In March 2022, the Canadian government announced a new program, Canadian Dentalcare, to provide publicly funded dental care coverage for low- to middle-income households. This policy development is part of the Supply and Confidence deal between the minority federal government, Liberal Party of Canada (LPC), and the social democratic New Democratic Party (NDP) to support the minority government until June 2025. This agreement is partly contingent on the introduction of universal dental coverage for low to middle income Canadians without private health insurance in exchange for the NDP’s continued support for the LPC’s minority government (Government of Canada PM’s Office 2022).
Dental care spending in Canada is among the highest in the world due in part to the prevalence of supplemental work-based private health insurance (Marchildon, Allin and Merkur, 2021) so Canada Dentalcare will be a significant addition to the spectrum of publicly funded health services. At present, most dental care is funded through out-of-pocket (OOP) expenditures and supplementary health insurance (held by over half (56.2%) of Canadians). There is limited public dental coverage, namely targeted at children (that is, through Healthy Smiles Ontario, a means tested scheme). Dental care comprises almost a quarter of OOP payments for households in the lowest (24%) and highest (25%) income quintiles in Canada based on estimates from pooled data based on the 2014 to 2016 survey of household spending. This represents a significant step toward filling a gap in universal coverage for Canada as dental care is not included in any PT universal health coverage program. Dental services are not considered an “insured service” by the Canada Health Act, the federal health care insurance legislation that stipulates what should be included in the insured medical services provided by provinces and territories (PTs).
The first step toward Canadian Dentalcare is a proposed application-based cash benefit for Canadian children below 12 years from households earning CA$90,000 or less, and without private insurance coverage, by the end of 2022. In the short term, eligible families can apply for the Canada Dental Benefit, a direct transfer payment of up to CA$650, administered through the Canada Revenue Agency. It is estimated that up to 500,000 children are eligible to benefit from this cash transfer projected as a targeted investment of up to CA$938 million (Department of Finance 2022). The federal government intends to expand Canadian Dentalcare to cover individuals under 18 years, seniors, and persons with disabilities by 2023. Full implementation of this scheme is slated for the end of 2025 for all Canadians with household incomes below $90,000 (Government of Canada, PM’s Office 2022).
This expansion of universal coverage to dental care is a significant policy development in Canada, but there are multiple challenges to implementation and effectiveness. First, the use of targeted cash benefits may be limited as there are no accountability requirements beyond self-reported status as not having supplemental private health insurance. Second, the dental profession is largely private and not subject to cost control mechanisms such as maximum tariffs or required to accept a case-mix that includes lower income households. Without such supply-side reforms, there may be limitations to the equity benefits of this policy change. Lastly, the introduction of Canadian Dentalcare represents an important policy window to expand and improve access to oral health services but may not reduce fragmentation or achieve meaningful reform to dentistry practices in Canada if administered via cash transfers.