Starting next month, Canadian residents over the age of 70 who have no dental insurance and whose household income is less than $90,000 a year can seek treatment under the new Canadian Dental Care Plan.
But seniors in Nova Scotia who have been approved under the plan are likely to be waiting months — if not years — to have their teeth cleaned.
That’s because only half a dozen dentists — six out of 500 licensed to practice in Nova Scotia — have agreed to participate in the long awaited federal plan that would extend oral health care to an estimated nine million Canadians who cannot afford it. Four of the six dentists are based in the Halifax Regional Municipality, according to this online search tool.
The take-up rate among dentists is beyond disappointing – like pulling teeth, to use an overworked metaphor — since federal Health Minister Mark Holland announced the plan last December in order for the Liberals to maintain the political support of the New Democratic Party.
“The Government of Canada is making life more affordable by helping families and their loved ones,” said Holland in a news release. “We know that a third of the people living in Canada do not have dental insurance, and in 2022, one in four Canadians reported avoiding visiting an oral health professional because of the cost. Access to oral health care should not be dependent on Canadians’ ability to pay.”
More affordable but not free
Through its five-year contract with Sun Life Insurance, Ottawa will reimburse dentists and dental hygienists for services they provide to seniors, disabled adults, and children under 18 as the program rolls out over the next year. (In Nova Scotia, dental visits for children under age 15 are covered by the province.)
People who make less than $70,000 will have basic dental services paid for by the federal government. People with income of $70- $90,000 will pay between 40 and 60% of the bill. In addition to that co-payment, patients will have to make up the difference between the usual fee the dentist charges for a service such as filling or extracting a tooth and the amount covered under the CDC Plan. In Nova Scotia, those fees are higher.
The Nova Scotia Dental Association surveys its members each year and publishes a Suggested Fee Guide based on what dentists estimate it costs to operate their business.
Information on the CDC Plan website states “The CDCP fees may not be the same as what providers charge. You may have to pay fees in addition to the potential co-payment.” You can find the fine print here.
Still, it appears no Nova Scotia dentist would be out of pocket for voluntarily seeing patients who enrol in the Canadian Dental Care Plan.
“Fees are not the primary issue here,” said Dr. Juli Waterbury, the president of the Nova Scotia Dental Association, when reached by the Halifax Examiner by telephone today.
Waterbury estimates the fees charged by Nova Scotia dentists are about 15% higher than what the Canadian Dental Care Plan will pay, but that difference will be made up by the patient.
So what exactly are the barriers preventing dentists in this province from providing care to people who don’t have insurance?
According to Waterbury, it’s “the administrative burden” the CDC Plan would add to dental offices, which have already been struggling to find/keep staff.
“Here in the Maritime provinces, we are suffering from a severe shortage of trained dental staff — our dental assistants and our dental hygienists,” said Waterbury. “Most offices in the province are trying to function short-staffed right now and most offices are also fully booked, so the capacity to take in new patients is very low, unfortunately.”
Although community colleges and private career schools continue to graduate dental assistants and hygienists, Waterbury claimed they are not keeping up with the number of new dentists and population growth.
Waterbury practices in Kentville with three other family dentists. She is en route to a meeting of the Canadian Dental Association in Ottawa this week where the CDC Plan will be front and centre. She said another reason dentists have been reluctant to sign on is they fear Sun Life and Ottawa could make unilateral changes to the program without consulting the profession.
But Waterbury believes the low participation rate in Nova Scotia is mostly a result of staff shortages. She said her office would need to hire an extra person just to handle the paperwork around pre-authorized treatments under the CDC.
“The four dentists in my office have chosen not to participate at this time,” said Waterbury. “However, we have told our patients we do expect this program will change over time and we will reassess our decision on a regular basis… I am hopeful this program will reach the point where I will be comfortable participating.”
What’s covered under the federal plan
Services that could be covered under the CDCP include the following, with some services only becoming available in fall 2024:
- preventive services, including scaling (cleaning), polishing, sealants, and fluoride;
- diagnostic services, including examinations and x-rays;
- restorative services, including fillings;
- endodontic services, including root canal treatments;
- prosthodontic services, including complete and partial removable dentures;
- periodontal services, including deep scaling;
- oral surgery services, including extractions.
The federal dental program is estimated to cost $4.4 billion a year with a budgeted investment of $13 billion over the first five years.
The original version of Medicare envisioned by founder Tommy Douglas in the 1950s included preventative dental care. Now that it’s finally being introduced 70 years later, the issue is whether there will be more than a handful of dentists in Nova Scotia able and willing to provide care.
There is a dentist, Dr Brandon Doucet who is the founder of the Coalition for Dentalcare. He has a book out, published by Fernwood. His interest in public health and the importance of dental care for everyone puts him at odds with many other dentists. And you have guessed the reason $$$.
My dentist’s office used to call me regularly to make an appointment for exam, cleaning, etc. I told them I could no longer afford this twice a year. Eventally the calls became incessant so I wrote a letter and delivered it to the office. I also said I was looking forward to the Canadian Dental Plan so that I could make annual appointments. The calls stopped. I looked back on the dental work invoices from last year – replacing fillings. I don’t know why they have to take an x-ray everytime nor why they have to charge for a specific area examination when it is so obvious why you are there. Finally, I heard Dr. Waterbury express concern about how long the contract was – i.e. 7 pages. I just looked at my “Standard Form Lease” and it is 11 pages long. Maybe I’m just getting “long of tooth.”
How does our 1.2% uptake compare with other provinces across the country? Uploading to Sunlife is already in play, with current group insurance programs, so that part is not an issue. What about sharing program dedicated hygienists between dental offices. Having services scheduled one day per week for starters. I do think there are ways to make this easier.
Not sure I see how this adds significantly to the administrative load in a dentist’s office. It will operate as a dental insurance plan. You get the work done, the bill is processed immediately on line and the patient pays the difference. That all happens now in a dental office. The difference is a few more people with dental plans. The other option is of course to just pay the bill and submit the receipt for reimbursement. The dental office doesn’t even have to be involved in that.
I don’t understand why the provincial government doesn’t have some kind of a data processing/back office operation where all this paperwork could be done. There are plenty of administrative staff already working at the NSH/IWK/DHW and in doctor/dentist offices who could move into these jobs that already understand how the software works in these billing systems. It is the kind of work that has “work from home” stamped on it. The doctors and dentists complain about the amount of administrative burden these publicly funded programs put on them but play coy about their profit motive.
This is exactly what ruined this country; greed. Dentists are enabled by governments to pursue self interest above the common good. And we are also seeing this in the erosion of our health care system in general. Governments are unwilling to fund it properly ensuring equality of care regardless of ability to pay. Instead they do nothing to stand in the way of increasing privatization of health services. It makes me despair for a future which looks like it can only get worse.
“ I am hopeful this program will reach the point where I will be comfortable participating.” I think what Waterbury means is “as long as our margins are not impacted”. It’s appalling and disgusting that this profession continues to gouge patients. Instead of denying basic care to seniors, perhaps the association should consider finding ways to make this incredible opportunity for Canadians come to fruition.