Lorian Hardcastle is an assistant professor in the Faculty of Law at the University of Calgary.
A provincial government report found last year that dental procedures cost up to 44 per cent more in Alberta than in neighbouring provinces. Does this inflated cost have an impact on dental health? You bet.
A staggering 62 per cent of Albertans reported limiting dental visits because of cost concerns. That is most Albertans skipping basic dental health care because of the price. That is a problem. If dental health is not maintained, complications can send patients to the emergency room at great public cost.
So how did Alberta's prices get so out of line from those in the rest of the country?
Professional dental societies publish fee guides in most provinces to give dentists – who are primarily self-employed – a benchmark for what to charge their customers. The fee guides also encourage price competition, improve transparency and better inform patients. But the Alberta Dental Association and College (ADAC) stopped publishing its fee guide in 1997, deciding to leave pricing up to the free market. Critics believe this may have contributed to the current high cost of dental care in the province.
As a result of pressure from the government, the ADAC released a new fee guide this month in an attempt to improve the situation. It recommends a reduction in costs for dental procedures of 3 per cent across the board. Alberta's Health Minister summed it up when she said Albertans "deserve better."
The new fees are still too high for many Albertans. For example, the new guide recommends a price of $75.36 for a standard oral exam for a new patient, compared with the $43.10 suggested in British Columbia's fee guide.
And while a 3-per-cent saving will benefit private insurers and those who can already afford to visit a dentist, this very modest reduction is unlikely to persuade the many individuals who previously could not afford dental care to seek it now.
Although Albertans pay the highest fees for dental care in Canada, high costs and low rates of public funding for dental health are a problem across the country. Most countries in the Organization for Economic Cooperation and Development far exceed Canada's per capita public expenditure on dental care and some include dental services in their publicly funded national health insurance programs.
In Canada, 93.8 per cent of all dental-health services are paid for privately, either through insurance or out of pocket, while public spending accounts for only 6.2 per cent. So much for universal health care.
Publicly funded dental programs vary widely across the country, with different provinces covering some combination of low-income seniors, children and those with disabilities, while the federal government covers qualified Indigenous people.
Significant evidence indicates that these public dental health plans are insufficient. A study by the Canadian Academy of Health Sciences found that about six million Canadians avoid visiting the dentist every year because of the cost and that those most likely to be deterred had the greatest need for dental care.
Unsurprisingly, research from Europe confirms that inequities in access to dental care were highest in countries with no public dental coverage.
What may surprise many is that lack of dental care affects more than oral health and has been linked to cardiovascular and respiratory problems and diabetes. Patients who cannot afford dental care may also wait until the problem is severe enough to necessitate visiting an emergency room, where doctors are not trained to treat underlying dental issues, and offer band-aid solutions such as antibiotics and painkillers.
According to the Association of Ontario Health Centres, about 60,000 patients with dental problems that should have been managed in the community visited Ontario emergency rooms in 2014 – at a cost of $30-million. An additional 230,000 patients visited family doctors at a cost of $8-million, where they often received painkillers such as narcotics. Thus, poor access to dental care may indirectly contribute to our current opioid crisis.
Multiply similar costs across the country and you have a pretty solid economic argument for expanding publicly funded dental care in Canada.
Although the federal Canada Health Act refers to universal public insurance for "medically necessary services," this is interpreted to mean hospital and physician care, while other important health services, such as dental care, pharmaceuticals and home care are funded through a mixture of out-of-pocket payments, private insurance and a patchwork of public programs. It is time this changed.
Instead of funding an ever-expanding list of hospital and physician services, some of which deliver relatively limited clinical benefits at very high cost, the provincial governments should target public spending towards those services that evidence demonstrates are most cost-effective – including basic dental care.