The School of Public Policy Publications (Sep 2020)
Comprehensive Dental Care in Canada: The Choice Between Denticaid and Denticare
Abstract
Canada’s universal health-care system does not include dental care, which presents problems for both low- and middle-income families. According to the latest Statistics Canada data, out-of-pocket dental expenses are increasing steadily. Lower-income workers struggle with a disproportionate share of these costs, leading one in 4.5 Canadians to avoid visits to the dentist. With dental care becoming increasingly unaffordable and private insurance harder to obtain, it’s time for Canada to consider bringing dental services into the public health system. Policy solutions have tended to fluctuate between a fill-in-the-gaps approach or comprehensive restructuring of dental care. This paper examines two new options: universal first-dollar coverage or denticare, and public dental insurance for all those without it or denticaid. Denticare would cover dental treatment with the same eligibility for public health insurance under the medicare system. Denticaid would only provide this to children under 12 and those lacking private insurance. Both denticare and denticaid would lower overall health-care costs, as improved oral hygiene would reduce rates of chronic and serious diseases. Integrating dentistry into the public health system would lead to increased patient contact, more efficient early screening and referrals. Direct clinical costs are estimated through micro-costing of expected annual dental services used. Indirect administrative costs are estimated through average costing based on existing per-patient administrative costs in the Canadian health-care system. Co-payments for both options are based on five household income brackets with the lowest bracket being exempt and the highest paying the maximum rate. The co-payment for advanced procedures would be 50 per cent and 20 per cent for all other services. Everyone over age 17 would have to pay an annual premium to be enrolled in the public plan; the lowest income brackets would be exempt and the highest would pay the maximum of $400. In denticare, public employees would no longer receive workplace dental benefits on the private market, while those same benefits would make them ineligible for denticaid. National clinical costs for a hypothetical denticare program in 2019, including administrative costs, are estimated at $27.50 billion ($737.09 per capita) with an upper estimate of $38.40 billion ($1,029.18 per capita) and a low estimate of $15.50 billion ($415.46 per capita). In all three scenarios, premiums paid by eligible individuals would generate $8.93 billion in annual revenues. After factoring in premiums, co-payments and the replacement of existing dental expenditures, the program’s net cost would be $6.01 billion in 2019, with an upper estimate of $15.09 billion and a lower estimate of negative $3.82 billion. Denticaid’s costs, including administrative costs, would be $15.09 billion ($404.49 per capita) in 2019, with a high scenario of $21.32 billion ($571.34 per capita) and a low scenario of $8.39 billion ($224.98 per capita). Denticaid’s premiums would generate less revenue to offset costs. The program’s net costs are estimated at $$7.47 billion in 2019, with a high estimate of $12.85 billion and a low estimate of $1.79 billion. There are additional challenges to consider, including dental office staffing levels in rural areas, dentists’ operating costs and orthodontic treatments. But none of this should prevent Canada from committing to a denticare program, which out-performs denticaid in terms of efficiency. Both federal and provincial governments would need to be involved in the necessary modifications to the Canada Health Act, with decisions on premiums and co-pays left to individual provinces. After those offsets, the remaining taxbased costs would be a relatively small increase in Canada’s public health spending and millions of Canadians would get access to good oral health.
