Letters have started to arrive in the mailboxes of Canadian seniors inviting them to sign up for dental care, but those who provide the services say they’re concerned whether the program will be administratively and financially viable for them to take part.
“If our questions aren’t answered and our concerns aren’t addressed, I don’t know if dentists are going to want to sign up for this program,” said Dr. Brock Nicolucci, president of the Ontario Dental Association.
By 2025, Canada’s national plan will provide dental care to all low- and middle-income Canadians, a program dentists and public health-care experts have advocated decades for. Weeks ago, the federal government announced that seniors would be the next to qualify for the program, starting in May.
To be eligible for the program, a person must have a household income below $90,000 and no access to an existing private insurance plan. Families with households incomes below $70,000 will face no co-payments. Families with incomes between $70,000 and $79,999 will face a 40 per cent co-pay, and for those in the $80,000 to $89,999 income bracket, the co-pay jumps to 60 per cent.
But Ottawa has given few details on what the program will look like for dental care providers. It’s still unclear how dentist will sign up, how the billing process will work, and whether what Ottawa pays for scaling, filings, extractions and other services will match what current private insurance plans pay.
Nicolucci points to existing public dental care plans run by provinces for low-income children and seniors. Some in Ontario pay as little as 18 per cent of the suggested fee, making it financially hard for dentists to take part, he said.
“That’s a great concern.”
Canada’s health minister has said the $13-billion federal dental program will compensate dentists “fairly.” Ottawa has signed a $747-million contract with insurance giant Sun Life to help administer the plan.
Minister Mark Holland said Canada’s dental care plan will follow a model similar to the non-insured health benefits for First Nations and Inuit, a current federal program that pays for some health services, including dental, that other provincial and private plans don’t cover.
But Nicolucci said even existing public dental care programs that compensate dentists often require so much paperwork that it’s not something dental clinics can easily handle, especially as they struggle with a shortage of support and administrative staff.
That’s a concern for Canada’s dental hygienists, too.
“We want to make sure that there’s a reduced administrative burden, that there’s not a heavy reliance on predetermination or pre-authorization,” said Ondina Love, CEO of the Canadian Dental Hygienists Association.
Love said hygienists have been told they can sign up for the program in February. Dental care providers meet weekly with federal officials to hash out the plan specifics, she said.
“The devil is really in the details. That’s what the government is working on right now, is finalizing the fee structure and what services are provided,” she said.
‘Health-care providers first’
“The introduction of any plan of this nature will invariably run into some challenges,” said Dr. Carlos Quiñonez, a dental public health specialist at Western University in London, Ont.
“Dentists speak significantly about the administrative burden with public dental care programs and I understand that,” Quiñonez said. “But the fact remains that checks and balances are needed to be able to make good use of public dollars, the most effective use of those scarce public resources.”
Quiñonez said despite administrative and financial burdens of taking on these patients, he thinks most dental care providers will still want to take part in the program, which Ottawa estimates will eventually pay for the dental care of 9 million Canadians.
“We must also remember that dentists, like dental hygienists, like denturists, are health-care providers first and then business people second. So in order to meet their responsibilities … I would hope that they would find ways to be able to make it worth their while.”
Reducing barriers for vulnerable people
Ottawa has also promised $250 million, starting in 2025, to establish an oral access fund that would be used specifically to reduce barriers for vulnerable people accessing dental care.
Dental hygienists like Rosemary Vaillant, who runs a mobile dental clinic that travels to roughly 40 long-term care homes Ottawa, said she hopes Ottawa also pays for services that will provide preventative care for seniors, especially as older people can struggle to keep up with regular oral health care like teeth brushing.
“It ends up causing bleeding gums, puffy gums, sore gums. And then the seniors don’t want to eat because their mouth is uncomfortable and that leads to infection and pain.”
Right now, Vaillant does what she can for her patients who currently pay out of pocket, sometimes splitting up an appointment so they can afford to get their teeth taken care of.
“We’ll do half the mouth, and then they’ll leave and we’ll reschedule them down the road and then do the other half,” she said. “I feel bad that they can’t afford it.”
John Kelso, 87, one of Vaillant’s patients, said he’s grateful to see seniors and other vulnerable Canadians receive free dental care.
“Your teeth are very important,” Kelso said. “I’m quite happy to see the whole thing. I wish it had been a few years ago.”