The School of Public Policy Publications (Sep 2020)
Starting from Scratch: A Micro-Costing Analysis for Public Dental Care in Canada
Abstract
With federal political parties increasingly interested in new options for dental services, it’s worth exploring two policy solutions to expand dental care into the public realm. Denticare would be a universal dental program for all Canadian residents. Denticaid would be a public dental insurance program for all Canadian children and uninsured adults. This paper estimates the costs of each option through micro-costing, which identifies the likely resources patients would use in each program and sums each unit cost in a given year to generate the estimated annual clinical cost. With no dental record-level information available for academic research, these estimates rely on survey data on oral health collected from across Canada. In particular, this paper uses the Canadian Community Health Survey (CCHS) and the Canadian Health Measures Survey (CHMS), both released by Statistics Canada. When neither survey contains the necessary data to inform assumptions and costing, data from similar high-income jurisdictions are used. Denticare’s costs are estimated using four key variables: the expected number of Canadians using dental services in a given year, the expected number of visits per year, the probability of dental treatments used per visit and the expected price of dental treatments. The first variable is based on Statistics Canada’s 2016 census data, multiplied by their 2019 overall provincial population estimates. The second relies mostly on the CCHS question “when was the last time you visited the dentist?” The third variable uses Australian data and the fourth integrates data from a variety of provincial dental fee guides. High, low and baseline cost scenarios are included, with each province and territory’s clinical costs projected five years after implementation in all three scenarios. To project future changes 1 in service costs, the rate of price increase is calculated from changes between the 2015 and 2019 suggested fee schedules. Methods for micro-costing the denticaid program are similar to the denticare model and the variables are mostly treated similarly. However, the population variable is manipulated to account only for individuals without private dental insurance. There are limitations to this approach. The CCHS is only a telephone survey and does not collect dental data from across every province. The lack of pan-Canadian service-level use data meant that data from an Australian survey was used in its place. This model could not account for the effects of income on the frequency with which any particular dental treatment category is accessed per visit. Australia also covers most dental treatments for children, so use of dental services could be higher than what could be expected in Canada. To obtain a more exact picture, provincial governments should try to collect service-level data on dental use and dental practice activity. However, this paper does provide Canadian policy-makers interested in exploring some sort of public dental care program with a rigorous estimation of the reimbursement of clinical costs for the options of both denticare and denticaid programs.
