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opinion

Lawrence Stanleigh is a dentist and keynote speaker based in Calgary

The high fees for dentistry in Alberta is a hot topic and the solution, as demanded by the current Alberta government, is to reintroduce a fee guide. What has been lost in this conversation: Why was the fee guide eliminated in Alberta? Is there evidence that fee guides improve access to care? Who benefits from having a fee guide in Alberta? What are the real solutions to improved access to care?

In the mid-1990s, the federal Competition Bureau published an article on the subject of dental fee guides in Ontario. It determined that 97 per cent of dentists charged fees that were identical to the published fee guide, rendering it a de facto schedule of fees (also known as price fixing). The bureau concluded that the fee guide created a floor below which dentists were not encouraged to go and that fee guides inhibited price competition.

Based on this study, the provincial government went to the Alberta Dental Association and recommended elimination of the fee guide. This was done in 1998.

Then, the Alberta economy boomed, the population grew and demand for dental services increased faster than the number of dentists. Shortages of dental staff, including registered dental hygienists, registered dental assistants and dental reception personnel, drove salaries upwards. This is simple supply and demand. As one business coach told me at that time, "If you want to play, you gotta pay." Other effects of a strong economy also drove costs dramatically upwards.

In the Alberta Health document "Alberta Dental Review, February, 2016," some procedures were found to be 25 per cent to 44 per cent more than in other provinces. The same document demonstrated that costs to run dental offices in Alberta are up to 45 per cent higher than in other provinces, and an analysis of Revenue Canada income revealed that dentists' take-home income is the same as other dentists in Canada, supporting the higher-cost-of-business statement of the Alberta Dental Association and College. Yet the solution identified in Alberta Health was to have a fee guide published again.

Do fee guides improve access to care? According to the Canadian Dental Association in May, 2010, there are no differences in access to care among the various provinces in Canada. The Montreal Economic Institute published a report in 2013 that said Canadians had better access to dental care than Britain, Australia, the United States, Japan or Finland. There is no evidence that a fee guide improves access to dental care.

Who really benefits from having a fee guide reintroduced to Alberta? The impetus was pushed by the millions of dollars spent lobbying the government by the for-profit dental-benefits insurance companies, who stand to have better predictability of how much they will be spending in benefit coverage, and maximize their profits.

I have asked the insurance companies repeatedly: If the fees were reduced by 25 per cent, would they reduce the premiums to their customers by 25 per cent? Silence has been the only response.

Access to care is the real issue. Although opinion surveys state Albertans are avoiding dentistry because of the fees, what impact has income reduction and high unemployment played in this decision to avoid dentistry? The ultimate goal is increased access to care for the poor, for seniors, for children of low-income families and for the disabled. These are the populations that really need help with regards to oral health care, and a fee guide, no matter what level of fee is determined, is not a solution to removing the barriers to access to care for these people.

Some provinces provide payment for dental care for seniors, for children up to their teenage years, and more comprehensive dental benefits for the disabled (not to mention dismal dental-benefits programs for First Nations peoples). These publicly funded programs are the most effective methods of removing barriers to access to care for those in greatest need. Why did previous Alberta governments eliminate these programs in times of abundance?

To increase competition, you need to have a free market with open public access to information in dentistry that is relevant, accurate and complete, as opposed to the severe restrictions imposed by the current Alberta Dental Association and College's advertising restrictions, a situation now being challenged in the courts.

A fee guide is not the solution to the access-to-oral-health-care equation. Restoration and improvement of publicly funded oral-health-care solutions, a free market and free, comprehensive public access to information about dentistry and the dental professionals providing oral health care is.

In 1997, the government demanded we eliminate a fee guide and in 2017 the government demanded we have one again. No matter, access to dental care for the poor, the disabled and other vulnerable populations will not change.

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