Wednesday November 29, 2017

Overall health includes oral health: Should dental be part of universal health care

With access to oral care a pressing problem, dental professionals consider whether universalizing dentistry would make for a better system.

With access to oral care a pressing problem, dental professionals consider whether universalizing dentistry would make for a better system.

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An estimated 20-30 per cent of Canadians have great difficulty getting access to dental care.

About six million have avoided their dentist in the last year because of the cost.

"We all agree that oral health and general health is one in the same, they should not be separated … dentistry right now is basically outside the system,"  Dr. Paul Allison, dean of the faculty of dentistry at McGill University, tells The Current

Most dental professionals are in agreement Canada's existing oral health system is failing patients and dentists alike — but is universalizing dental coverage the best way to fix problems of inadequate care?

Medicaid Children Dental

Children and Indigenous communities are among the most vulnerable to poor dental care. (Michael Conroy/Associated Press)

Existing public programs

Although most Canadians access oral care through private insurance, provincial and federal governments do partner with dentists to offer public dental services to those in need — but subsidies have been dwindling.

"For example in Ontario, the government came to dentists and said 'would you accept 90 per cent of your regular fee to look after these people' and then you said 'yes we would be happy to do our socially responsible part,' explains Dr. Larry Levin, the president of the Canadian Dental Association.

"And so the fees were established at that level — and then a few years later they came back and said 'well would you take 85 per cent?' What is it [now?] It's about 40 per cent."

With such low subsidization, dentists are disincentivized to participate in public dental programs. Those that do are losing significant money with every patient, given overhead costs. 

"Increasingly dentists are saying 'that's not a fair way for society to arrange its affairs,'" says Levin. 

Universal health care?

"We should have dental care as part of the universal health-care system," follows Dr. Paul Allison.

"We all agree that oral health and general health is one in the same, they should not be separated," he tells The Current.

"We should be able to define at least a minimum level of care to get people out of pain, to get rid of their disease, and to give them some preventive care."

'The focus has to be on identify who needs the help.' - Dr. Larry Levin

But Levin contends the majority of Canadians are well served by the current system, and a new model should focus on delivering services to those left out.

"People who have low incomes, people who have disabilities, children in those categories, seniors, and medically compromised people as well — the focus has to be on identifying who needs the help, and then as a supportive Canadian society, providing the help that those people need."

Target the most vulnerable 

Levin is among those advocating for a pan-Canadian model which targets particular circumstances and conditions.

"So there's a basket of procedures and treatments that everyone should have access to who finds themselves in that difficult position," Levin tells The Current's Anna Maria Tremonti. 

"We know that government's funds aren't bottomless. So targeted funds will help the people in need in the most expedient way to get there."

Allison agrees offering care to Canada's most marginalized groups must be the priority, but believes universal health care to be the necessary prescription.

"There are far fewer inequalities in general health access ... compared to the dental system in Canada. We really need to think about bringing in dental care into the public system."


Listen to the full conversation at the top of this post. 

This segment was produced by The Current's Cathy Simon, Willow Smith and Karin Marley.