7 Principles to Guide a National Dental Program in Canada

Prime Minister Justin Trudeau recently announced his intention to establish a national dental program for low-income Canadians. The program is arguably one of the most important health care initiatives since Canadian Medicare and stems from the Liberal-NDP party.supply and trust” deal.

The program will cover approximately 6.5 million Canadians, paying dental costs for families earning less than $90,000 per year, with no co-payment for those earning less than $70,000. Coverage will start with children under 12 in 2022, then expand to under 18, older people and people with disabilities in 2023, with full implementation by 2025.

Billion Dollar Questions

The committed federal budget $5.3 billion for the new program, which resulted in several “billion dollar” questions, including:

  • How will the money flow? Will it be a direct federal program administered by a public agency as promoted by the NDP? Where will the money go traditional federal/provincial/territorial (FPT) for health care?

  • How will the national program align with other existing programs at the FPT level, not to mention dental insurance plans offered by employers and individuals?

  • How will the services be provided? In public clinics, including community health centers and hospitals, and/or in private clinics where most dental care is provided today? And what services will be covered?

There are a myriad of details here, but at a minimum there appears to be a growing political, public and political consensus that access to dental care should be consistent, reliable and equitable for all Canadians in all jurisdictions. . Therefore, as with health care, federal policy leadership is essential.

Read more:
Closing the Gaps: Why Canada Still Needs Public Dental Health Despite Decades of Medicare

This means that the federal government could establish a set of principles to guide either its own direct program or provinces and territories in eligibility for funding.

Principles and possibilities

A woman in a blue suit stands in front of a lectern with people sitting behind her
Finance Minister Chrystia Freeland tables the federal budget in the House of Commons on April 7, 2022. The budget committed $5.3 billion over five years for a national dental plan.

As specialists in dental public health, we offer a set of principles around which we hope FPT governments, the oral health professions, patient advocates and the public can rally. The principles apply to both direct programs and/or traditional FPT agreements. Either way, we’re just getting started, but the timeline is tight, so we believe these principles can be used to facilitate effective policy and program development.

Most importantly, we offer these principles to move forward healthily: serving Canadians who, for far too long, have not been able to meet their oral health needs due to lack of access to care.

The principles are:

  1. Basket of basic services. The federal government can establish a schedule of dental services that is scientifically and ethically defensible. Defining this basket can help answer a pressing question in Canadian health care policy: What is medically necessary or essential dental care? There should be a basket of basic services that all Canadians should have access to. Such a basket would arguably relieve pain and infection (eg, extractions), prevent disease (eg, topical fluorides), and restore physical and social function (eg, dentures). Within the context of current FPT health care arrangements, provincial and territorial programs would need to provide this defined basket to be eligible for funding.

  2. Fair compensation. Public dental programs in FPT jurisdictions can vary widely their rates of pay for services provided in the private sector. In some jurisdictions, repayment rate are so low that they discourage practitioners from providing care, limiting access for those who need it most. A negotiated fee schedule should recognize this fact, as well as understand the changing realities imposed by COVID-19[feminine]which have made the provision of dental care much more expensive.

  3. Public and private administration. The new program can be administered publicly and privately. Governments do not have to deal with claims processing. Many FPT dental programs are already benefiting from the effectiveness of not-for-profit and for-profit claims processors specializing in the payment of dental bills. Yet to maintain accountability, public oversight of appropriate spending is important to make the most of limited public resources.

  4. Public and private delivery. In all FPT jurisdictions, publicly funded programs are provided in private, public or mixed places. Private sector delivery currently eclipses public sector delivery, yet both sectors are important. Leveraging the strength of both could help address specific needs, especially in a program that aims to target the unique and complex needs of medically compromised seniors and people with disabilities.

  5. Portability. One of the strengths of our medicare system is that no one falls through the cracks when moving from one province or territory to another. The jurisdiction of origin holds the cover until coverage in the destination jurisdiction begins. This approach should apply to the new program.

  6. Accessibility. Another positive aspect of Medicare is that it facilitates accessibility by charging no upfront cost to the patient. The new program would take advantage of the same principle for those with incomes below $70,000. For those earning between $70,000 and $90,000, co-payments will apply, but should be geared to income. There could also be a subset of services (those deemed most important) whose costs would be borne entirely by the government, and then another set of services where co-payments would apply, again in proportion to income .

  7. Data, evaluation and reports. Canada does not have a well-developed network data infrastructure collect, share and analyze oral health information. Consequently, public investments in dental care in Canada have not been properly evaluated. This will be essential for the new program given its importance and therefore investments in population health surveillance and/or assessment are needed. Evaluation and, more importantly, communicating the results of evaluation should be part of the accountability measures.

The funds are on the table and we are still in the early days of resolving what is called a “nasty problem.” In other words, dental care is arguably one of the most difficult, complex and underestimated issues in health care. It is good news that there is now a real chance to clarify and act on this important part of Canada’s health care system.

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