responsi- least one dental visit in the previous year. For these ble for managing programs for the disadvantaged, people access is excellent and will continue to be in should use the same procedures and systems as the future. There is to care and oral health has improved significantly in strong indication that this will increase utilization the last 30 years. Therefore, a two- ployed, others are employed but make relatively lit- pronged strategy to encourage financing of private tle money. Low-income chase of either a traditional prepayment plan or a employed people are often referred to as "the work- dental savings account. In 1996, 53 million people, 20% of tration of the program would be contracted to the pri- the population, were "working poor. This will empower the disadvantaged to For the long-term unemployed, expansion of pub- make choices regarding dental care in a manner simi- lic financing that compensates dental care providers lar to the rest of the population. However, indi- of these patients are either homebound or institution- vidual employee contributions could be withheld from alized. Furthermore, the health providers who care wages much like Social Security and Medicare. For these reasons, adequate financing administrative costs of employer-based programs in the for this group of people will require reimbursement at small business market can be used to purchase dental rates substantially above market rates. This would also reduce the cost of the plan, Properly caring for populations with disabilities making it more affordable to low-wage workers.

The sufferer has pain she were capable of making and communicating and tenderness in the sinus area discount 160mg tricor fast delivery, discharge from the decisions purchase 160 mg tricor with mastercard. Treatment involves treating the underlying condition generic tricor 160 mg amex, which is health outcomes research Research that meas- often an allergy, and using nasal vasoconstrictors ures the value of a particular course of therapy. Hearing aids contain a microphone, in the back of the neck, on the scalp, and sometimes amplifier, and speaker. The term tension-type headache is now preferred, reflecting the fact that research has shown heart The muscle that pumps blood received from that these headaches may not be related to muscle veins into arteries throughout the body. Although the cause is unknown, they are positioned in the chest behind the sternum (breast- believed to be related to the levels of neurotransmit- bone); in front of the trachea, esophagus, and aorta; ters in the brain and are possibly complicated by and above the diaphragm. Stress, lifestyle changes, and the size of a closed fist and weighs about 298 grams changes in sleep patterns are among many possible or 10. Two-thirds of the heart lies in the left side of the chest, with the balance headache, thunderclap A sudden and excruci- in the right side of the chest. Some physicians feel that of specialized cardiac muscle, and it is four-cham- in the absence of a known headache disorder, such bered, with a right atrium and ventricle, and an as migraines, a thunderclap headache may some- anatomically separate left atrium and ventricle. A blood flows from the systemic veins into the right person who experiences this type of headache atrium, thence to the right ventricle, from which it is should immediately seek medical attention. The heart is thus headaches felt to involve abnormal sensitivity of the functionally composed of two hearts: the right heart blood vessels (arteries) in the brain to various trig- and the left heart. The right heart consists of the right gers, resulting in rapid changes in the artery size atrium, which receives deoxygenated blood from the due to spasm (constriction). Other arteries in the body, and the right ventricle, which pumps the deoxy- brain and scalp then open (dilate), and throbbing genated blood to the lungs under low pressure; and pain is perceived in the head. Migraine headache is the left heart, which consists of the left atrium, which the most common type of vascular headache. Not infrequently, this leads to the death of a physician while he or she listens to the chest with part of the heart muscle due to its loss of blood sup- a stethoscope. Typically, the loss of blood supply is caused by a never treated, sometime the condition it represents complete blockage of a coronary artery by a blood may require treatment. The interruption of blood flow is usually caused by arteriosclerosis, with narrowing of the heart rate The number of heartbeats per unit of coronary arteries, the culminating event being a time, usually per minute. Death of the heart muscle often the number of contractions of the ventricles (the causes chest pain and electrical instability of the lower chambers of the heart). Electrical instability of the heart too fast (tachycardia) or too slow (bradycardia). The pulse is often taken at the brain damage and death can result from heart wrist to estimate the heart rate. That portion of the septum resuscitation) within 5 minutes of the onset of ven- that separates the right and left atria of the heart is tricular fibrillation. When paramedics arrive, med- termed the atrial, or interatrial, septum, whereas the ications and/or electrical shock (cardioversion) to portion of the septum that lies between the right and the heart can be administered to convert ventricular left ventricles of the heart is called the ventricular, or fibrillation to a normal heart rhythm. All four is not uncommon and is detected with an electro- heart valves are one-way valves, permitting forward cardiogram. Blood enter- or scarring of the electrical pathways in the heart ing the heart first passes through the tricuspid valve, muscle, either naturally or as a result of disease. After returning from Heart block typically requires no treatment, but can the lungs, the blood passes through the mitral be a factor in the decision of whether or not to put (bicuspid) valve and leaves the heart via the aortic a pacemaker in a heart that is failing or irregularly valve to pass through the aorta. A heart murmur is created by and warmth that occurs in waves, rising up behind blood flow through a heart valve, by blood flow the breastbone (sternum) and moving toward the through a narrowed chamber, or by an unusual neck. It connection between the chambers, as seen with is usually due to gastroesophageal reflux, the return congenital heart disease. See also gas- mur does not represent any disease or condition troesophageal reflux disease. There are many forms of heart murmurs heart-lung machine A machine that does the representing a variety of heart conditions. Each type work both of the heart and of the lungs: pumping of murmur is characterized by its location, timing, and oxygenating blood. Blood returning to the heart duration, as well as the intensity and quality of the is diverted through a heart-lung machine before being returned to arterial circulation. See also heat rash A red or pink rash usually found on airway obstruction; tracheostomy. Heat rash is most common in babies, but may affect adults in hot, Helicobacter heilmannii A bacterium that humid climates. Most cases of heat rash heal by infects most cats, dogs, and pigs and causes them themselves, and treatment is directed toward the stomach inflammation (gastritis). This bacterium is the most Heberden’s node A small fixed bony enlarge- common cause of ulcers worldwide. A tion may be acquired from contaminated food and Heberden’s node is a calcified spur of the bone of water or through person-to-person contact. It is that joint (distal interphalangeal joint) and is asso- common in people who live in crowded conditions ciated with osteoarthritis. Infected persons which short, tight muscles make it impossible to usually carry H. Also known as trismus pseudo- down of red blood cells (hemolysis; the H in the camptodactyly syndrome.