One of the big-ticket items in the most recent federal budget was the new NDP-approved dental care program. Since oral health falls under provincial jurisdiction, the announcement raises several questions as to the application of this program across the country.
Expanding access to dental care is a goal we can all get behind, especially when we consider that nearly 20 per cent of Canadians see cost as a barrier in this area. But the situation will not improve if the funds are used inefficiently. Certain guidelines, if followed, would increase the chances of achieving the best possible outcome.
First, for the sake of the health of our public finances, if the federal government is to introduce a permanent spending program like this, it must also cut its expenditures elsewhere by at least an equivalent amount. Failing to consider the extra strain such a program will impose on already heavily taxed Canadian families is irresponsible.
Moreover, the federal government must let the provinces organize the delivery of dental care and the distribution of funds. Not only is health care a provincial responsibility, but the provinces are in the best position to answer the needs of their population and adjust the program as those needs change over time. In other words, the dental care program must not take away the provinces’ ability to innovate in elaborating their public policies just because the financing comes from the federal government.
And speaking of elaboration, the dental care program should be modelled after Quebec’s current drug insurance plan. Specifically, this means having the government cover the cost, or part of the cost, of select dental services for those who do not already have dental insurance. Indeed, those who already have a good dental coverage plan, as many Canadians do, often through their employer, should not be forced to abandon it in favour of a government-run plan. This way, just as for prescription drugs, the province’s entire population would have dental insurance without limiting choice.
Including dentists and dental hygienists in the elaboration of the government-run program could also ensure that it is well-adapted to the realities of their profession. Surely, maintaining their professional autonomy is of the utmost importance.
It is worth mentioning that improving the accessibility of dental care can be achieved without increased spending. Introducing public policies that instead increase efficiency can also lead to greater access to health services.
A concrete example of such a policy is the autonomy that was finally granted to dental hygienists in Quebec in 2020 to allow them to work within their own clinics without the supervision of a dentist. Quebec was one of the last provinces in the country to do so, with Prince Edward Island alone now still prohibiting independent practice for these professionals. Entrepreneurship has therefore been encouraged across the country, likely reducing the cost of routine cleaning and thereby improving access to preventive treatments.
Achieving more with the immense amount of money we already spend on our provincial health care systems needs to be explored before resorting to increased spending. Other countries, such as the United Kingdom, can serve as models, as they have less costly universal health care systems that offer greater dental coverage than Canadian provinces currently do.
At the end of the day, we must avoid nationalizing dental care and instead provide coverage for those who can’t afford it. Creating a government-run monopoly would lead to the same problems we see elsewhere in our health care systems – long wait lists, shortages, an overabundance of bureaucracy – none of which will help improve the accessibility of this important service.
Maria Lily Shaw is an economist at the Montreal Economic Institute.