The president of the British Columbia Dental Association says just 15 per cent, or one in seven dentists across the province is registered in a soon-to-be-launched national dental care program.
“The reality is you’re going to need participation at close to 50 per cent to make the program really accessible and viable,” said Rob Wolanski of the problematic uptake rate among B.C. dentists for the Canadian Dental Care Plan (CDCP). The plan will offer basic dental coverage to anyone reporting family net income of less than $70,000 and a sliding scale of discounts to anyone earning between $70,000 and $90,000.
But Wolanski said dentists have not been fully informed on the program’s terms and conditions and as such the association is advising dentists to hold off on enrolling until that information is provided by the federal government.
“We don't even know what all the issues are, because a lot of that stuff in our agreement was signed behind closed doors,” said Wolanski.
There are several problems at play for dentists, said Wolanski.
“This program wasn't created because a government had planned this well in advance,” said Wolanksi.
“It was done for purely political reasons, right, for the supply agreement [the NDP] had with the Liberals. So what that meant is they had to move fast,” he asserted.
Wolanski said the government appears to have taken the non-insured health benefits (NHIB) program for First Nations dental coverage “off the shelf” and mirrored it. The problem is that in B.C. the NHIB program was scrapped by the First Nations Health Authority for its own, more successful model, in 2019.
The problems began when provincial associations across Canada were not able to discuss the program with their members until October as the government imposed non-disclosure agreements on negotiations. Those NDAs have been rescinded, said Wolanski, but details of what the government plans for the program are not yet known and dentists who do register will be subject to the regulations.
One initial concern has been compensation. Wolanski says dentists now know that, on average, they will be compensated roughly 86 per cent for the work they do on eligible patients. Some procedures will be compensated at close to 100 per cent while others only at 40 per cent of what they charge patients (and their private insurers, if applicable) at the current fee structure.
Wolanski said most dentist offices run with overhead costs of about 70 per cent, so what may seem like minor reductions in fees equate to much larger bites into office salaries and investments.
Wolanski said rural dentists could feel the greatest brunt of the program fee structure: “Offices could absorb that if it's a small percentage, but if it's a large percentage, you're in trouble.”
Dentists, said Wolanski, already have a number of initiatives that take up about two per cent of their revenues, from seniors’ discounts to existing provincial subsidies and pro bono work for vulnerable patients.
Wolanski said he is wary of not just the fee structure eating into overhead costs but also the burden on staffing, which is already a critical issue in offices across the province.
For starters, Wolanski said it’s unclear to the association how front-end staff are supposed to monitor billing and eligibility with the program’s administrator Sun Life.
“In a normative dental plan, the relationship is between the insurance company and the patient. This program changes that relationship and they want to establish the relationship between the insurance company and the dentists,” he said. “All the risk of falls onto the dentist.”
How dentists are compensated and what administrative measures they will need to take are details that have yet to be fully fleshed out by the government, he said.
Another problem, at least in the short-term, has been political messaging around the program, said Wolanski. By this he means that the public is getting the impression they can get free dental work.
“It’s not a normalized dental program, it’s a subsidized care program. And by that what I mean is a subsidized care program has characteristics designed to reduce costs. And the minister has said ‘we have to respect taxpayers' money,’ and we get that. But the way they do that is typically two ways: they reduce fees and they reduce the number of procedures that can be covered,” said Wolanski, noting orthodontic work is not covered, for instance.
“It's not free dental care. It is going to have a cost associated with it, and for patients we can't even tell them what that cost will be because it will all depend on what happens moving forward,” said the Nanaimo-based dentist.
One matter that could alleviate concerns is what government has called an “alternate pathway” whereby a dentist may not enrol in the program but still direct bill Sun Life for an eligible patient.
However, even this alternative pathway comes with risks because it’s understood the dentist will have to agree to the terms and conditions of the program, which could mean unnecessary bureaucracy, including exposure to audits, said Wolanski.
According to the government, “most services covered under the CDCP will be available in May 2024 when the first cohort of successful CDCP applicants will begin to receive services. Some oral health services such as crowns, which require pre-authorization will be available beginning in November 2024.”
The government states the plan will cost $13 billion over the next five years and $4.4 billion moving forward annually. About nine million Canadians will be eligible for some discount.
