After winning a majority in last fall’s provincial election, British Columbia’s New Democratic Party have a strong mandate. They now have the opportunity to implement public dental care, an overwhelmingly popular policy goal that would plug a major gap in Canada’s universal health care system.
Dental care in Canada is private, with 95 percent of dental spending coming from work-related insurance and out-of-pocket payments and only 5 percent from government programs. The government share of spending is even lower than in the United States. More than one in three Canadians lack dental insurance, and one in five report avoiding the dentist every year due to financial constraints.
As more people retire or lose their work-related insurance, these figures are rising. The spread of the gig economy, which does not provide benefits to its workers, is also contributing to insufficient coverage. The BC NDP should act now and provide Canada with a blueprint for dental care that it can lock in place for the post-pandemic recovery.
The Costs of Not Providing
NDP premier John Horgan has acknowledged the problem. In December 2018, Horgan declared his intention to offer dental insurance to the uninsured. Since then, COVID-19 has resulted in large-scale job losses across BC and Canada as a whole, depriving the unemployed of their dental insurance, not to mention the disposable income needed to pay for procedures out of your own pocket.
Universal access to dental care would have knock-on benefits for Canada’s health care system as a whole. Poor oral health has negative effects on overall health and can exacerbate the cycle of poverty. Comprehensive oral health care has been shown to decrease harms that are disproportionately experienced by the poor, such as unemployment and housing insecurity.
One percent of ER visits in BC are for nontraumatic dental injuries, which may seem insignificant. But scaled up to a nationwide level, ER visits of this kind cost an estimated $155 million per year.
Treatment in the ER often consists of antibiotics for decayed teeth and opioid prescriptions for pain. This reactive care helps fuel the opioid crisis, while the overuse of antibiotics contributes to the emergence of resistant superbugs. These patients would be better served by preventative care from a dentist.
John Horgan’s plan to extend dental insurance to the uninsured would be a step in the right direction. But there are better options for dealing with this shortfall of coverage.
A Public Model
A single-payer model based on Canada’s universal health care system would be more efficient than the multi-payer system Horgan is proposing. It could standardize pricing and treatment plans more efficiently and decrease administrative costs. We could also save money by training mid-level dental providers to carry out more routine procedures that are currently often monopolized by dentists who charge a higher price.
That doesn’t mean we should copy the existing single-payer system for health care in every respect. Instead of funding private clinics, as the health system currently does, the government could bring many dental clinics into public ownership. That would be an efficient way of serving the communities that currently struggle with dental care access.
Simple, low-cost dental clinics could be set up in community health centers, schools, long-term care facilities, and prisons. Public ownership would make it possible to hire staff on a salary rather than the more expensive fee-for-service model. Public ownership would also facilitate the provision of routine dental care by dental therapists, who can perform procedures like fillings and simple extractions at a fraction of the cost of a dentist.
Staffing costs account for the lion’s share of expenditure on a public dental program, so maximizing the use of dental therapists would make tax dollars go further. It would also let dentists concentrate on the more complex procedures for which they have been trained.
In order to make this plan a reality, the BC NDP will have some work to do. The regional government will need to open a dental therapy training program and hire graduates to work in the new system. BC already has several dental hygiene schools that are well-positioned to embed dental therapy skills as part of a dental hygiene degree or in the form of postgraduate training. This would allow hygienists who want to expand their range of practice to return to school and become dental hygienists/therapists with dual training.
We should expect the usual chorus of voices telling us that we simply can’t afford a new public program like this, especially after the economic losses associated with COVID-19. But the money hasn’t dried up: Canada’s billionaires have added $53 billion to their net worth since the start of the pandemic. Shifting the cost of universal dental care from ordinary citizens onto the wealthy through progressive taxation is a necessary step.
British Columbia has the necessary pieces in place — dental hygiene leadership, regulation, accreditation, education, examination, quality assurance, and human resource capacity. What it needs now is the political will to put them all together.
If the BC NDP proved to be a pioneer in the provision of universal dental care, it would rejuvenate the party. The momentum from a successful dental care reform would put wind in the party’s sails at both the federal and provincial levels. Canadians have already waited long enough: it’s time for the NDP to take the first step toward public dental care.