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UBC Theses and Dissertations

Administrative barriers to care of government-funded orthodontic coverage for Indigenous youth in Canada Cross, Tyra J


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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