Building a sustainable and effective federally funded program
While there is a need to fill the gaps in access to dental care that many Canadians face, especially children, seniors, and persons with disabilities, etc., it is also important that the foundational building blocks of Canada’s dental care delivery system remain in place. These building blocks include the network of private dental offices across the country, a robust system of employer-provided dental benefits, and a common set of tools (such as CDAnet/ITRANS digital electronic claims, fee guides, etc.) used by both the dental care and health benefits sectors.
In implementing a long-term approach to providing access to oral health care for all Canadians, there is an opportunity to leverage the existing network of 16,000 private dental offices across Canada, most of which are small businesses and employers providing jobs, focused on serving the needs of their communities. Federally funded initiatives should promote the delivery of care primarily through the existing network of dental offices, supplemented as needed by public clinics. It is also crucial that any program use the skills and expertise of dentists and all other oral health professionals, including dental hygienists, dental assistants, denturists, dental therapists and dental technologists. However, the advantages of providing care by dentist-led teams, with collaboration from other providers, should be clearly recognized and prioritized.
There may be occasions where, based on the unique needs of certain demographics or regions, alternative approaches may be needed in addition to dental care delivered via private clinics. In provinces like Prince Edward Island and in northern Canada, for example, school-based programs play an important role in supporting children’s oral health. Other public health programs can also play a role in raising public awareness of the importance of oral health or providing patient education. There may even be the need for some publicly funded, community-led initiatives to make dental care accessible in rural, remote, and northern communities where private delivery of dental care is not economically viable. In partnership with other levels of government, the federal government should work toward innovative approaches to supplement private delivery of care in specific circumstances where alternatives are needed.
Nearly 18% of Canadians live in rural and remote communities12, where access to dental care presents a challenge. Additionally, 6.2 million Canadians live with special health needs13, and there are a limited number of oral health providers with the required training to comfortably provide comprehensive care for these patients and limited facilities for provision of care under sedation.
Simply increasing the funding for dental care is insufficient to attain good oral health for these Canadians. The federal government needs to support initiatives that aim to address disparities in geographic distribution of oral health providers, specifically dentists, as well as skillsets required to meet the needs of populations with special health needs.
Any new federally funded initiatives should not create additional administrative burdens for dental offices. Program design should ensure that administrative procedures do not impact or delay the provision of care to patients. The focus for dentists and dental office staff should continue to be providing safe, quality treatment—with the need to spend time on paperwork and communications with dental benefits providers or government programs kept to a minimum. This is particularly important given the staffing shortages facing dental offices and the broader health care sector.
One way to streamline program administration would be to make use of several tools developed collaboratively by CDA and others and then widely adopted across Canada. These tools include:
The federal government should ensure any federally funded dental care does not disrupt access for the many Canadians who already have access to employer-provided benefits. Public dental care programs should remain a payer of last resort, after any privately funded coverage. This can be done by either restricting eligibility for federally funded dental care programs to only those without employer-provided dental benefits, or by requiring that all privately funded dental benefits be exhausted before public dental coverage kicks in.
The federal government should also, in collaboration with other levels of government and industry stakeholders, explore ways to put in place a system that preserves and promotes further employer-provided dental coverage. This is essential to the long-term success of any federally funded dental care program. A situation where employers start offloading the responsibility of dental coverage to the public sector must be avoided because a shift of any significant amount of private sector investment in dental care would quickly overwhelm government budgetary envelopes. Though there are already some incentives built into both the corporate and income tax systems for employers to provide health and dental benefits, the federal government should explore other options that would retain or increase private sector investment in the provision of dental benefits. Beyond legislative solutions—which may prove tricky given more than 90% of the private sector workforce in Canada falls under provincial and territorial jurisdiction —the government could look beyond our borders for inspiration. For example, the United States and Germany are two examples of advanced economies with federal systems of government that could provide models to follow (see Appendix A - Background). Resolving the potential challenge of employers offloading the responsibility of dental coverage to the public sector needs to be a top priority for the federal government.