After 57 years, Canadians finally have a reason to ‘say cheese’
Posted on December 14, 2023 in Health Policy Context
Source: TheStar.com — Authors: Armine Yalnizyan
TheStar.com – Business/Opinion
December 14, 2023. By Armine Yalnizyan, Contributing Columnist
Lack of a strategy around dental care has been a costly oversight for decades. This welcome news comes not a moment too soon, Armine Yalnizyan writes.
Problems with our teeth result in roughly 2.3 million school days and 4.2 million working days missed each year. At the average hourly wage in 2022 ($31.96), lost work time clocks in at $1.2 billion, more for parental care, Armine Yalnizyan writes.
It’s a strange truth of Canadian public policy: for the past 57 years we’ve covered the costs of caring for each others’ lips, tongues and throats, but not our teeth and gums.
That toothless approach to health care places Canada fourth-last out of 31 OECD nations regarding government supports for dental care, although as of this week, we’re on our way up: the federal government finally made good on a promise to the NDP to guarantee access to oral health services for the nine million or so residents of Canada who have no insurance coverage and insufficient funds to take care of their teeth.
That’s right. One in four Canadians report avoiding dental care because of the cost.
A mounting body of evidence shows a correlation between poor oral health and higher incidence of diabetes, cardiovascular disease, pneumonia and Alzheimer’s. The government’s own backgrounder notes that people with gum disease have double to triple the likelihood of suffering a heart attack or stroke.
The program will take more than a year to completely roll out, but by 2025, people with family incomes less than $90,000 and no existing insurance have reason to say “cheese.” The federal minister of health, Mark Holland, rightly said, “This is a proud moment, I think for all Canadians, in expanding what is the definition of health care in Canada.”
It’s health care with teeth.
The price tag is $13 billion over five years, though $6 billion of that was already budgeted in the form of cheques going to parents of 240,000 children younger than 12 for their basic dental needs. New funding adds critically needed preventive care and expanded access.
When complete, the annual cost will be more than $4 billion. But we’re already spending plenty more now, much of it not well:
In 2023, the Canadian Dental Association estimates total expenditures on dental care will be $19.6 billion, of which we privately pay 94 per cent. Only six per cent is publicly funded.
- Problems with our teeth result in roughly 2.3 million school days and 4.2 million working days missed each year. At the average hourly wage in 2022 ($31.96), lost work time clocks in at $1.2 billion, more for parental care.
- Use of emergency care for non-urgent dental care due to lack of a provider cost the public purse an estimated $1.7 billion in 2017 (the latest data we have). COVID and inflation likely increased that. We spend multiples more on kids from poor neighbourhoods and rural/remote locations than more affluent households. Many serious dental surgeries could be avoided if better care was available early on.
That’s the truth about so much of dental health-care spending. Tooth decay is a preventable disease and a low-cost public health intervention. By publicly funding this care, we should be getting vastly improved preventive and primary care, better health outcomes, and new levers to contain costs.
Three tricky aspects of the plan require our continued attention:
- Sun Life will administer the program for the first five years, but Service Canada will handle all disputes. A private sector insurer can provide leadership to move the dial toward more preventionand better health — the real cost-saver — as was the case with Kaiser Permanente in the U.S. since the 1940s. But will it? Who ensures that happens?
- Population growth is outpacing supply of dentists everywhere in Canada. When Tommy Douglas publicly insured dental care for school-aged kids in Saskatchewan in the late 1970s to early 1980s, the focus was not on care by dentists, the most expensive part of the system, but on bringing primary and preventive care to kids in schools using dental therapists. The province created a school to train thousands within mere months, to bring the right care at the right time. As Tommy used to say: “Why spend a dollar when 99 cents will do?” Can we do the same again?
- The federal contribution is designed to fill in the gaps, not supplant existing dental insurance, both public and private. What happens if provinces and employers reduce coverage?
In Ontario, the Healthy Smiles program introduced dental care for those younger than 18 in 2010, and the Ford government introduced Ontario’s expanded access to care for those older than 65 in 2019.
Today it’s not just kids and the elderly who need help. It’s the twenty-, thirty-, even forty-somethings whose jobs don’t come with benefits packages, and whose pay hasn’t kept up with soaring rents and groceries.
If they don’t have a Bank of Mom and Dad to rely on, many young and middle-aged adults are in trouble, because what is cosmetic today turns into something with far greater consequences with alarming speed. And ours is a rapidly aging population, with higher costs on the menu.
Thank goodness we didn’t look this gift horse in the mouth.
Lack of a strategy around dental care has been a costly oversight for decades. This welcome news comes not a moment too soon, improving lives and saving money, one healthy smile at a time.
So let’s raise a glass (of fluoridated water?) to finally adopting cost-effective policy that creates lasting change. In fact, maybe breaking out the bubbly is merited: after half a century the feds delivered on national child care and dental care in the last two years. Pharmacare’s waiting in the wings. Hat trick, anyone?
https://www.thestar.com/business/after-57-years-canadians-finally-have-a-reason-to-say-cheese/article_ed3b3954-991f-11ee-bfa6-db10a9adccaf.html
Tags: budget, Health, jurisdiction, participation, standard of living
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