Parties’ Dental Plans prompt some gnashing of teeth
Programs already in place need more government attention, says ODA president
Before the provincial government expands public health insurance to cover dentistry, it ought to pay more for the programs Ontario already has, the Ontario Dental Association says.
“I think the real issue here is we have programs in place,” says Dr. LouAnn Visconti, a Timmins dentist who is president of the association. “We’re not under the same model as the physicians. The government has limited resources. What our model is is to work with the government. We’d like to partner with the government not only on existing programs, but to go forward on future programs.”
The trouble is the current programs don’t pay the bills.
Visconti singles out Healthy Smiles Ontario, the combination of six programs the Liberal government merged in 2016 that were all aimed at cleaning and fixing children’s teeth. Some get treated in public health clinics. Others get coverage cards that work like health cards: present one to a private-practice dentist and the government pays for the service directly.
The dentists association had called for that streamlining for years, but it came with a catch. Testifying at a legislature committee last fall, then health minister Eric Hoskins said the number of kids eligible for the $100-million program had gone from 460,000 to 573,000.
“They’ve increased the number of children eligible, which is great, but they didn’t put any funds they saved from the administration cost back into the program,” Visconti says.
For some procedures, Healthy Smiles Ontario covers less than a third of the standard price, she says. Which is tough on dentists when overhead — the costs of running an office, paying for equipment, supplies and staff
— is about two-thirds of what they normally charge. They’re eating the difference, an amount Visconti estimates at $50 million a year.
Not including teeth in public health coverage has consequences. Ontario’s emergency rooms see about 60,000 people a year for dental problems, mostly toothaches and abscesses that routine cleanings and checkups could probably have headed off. In the Champlain health region that includes Ottawa, it’s about 5,000 people a year or about 14 a day.
Patients with tooth problems that aren’t life threatening are usually sent off with antibiotics and painkillers because that’s all hospitals are equipped to do for them. That doesn’t solve the underlying complaint and it means more antibiotics and opioids swirling around in people’s bodies. There’s a genuine problem here. All the parties have plans to tackle it: the Progressive Conservatives would boost services for the neediest, the Liberals would give a little help to everyone and the New Democrats would come the closest to adding dental care to Ontario’s existing health coverage by sponsoring a benefits program for everyone who doesn’t already have one.
“We are thrilled that there’s been talk by all parties about dental care. After years of silence on the issue, it’s great that it’s at the forefront of talk at Queen’s Park,” Visconti says. But none of the parties are addressing the dental association’s main complaint.
Increasing the fees Healthy Smiles Ontario pays — giving dentists more money for the same work — would lead only indirectly to more dental care, of course.
Ontario’s doctors have their fees dictated by the provincial health ministry and many hate the arrangement. In theory, they negotiate. When negotiations fail, which have recently, the ministry just sets the numbers unilaterally. Visconti’s counterparts at the Ontario Medical Association are barely speaking to the government, they’re so mad.
The doctors aren’t necessarily right, but they’re definitely angry. Plenty of doctors are backing the Tories because short of moving out of Ontario, trying to get a friendlier government is about all they can do.
When the Liberals under Dalton McGuinty took eye exams for healthy adults off the public coverage list in 2004, many optometrists were happy because it meant their fees could float. The government decides what it’s willing to pay for children’s eye exams and for adults covered under other programs, but a lot of optometrists’ business is done at market rates. Practices with great locations or longer hours can charge extra.
Dentists have mixed practices, more like optometrists than like doctors. Some try to minimize the number of patients they see who cost them money; northern New Democrat MPP France Gélinas complained to Hoskins when he testified that she had constituents eligible for Healthy Smiles coverage who couldn’t find dentists to treat them.
If the government paid more, dentists would have more incentive to take patients with public coverage. But if the government expanded the number of people it tries to cover at the same rates, well, you can see why dentists might not be thrilled.
“Is it going to be sustainable in the long run?” Visconti asks. “As they increase the number of people who are eligible under these programs, if they’re not going to cover the costs, it’s just not going to be sustainable.”
THE PARTIES’ PROMISES
All three major parties are promising more governmentbacked dental care if they win the June 7 election.
The Progressive Conservatives say they’ll pay $98 million a year for more clinics run by local public health units.
The Liberals have a $400-million promise to create a backstop plan that would cover drug and dental costs for people who don’t have workplace benefits or coverage under other public programs.
The New Democrats have the most ambitious promise. They’d require all employers to provide basic dental benefits for all workers and launch a public program to cover dentistry for anyone who doesn’t have a stable employer. It would cost about $1 billion a year once fully in place.
We are thrilled that there’s been talk by all parties about dental care.