Dental dilemma: No 'magical financial solution' to fixing oral health care
Published Saturday, September 13, 2014 10:00AM EDT
While millions of Canadians cannot afford to go to the dentist for basic care, experts are not looking for “a magical financial solution” to making dental care accessible for everyone.
With its report, “Improving Access to Oral Health Care for Vulnerable People Living in Canada,” the Canadian Academy of Health Sciences has issued a number of recommendations for improving both access and the care itself.
The report is not a blanket request for more funding from federal, provincial and municipal governments.
“We’re not expecting there to be a magical financial solution,” says Dr. Paul Allison, chair of the expert panel that issued the report.
“On the other hand there are imaginative ways one can explore delivering care in different ways. The classic model of dentists in a private office is not working for these groups.”
The first order of business, then, will be to get dental- and health-care stakeholders together to develop an agreed-upon national standard for preventative and restorative oral health care, “irrespective of (patients’) physical or geographical ability to access services, or their capacity to pay,” the report says.
While different regions of the country will have different priorities based on their demographics, there would be a number of large- and small-scale projects to choose from based on need.
Some of the ways that access and overall oral health can be improved:
- Mobile dental units;
- Clinics at community health centres or long-term care homes;
- Or programs that provide preventative care for children under a certain age.
After those standards are established, a process that could take about a year, stakeholders have to identify the systems and the personnel needed to deliver that care.
While dental care is not included in the Canada Health Act and so does not fall under the national system of health insurance, it could be added either wholly or in part. A select number of basic services, such as regular cleanings, could be offered to all Canadians, with extra services available to Canadians deemed to be at greater need, the report says.
The exact cost of publicly financing basic dental care for all Canadians has yet to be determined, Allison said. However, the report notes that because workplace dental benefits are not treated as employee income, they are not taxed as such. This leaves “a significant level of foregone revue that could, at least in theory, be used to finance care for underserviced groups,” the report notes.
Estimates suggest that the federal government loses about $1.6 billion due to employee and employer tax breaks, and “the total loss in revenue may be much higher once foregone revenues from provincial and payroll taxes are considered,” the report says.
Indeed, the Commission on the Future of Health Care in Canada estimated that the loss in revenue from all benefits, including dental insurance, for all levels of government is about $4 billion.
The report also suggests that dentists themselves have a role to play in improving access to care. Dental schools should “promote and deliver continuing education that equips practicing professionals with the knowledge and skills to understand and treat the oral health care needs of vulnerable groups.”
In the end, Allison said, a lack of oral health care “goes against what we would say are the values of the Canadian health care system. And I think we should acknowledge that and try to do something about that.”
Because more than 90 per cent of dental services are provided through the private sector, there is no agreed-upon, national standard for oral health care in Canada. Services that are publicly funded are provided by various levels of government and the types of services offered vary greatly by jurisdiction.