ACCIONES DE TUTELA COMO REFLEXIONES PARA LA LEGISLACIÓN AMBIENTAL

Table 3.1 dem onstrates different levels of tre atm e n t need, factors to consider and expected services to be provided.

C h a p te r 3 - The theoretical fram ew ork 105 N orm ative treatm en t need

P lan n in g of h ea lth services based on norm ative tre atm e n t need assum es th a t oral disease, as judged by the professional, needs some kind of tre atm e n t. This level of need gives fuU tre a tm e n t to every individual who is in need. The full tre a tm e n t could be an over-estim ate. Normative tre a tm e n t need is appropriate for hfe-threatening oral conditions such as oral cancer, precancerous lesions, chronic progressive conditions such as dental caries, and conditions needing em ergency tre a tm e n t such as severe infection. Therefore, for dental tre a tm e n t need for the above conditions, such as restorative treatm en t, extraction, endodontic treatm en t, tre atm e n t for oral cancer or infection, norm ative tre a tm e n t need is dominant.

G eneral h ealth related treatm ent need

This level of tre a tm e n t need includes the general h ealth factors of older people. D ental care will be provided to older people who have a norm ative need and who have general h ealth problems affecting the prognosis of dental disease or th e m aintenance of acceptable oral h ealth after treatm en t. D ental care will also be provided to those who are in greatest need due to th e ir general h e a lth problem s and to those where dental disease w ül affect the condition of a chronic disease or th e ir general h ealth status. Therefore, the tre a tm e n t need is more selective. It will be based on general h ealth statu s and th e norm ative need.

C h a p te r 3 - The theoretical fram ew ork 106 Im p act-related treatm en t need

Perceived oral im pacts on daily perform ance are included in th is level of tre a tm e n t need. The tre a tm e n t need which affects activities in daily hving will be more reahstic. Therefore, the tre atm e n t need is more selective an d will be b ased on the level of oral impacts.

P rop en sity related treatm en t need

Propensity related tre a tm e n t need takes into account the propensity for certain h e a lth behaviours of people. In addition to impact-related treatm ent need\ p ast an d p resen t den tal behaviours which relate to the effectiveness of dental tre a tm e n t, could provide a more realistic tre a tm e n t need. This level of tre a tm e n t need is the most significant to the h ealth p lan n er in order to be able to allocate h e alth care resources which are effective both curatively and for long term health.

A ccessib le treatm en t need

This level of need considers all barriers to tre a tm e n t of th e people. The economic factor is included in this level of tre atm e n t need. Those who can pay for th e use of d ental services will have a b etter chance in term s of ‘access’ to d en tal services.

N on -accessible treatm ent need

Non-accessible tre a tm e n t need considers people w ith high b arriers due to socio- environm ental factors such as th eir economic disadvantage which will affect the use of dental services. This economically disadvantaged group will need an

C h a p te r 3 - The theoretical fram ew ork 107

im provem ent of th e service system or change in economic or other environm ental barriers.

T a b le 3.1 D ifferen t lev els o f t r e a t m e n t n e e d , f a c to r s to c o n s id e r a n d e x p e c t e d s e r v ic e t o b e p r o v id e d

T reatm ent n e e d level Factors to c o n sid er E xpected service to b e provided

N orm ative tre a tm e n t n e e d P ro fessio n al j u d g e m e n t Full t r e a t m e n t G e n e ral tiealtti re la te d tre a tm e n t n e e d P ro fessio n al j u d g e m e n t G e n e r a l h e a lth s ta tu s Full t r e a t m e n t for c a r ie s , in fe c tio n a n d p ro g re s s iv e p a t h o l o g y plus s e le c tiv e t r e a t m e n t b a s e d o n g e n e r a l h e a l t h s ta tu s a n d n o r m a tiv e n e e d Im p a c t-re la te d tre a tm e n t n e e d P ro fessio n al j u d g e m e n t G e n e r a l h e a lth s ta tu s P e r c e iv e d i m p a c t s (OIDP) S e le c tiv e t r e a t m e n t a s for g e n e r a l h e a l t h r e l a t e d n e e d a n d b a s e d o n le v e l o f i m p a c t s Propensity re la te d tre a tm e n t n e e d P ro fessio n al j u d g e m e n t G e n e r a l h e a lth s ta tu s P e r c e iv e d im p a c t s (OIDP) B e h a v io u ra l p r o p e n s ity S e le c tiv e t r e a t m e n t a s for i m p a c t - r e l a t e d t r e a t m e n t n e e d a n d b a s e d o n le v e l o f p r o p e n s ity F lealth p r o m o tio n (for t h o s e w ith lo w p ro p e n s ity ) A ccessible tre a tm e n t n e e d P ro fessio n al j u d g e m e n t G e n e r a l h e a lth s ta tu s P e r c e iv e d i m p a c t s (OIDP) B e h a v io u ra l p r o p e n s ity F in a n c ia l p r o b le m s S e le c tiv e t r e a t m e n t a s fo r p r o p e n s ity r e l a t e d t r e a t m e n t n e e d a n d b a s e d o n e c o n o m i c s ta tu s

H e a lth p r o m o tio n (for t h o s e w ith lo w p ro p e n s ity ) N o n -accessib le tre a tm e n t n e e d P ro fessio n al j u d g e m e n t G e n e r a l h e a lth s ta tu s P e r c e iv e d i m p a c t s (OIDP) B e h a v io u ra l p r o p e n s ity F in a n c ia l p r o b le m s S e le c tiv e t r e a t m e n t a s for p r o p e n s ity - r e la te d t r e a t m e n t n e e d a n d b a s e d o n e c o n o m i c s ta tu s

H e a lth p r o m o tio n (for t h o s e w ith lo w p ro p e n s ity )

E n v iro n m e n ta l a n d s y s te m c h a n g e i.e f in a n c ia l s u p p o r t, a c c e s s im p r o v e d

C h a p te r 3 - The theoretical fram ew ork 108