Social values, regulatory tensions and professional practices with underprivileged populations: the case of Quebec’s oral health care system

Aim: Dentists experience frustrations in their practices with people living on welfare and often perceive the latter in a negative light. The difficulties encountered are detrimental to the patient-professional relationship and contribute to compromising access to care for this underprivileged population. In order to fully understand patient-professional interactions, it is essential to consider the macroscopic contexts that partake in their structuring. This paper will therefore examine the systemic influences on these interpersonal relationships to deepen our understanding of an important access-tocare and health equity determinant. Methods: Two frameworks are applied to the analysis of Québec’s oral healthcare system: the social values framework (Donabedian A. In: Aspects of Medical Care Administration. Harvard University Press; 1973, p. 58) and the regulatory logics framework (Contandriopoulos AP. In: La Santé demain. Economica ; 1999. p.87). Results: Our assessment leads us to posit two phenomena: 1) certain negative stereotypes regarding patients living on welfare allow dentists to manage the inevitable regulatory conflicts (i.e. professional vs economic) involved in their practices and 2) patient behaviors are frequently judged on the basis of the social values embodied in Québec’s oral healthcare system’s organization, delivery and financing. Conclusion: Currently, Québec’s oral healthcare system fails to provide effective access to care for individuals who are particularly at risk for dental disease. Dentists should increase their sensitivity to systemic impacts on their rapport with people living on welfare and governments must significantly augment their involvement in the oral healthcare sector. New considerations for the field of dental professional education are also advanced. Prat Organ Soins. 2011;42(3):195-204