A proposed new federal dental program has the potential to boost oral health for low-income Canadians, who often don’t see a dentist because of the costs, and result in significant savings for eligible families who pay out of pocket for dental services.
The recently announced Liberal and NDP pledge to roll out a countrywide income-based dental-care program could benefit many families in a country where almost a third of the population, or 12 million people, didn’t have dental insurance in 2020.
But the federal government’s timeline for implementing the plan is “ambitious,” two researchers told The Globe and Mail. And which services would be covered under the new dental subsidies remains an unanswered question, they added.
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Prime Minister Justin Trudeau announced his government’s intention to prioritize the launch of the dental-care program as part of a deal between the Liberal Party and NDP.
The new dental plan would target families with an annual income of less than $90,000, with no co-payments required for anyone making less than $70,000 a year. Coverage would start with children under 12 years old in 2022; expand to those under 18, seniors and persons with disabilities in 2023; and reach full implementation by 2025.
“Working-poor families give up toys for their children, they give up educational opportunities like night school, and food-insecure families give up things like food in order to be able to access the dental care they need,” said Dr. Carlos Quinonez, a dental-care policy expert and assistant professor at the University of Toronto’s Dalla Lana School of Public Health.
Per-capita spending on dental care reached $437 a year in 2019, before dipping in 2020 and 2021. As of 2019, private insurers covered 55 per cent of dental service expenditures in Canada, with Canadians paying out of pocket accounting for around 39 per cent, and existing federal and provincial programs accounting for just 6 per cent of expenditures, according to the Canadian Institute for Health Information.
Across the country, provincial and territorial dental coverage includes dental surgeries requiring hospitalization and plans targeted at specific groups such as children and social-assistance recipients. Federal programs cover eligible First Nations and Inuit individuals, veterans and refugees, among other groups.
The Liberal-NDP subsidized dental coverage would benefit any lower-income Canadian who doesn’t have workplace dental insurance, including Canadians working for smaller employers, freelance and gig workers, as well as seniors and people living with disabilities, among others, said Katherine Scott, senior researcher at the Canadian Centre for Policy Alternatives.
But whether Ottawa will be able to set up a new dental-care plan as soon as this year, even if only for kids under 12, remains far from certain, Ms. Scott added.
“It’s hard to say whether there’s been any negotiations thus far” between the federal and provincial and territorial governments, she said.
The speed of the rollout will also depend on whether the Trudeau government intends to apply the NDP’s blueprint for a federal dental plan for uninsured low-income Canadians or follow the more traditional route of channelling funds through provincial and territorial coffers, Dr. Quinonez said.
Also, not every eligible Canadian may be able to go to the dentist as soon as the plan is in place. More generous government dental coverage could spur more people to visit the dentist, which could result in a short-term mismatch between the supply and demand for dental services, at least in some parts of the country, Dr. Quinonez said.
While Canada doesn’t have a shortage of dentists over all, access to dental services can be an issue in smaller communities and rural areas, according to the Canadian Dental Association. The sector has also been struggling with a severe shortage of dental assistants, which was made worse by the pandemic, said Michel Breau, head of advocacy and governance at the CDA.
“It will be important that these new initiatives don’t disrupt access to dental care for Canadians that already have that,” he said.
Mr. Breau raised the concern that a new dental program could lead some employers to drop dental workplace benefits for workers who’d be covered by the plan.
Another issue is how much governments would be willing to pay for specific dental services, according to Dr. Quinonez. In provinces such as Ontario, where the rates dentists can charge for patients using currently available public dental-care plans are a fraction of what they’d normally receive, “many dentists are finding it very difficult to engage these programs and keep their lights on,” he said.
Then there’s the question of what would be included in a national dental-care plan. For example, orthodontic care, which includes braces, is rarely included in public plans, Dr. Quinonez said.
“Will you be able to get root canals? Will you be able to get crowns? I mean, those details are not yet available,” he said.
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