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01 March 2024 | Country Update
Canada continues to expand dental coverage -
06 October 2022 | Policy Analysis
Expanding dental care coverage through targeted cash-benefits for Canadian children
5.12. Dental care
Almost all dental health services are delivered by independent practitioners operating their own practices. With the exception of surgical-dental services (performed by a dentist in a hospital) which are considered insured health services under the Canada Health Act, payment for dental care is through private health insurance or direct OOP payment. If a PT resident is receiving social assistance, then a portion or all of the costs for personal dental services may be covered by the PT government, with variations in eligibility and coverage rules across provinces and territories. Similarly, if an individual is an eligible First Nation or Inuit, then a portion or all of the costs will be covered by the federal government through the NIHB programme.
Unlike many other high-income countries, Canada provides a very low level of public subsidies to access dental care. Currently, about 94% of all dental services are funded privately, a level that is lower than in other countries with a large private market for dental care (e.g. the United States at 13% and Australia at 18%) (Allin et al., 2020c). This degree of dependence on private funding has contributed to high levels of inequalities in terms of dental care (see Chapter 7). Almost 54% of all dental care is funded through private health insurance, the majority of which is through employment-based benefit plans. The remaining amount is funded directly by OOP payments (40%) or through public funds (6%) (CIHI, 2019a).
In order to address these inequities, a few targeted oral health and dental service programmes have been initiated by governments. The first provincial programme of this type, launched by the government of Saskatchewan in the 1970s, targeted schoolchildren. Utilizing dental therapists as paraprofessionals, the Saskatchewan Health Dental Program proved to be highly effective but was disbanded within a decade (Wolfson, 1997). This was followed by a similar programme in Manitoba targeting rural children but it too was eventually discontinued by a subsequent administration (Marchildon, 2011). To date, most PT programmes target specific groups such as low-income children, the population for whom most attention has been paid, as well as social assistance recipients, and individuals with developmental disabilities (Shaw & Farmer, 2015). In Ontario, for example, through cost-sharing agreements with the provinces, municipalities finance and deliver care for low-income children and social assistance recipients, and since November 2019, also low-income older adults.
The federal government implemented a new wave of dental coverage for low-income seniors in 2023, called Canada Dental Care Plan, building on the Canadian Dental Benefit program introduced the previous year that targeted children under 12 in low-income families. The Canada Dental Care Plan was part of an agreement struck between the minority Liberal government with the New Democratic Party (NDP). Eligibility criteria for coverage of a suite of preventive and treatment oral health services include
- not having dental coverage;
- family net income lower than CAD 90 000 per year,
- Canadian resident, and
- filed taxes in the past year.
The Canadian Dental Benefit for children was a tax-free benefit program (funds provided directly to individuals), while the Canada Dental Care Plan is an insurance coverage program that pays dental care providers directly using a national fee schedule. This latest expansion places the government on track to fulfilling the agreement to cover all eligible low-income households by 2025.
Authors
References
Flood, C., et al. 2023. Toward a Universal Dental Care Plan: Policy Options for Canada. Institute for Research on Public Policy. Available online: https://irpp.org/research-studies/toward-a-universal-dental-care-plan-policy-options-for-canada
Rachini M. 2023. Canada’s new dental care plan could impact nearly 9 million Canadians – are you one of them? CBC News. https://www.cbc.ca/news/canada/canada-dental-care-plan-benefit-1.7055975
Government of Canada. 2023. Making dental care more affordable in Canada. News Release. https://www.canada.ca/en/health-canada/news/2023/12/making-dental-care-more-affordable-in-canada.html
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.
Authors
References
Department of Finance. 2022. https://www.canada.ca/en/department-finance/news/2022/09/making-dental-care-more-affordable-the-canada-dental-benefit.html
Flood, C. M., S. Allin, S. Lazin, G. Marchildon, P. Oliver, C. Quiñonez. In development. Policy Options for Canadian Dentalcare.
Government of Canada: PM’s Office. 2022. Delivering for Canadians Now. https://pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now
Government of Ontario. 2022. Teeth cleaning, check-ups and dental treatment for kids. Available at: https://www.ontario.ca/page/get-dental-care
Marchildon G.P., Allin S., Merkur S. 2020. Canada: Health system review. Health Systems in Transition; 22(3): i–194. https://eurohealthobservatory.who.int/publications/i/canada-health-system-review-2020
Ontario Dental Hygienists’ Association. 2022. “Oral Health and Overall Health.” Dental Hygiene Facts. https://odha.on.ca/wp-content/uploads/2016/08/Overall-Health-14-1-final.pdf