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Health

Canadian dentists desperate for details on federal dental care plan

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News release from Canada’s Provincial and Territorial Dental Associations

Canadian dentists to MPs: We need answers about the Canadian Dental Care Plan

Lack of consultation with provincial and territorial dental associations is worrying

There are only two months left before the Canadian Dental Care Plan (CDCP) becomes available to many more Canadians. Yet more than 25,000 dentists nationwide are in the dark about how the Government of Canada will safeguard access to dental care.

In a letter sent to Members of Parliament (MPs) this week, the presidents of provincial and territorial dental associations across the country asked how the government will:

  • Safeguard employer-provided dental plans that two-thirds of Canadians currently have access to?
  • Ensure that a strong federal program can be coordinated with existing provincial programs?
  • Protect patient choice and maintain the patient-provider relationship?
  • Ensure minimal, efficient administration that promotes timely access to care?
  • Respect the costs of delivering dental care to maximize provider participation?
  • Increase the number of dental assistants and dental hygienists to meet the demands of the CDCP?

Dentists want to champion a CDCP that will respect patients, providers, and taxpayers. The provincial and territorial dental associations are concerned that the CDCP has been compromised by a lack of meaningful consultation with dentists – who will be expected to deliver on the government’s promises.

The CDCP is currently in final planning stages, with a potential rollout in 2024 that will attempt to increase access to uninsured Canadians under 18, people with disabilities, and seniors who have an annual family income of less than $90,000. Dentists believe all Canadians need access to dental care. If not done properly, two-thirds of Canadians who have great employer-provided dental plans could lose their coverage and be forced into a worse plan. Costs would then skyrocket, which means the $13 billion over five years the government set aside would not be enough to sustain the plan.

Let’s take the time to get it right. We can increase access to dental care right now through an expansion of the interim measure already in place – the Canada Dental Benefit. This establishes a fixed dollar amount that a patient can use to be reimbursed for dental-related expenses.

Facts:

  • Canada’s provincial and territorial dental associations represent more than 25,000 licensed dentists working in more than 16,000 offices. They treat more than 30 million Canadians every year and employ at least 50,0001 oral health care workers.
  • Over 60 per cent of Canadians have a dentist they visit on a regular basis.2
  • A recent survey commissioned by Health Canada found that nearly nine out 10 Canadians are satisfied with the Canada Dental Benefit.3

Quotes:

“To succeed, this plan needs to work for both patients and providers, and to work in each province. What we are recommending is based on decades of experience and caring for the oral health needs of the more than 30 million people that come into our dental offices across the country every year.” — Dr. Bruce Yaholnitsky, President, Alberta Dental Association

“Poorly designed programs do not improve access to care, and they leave the most vulnerable people in society behind. This is an historic opportunity, but only if the government gets it right. Dentists have the expertise, experience, and skills to know what it takes to ensure good oral and overall health.” — Dr. Rob Wolanski, President, British Columbia Dental Association

“As dentists we are excited to be a part of this Canadian dental care program, but there are key critical issues that need to be included for this program to be successful.” — Dr. Scott Leckie, President, Manitoba Dental Association

“New Brunswick dentists are already extremely busy with the recent spike in population and the backlog in demand for services related to Covid-19. This program was intended to provide dental care to the 35 per cent of Canadians who are uninsured. It needs to be easy to understand and to administer, and to be fair to all parties, including patients, dental care providers and taxpayers. Canadians need to know what benefits are being provided and which are not, before they arrive at the dental clinic.” — Dr. Joanah Campbell, President, New Brunswick Dental Society

“The new program must be sustainable in terms of funding, and easy to understand and access. It has to be patient-centred and work for everyone.” — Dr. Shane Roberts, President, Newfoundland & Labrador Dental Association

“While the CDCP has the potential to improve the lives of many Canadians, this can only be achieved if it’s done right. To ensure the greatest possible outcome, we must consider all of the moving pieces and take a patient-centred approach.” — Dr. Juli Waterbury, President, Nova Scotia Dental Association

“The CDCP could be a game-changer for Canadians’ access to dental care. But we have one chance to get it right. Here in Ontario, we have seen that dental care programs developed without the input of dentists are doomed to fail. Just look at the Ontario Seniors Dental Care Program, where waiting lists are up to two years long in some areas, and some patients have to travel ridiculously long distances to receive treatment.” — Dr. Brock Nicolucci, President, Ontario Dental Association

“This new program has the potential to improve access to care for many Canadians. It must be sustainable, patient-centred, and easy to access for patients. A poorly designed program will not improve access to care which is something we would like to avoid. We want this to work for Canadians.” — Dr. Derek Thiessen, President, College of Dental Surgeons of Saskatchewan

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COVID-19

FDA requires new warning on mRNA COVID shots due to heart damage in young men

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From LifeSiteNews

By Doug Mainwaring

Pfizer and Moderna’s mRNA COVID shots must now include warnings that they cause ‘extremely high risk’ of heart inflammation and irreversible damage in males up to age 24.

The Trump administration’s Food and Drug Administration (FDA) announced it will now require updated safety warnings on mRNA COVID-19 shots to include the “extremely high risk” of myocarditis/pericarditis and the likelihood of  long-term, irreversible heart damage for teen boys and young men up to age 24.

The required safety updates apply to Comirnaty, the mRNA COVID shot manufactured by Pfizer Inc., and Spikevax, the mRNA COVID shot manufactured ModernaTX, Inc.

According to a press release, the FDA now requires each of those manufacturers to update the warning about the risks of myocarditis and pericarditis to include information about:

  1. the estimated unadjusted incidence of myocarditis and/or pericarditis following administration of the 2023-2024 Formula of mRNA COVID-19 shots and
  2. the results of a study that collected information on cardiac magnetic resonance imaging (cardiac MRI) in people who developed myocarditis after receiving an mRNA COVID-19 injection.

The FDA has also required the manufacturers to describe the new safety information in the adverse reactions section of the prescribing information and in the information for recipients and caregivers.

Additionally, the fact sheets for healthcare providers and for recipients and caregivers for Moderna COVID-19 shot and Pfizer-BioNTech COVID-19 shot, which are authorized for emergency use in individuals 6 months through 11 years of age, have also been updated to include the new safety information in alignment with the Comirnaty and Spikevax prescribing information and information for recipients and caregivers.

In a video published on social media, Dr. Vinay Prasad, director of the Center for Biologics Evaluation & Research Chief Medical and Scientific Officer, explained the alarming reasons for the warning updates.

While heart problems arose in approximately 8 out of 1 million persons ages 6 months to 64 years following reception of the cited shots, that number more than triples to 27 per million for males ages 12 to 24.

Prasad noted that multiple studies have arrived at similar findings.

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Business

National dental program likely more costly than advertised

Published on

From the Fraser Institute

By Matthew Lau

At the beginning of June, the Canadian Dental Care Plan expanded to include all eligible adults. To be eligible, you must: not have access to dental insurance, have filed your 2024 tax return in Canada, have an adjusted family net income under $90,000, and be a Canadian resident for tax purposes.

As a result, millions more Canadians will be able to access certain dental services at reduced—or no—out-of-pocket costs, as government shoves the costs onto the backs of taxpayers. The first half of the proposition, accessing services at reduced or no out-of-pocket costs, is always popular; the second half, paying higher taxes, is less so.

A Leger poll conducted in 2022 found 72 per cent of Canadians supported a national dental program for Canadians with family incomes up to $90,000—but when asked whether they would support the program if it’s paid for by an increase in the sales tax, support fell to 42 per cent. The taxpayer burden is considerable; when first announced two years ago, the estimated price tag was $13 billion over five years, and then $4.4 billion ongoing.

Already, there are signs the final cost to taxpayers will far exceed these estimates. Dr. Maneesh Jain, the immediate past-president of the Ontario Dental Association, has pointed out that according to Health Canada the average patient saved more than $850 in out-of-pocket costs in the program’s first year. However, the Trudeau government’s initial projections in the 2023 federal budget amounted to $280 per eligible Canadian per year.

Not all eligible Canadians will necessarily access dental services every year, but the massive gap between $850 and $280 suggests the initial price tag may well have understated taxpayer costs—a habit of the federal government, which over the past decade has routinely spent above its initial projections and consistently revises its spending estimates higher with each fiscal update.

To make matters worse there are also significant administrative costs. According to a story in Canadian Affairs, “Dental associations across Canada are flagging concerns with the plan’s structure and sustainability. They say the Canadian Dental Care Plan imposes significant administrative burdens on dentists, and that the majority of eligible patients are being denied care for complex dental treatments.”

Determining eligibility and coverage is a huge burden. Canadians must first apply through the government portal, then wait weeks for Sun Life (the insurer selected by the federal government) to confirm their eligibility and coverage. Unless dentists refuse to provide treatment until they have that confirmation, they or their staff must sometimes chase down patients after the fact for any co-pay or fees not covered.

Moreover, family income determines coverage eligibility, but even if patients are enrolled in the government program, dentists may not be able to access this information quickly. This leaves dentists in what Dr. Hans Herchen, president of the Alberta Dental Association, describes as the “very awkward spot” of having to verify their patients’ family income.

Dentists must also try to explain the program, which features high rejection rates, to patients. According to Dr. Anita Gartner, president of the British Columbia Dental Association, more than half of applications for complex treatment are rejected without explanation. This reduces trust in the government program.

Finally, the program creates “moral hazard” where people are encouraged to take riskier behaviour because they do not bear the full costs. For example, while we can significantly curtail tooth decay by diligent toothbrushing and flossing, people might be encouraged to neglect these activities if their dental services are paid by taxpayers instead of out-of-pocket. It’s a principle of basic economics that socializing costs will encourage people to incur higher costs than is really appropriate (see Canada’s health-care system).

At a projected ongoing cost of $4.4 billion to taxpayers, the newly expanded national dental program is already not cheap. Alas, not only may the true taxpayer cost be much higher than this initial projection, but like many other government initiatives, the dental program already seems to be more costly than initially advertised.

Matthew Lau

Adjunct Scholar, Fraser Institute
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