UPDATE: Since this story was published, Sun Life, which manages the Canada Dental Care Plan (CDCP), has released a list of providers by location on its website, HERE.
The much-lauded CDCP is set to start covering seniors who qualify in just over a week, but area resident Margaret-Anne Baker wonders whether dental care providers in Muskoka will sign on.
Baker said her dental office has indicated it will not join the program because, as the Ontario Dental Association (ODA) states, there are too many uncertainties.
As of last week, there was no list available for qualifying seniors to see which dental care professionals had signed onto the plan near them. “This program starts on May 1st; you’d think there would be a list available,” said Baker last week. A list has since been released, but the uptake in Muskoka has been slow.
That’s because, according to Dr. Brock Nicolucci, President of the Ontario Dental Association, the dental community has concerns. They include having to sign an open-ended agreement with Health Canada to offer the plan and the human resources required to manage it. He questioned why the plan doesn’t follow patients rather than requiring dentists to sign up.
“It allows the dentists to have a relationship with the patient, not with the government,” said Nicholucci. “We were brought to the table at the 11th hour… after they develop a plan, then they bring us to the table.”
In a conversation with Health Canada staff, they noted that the voluntary plan would not work without the dental healthcare practitioners and indicated that Health Canada is working through some of their concerns. Staff also noted that putting the onus on patients to pay out of pocket and then get reimbursed, rather than the care provider, is not realistic; many may not have the funds.
“One in four Canadians have reported avoiding visiting an oral health care professional because of the cost. The Canadian Dental Care Plan (CDCP) will help ease financial barriers to oral health care for up to 9 million Canadians,” stated Christopher Aoun, with the office of the Minister of Health, via email.
“We know that oral health care professionals are critical in ensuring the success of the plan. Health Canada and the Minister of Health Mark Holland have personally met with each association to consult on the program since 2022. We are working collaboratively to make it a success for everyone. We are excited to see that thousands have already chosen to sign up and support our efforts. We are continuing to have meaningful conversations with providers who want to ensure that Canadians have access to oral health care.
“It is easy for providers to participate, the CDCP works like existing systems that providers use when direct billing private insurance plans. Providers can visit Sun Life and complete a quick form to confirm their participation. Similarly to private insurance, once they are set up in the system, they will receive payment from Sun Life within 48 hours of submitting their patient’s visit. However, we have heard that some oral health care providers would like to be involved but don’t want to have to register. We are looking at an alternate way they can help provide care without registering and will have more to share on this new option soon,” according to Aoun.
More information about the plan is HERE.
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brian tapley says
A good idea. I always wondered why dental and optics were sort of left out of OHIP in the first place.
So, what is likely to happen here?
If some politician reads this they might let me know, it is there job. Tamara has my email.
Thomas R Spivak says
Unless I missing something here, from what I’ve been reading the dentist’s are being a bit selfish and if they need only register them what’s the problem?
Paying up front is not an option for for many people and dental care is paramount to good health.
Come on, both sides need to get on the ball with this fast.
Dr. Fares Sbaiti says
To those who are wondering, we have identified 15 different set of issues with the plan. The most important ones are:
1- the basket of services is very limited, restrictive, and encourages supervised neglect and teeth loss. It’s more like: see you once a year to take out a few teeth. That is not oral health
2- privacy issues: Sunlife will have access to your medical and dental records. So they can decide who to increase premium on, or who to refuse coverage (for other types of products they offer). They can also audit offices and launches college complains on us.
3- the program is not free to people, but the government isn’t telling you that. Patients are paying anywhere from 30 to 70 percent of the cost. I imagine seniors yelling at me in my office saying “Trudeau said free”
4- 13 billion for 5 years divided by 9 million that’s $288 per person a year. It can’t be unlimited! CDCP will collapse in 18 months as the average spending per patient in our office as per our association is $1100
5- the government plans to ruin dentistry similar to what they did to medicine and daycare (10/ day program). How’s our medical system working for you? All of that to get more votes and leave a ticking time bomb to the next government
6- the CDCP compensates us barely our true cost to provide service.( average 79% of our customary fees) . We fear other insurance carriers will follow suit so privately insured patients will have to pay more out of pocket. It’s lose, lose, lose, for everybody
7-they’re asking us to sign an open ended contract, that can change unilaterally anytime. Would any of you sign a blanc lease? Why should I? Do you trust the government? Why should I?
8- paperwork and admin tasks are unbelievably complicated. And the wording of the agreement makes it our responsibility to check eligibility, coverage, cost and do the math on the day of service.
This is just a sample. The devil is in the details
Paul Whillans says
Dr. Sbaiti:
I find your submission very unfortunate
The Ontario Dental Association proudly declares : “We advocate with a unified voice for accessible and sustainable optimal oral health for all Ontarians.”
According to Health Canada, 33% of Canadians do not have dental health care coverage (likely more in Huntsville due to our demographics….so 7000+ people). As well 25% of Canadians have “avoid dental care” due to the cost (again likely higher in Huntsville….so 5000 +).
To be clear, no one is asking you to change your pricing….. NO ONE…
I do agree that some of Health Canada’s communication has implied that the services cover 100%. But any investigation of the CDCP at all clearly shows that 100% is not on the table. Here the CDCP is completely honest and open.
But here is the reality……In Huntsville, I estimate that roughly 25% of the population avoids dental care, suffers through the pain and potentially life threatening consequence that may follow, largely because they are poor. The government has offered to pay and estimated 80% of those costs for the less fortunate. But it only works if dentists in town agree.
Multiple times you then have asked “why would I” the short answer is simply that you are a professional and you
(We) advocate with a unified voice for accessible and sustainable optimal oral health for all Ontarians.
Norm Raynor says
When I was young my family was very poor. Welfare type poor. My mother would bring me from Kearney to Huntsville on a Saturday to a dentist named Dean Murdy. Dr Dean fixed my teeth and didn’t charge an arm and a leg to do it. I am not so sure that the government didn’t pay his bill. That was the 1960’s. Are there any dentists around like Dean Murdy anymore?
Fares Sbaiti says
Hi Mr. Whillans,
I apologize if my post missed the point. I focussed on what it meant to us/dentists, but I did not expand enough on why the CDCP is terrible for people. I am well aware there are vulnerable people that cannot afford emergent dental care, let alone necessary preventative or optimal care. That’s why the Ontario Disability Program and the kids Healthy Smiles make 10% of my patient base. These programs have some issues, and they pay 27% to 40% of our customary fees, but most dentists I know participate. Definitely higher participation rate than the CDCP by far.
“We advocate with a unified voice for accessible and sustainable optimal oral health for all Ontarians.” And that is what we are doing. Hear me out:
I know we are allowed to bill our customary fees under the CDCP (so the patient pays the difference) and the government is giving coverage to potentially 9 million unfortunate Canadians. This means we should expect an extra 9 million patients knocking on our office doors at full fee. We just hit the jackpot! We shouldn’t say no to that. However, 13 Provincial and Territorial Dental associations, their presidents, and 90% of the dentists in the country are saying NO. Why? Because we want an “accessible and sustainable optimal oral health l’ program.
We tried to sit down with the ministry but we were shut down. Our dental association (ODA) contact the minister of health to present an accessible, sustainable and optimal oral health program many times between may and December 2023. The ministry brushed them off saying, and I quote “We are consulting our experts and we don’t need you now”. Mr. Holland only agreed to discussing with the ODA (and other association) very late in the process, after the details were out and the dentists voiced their rejection that showed low uptake.
The CDCP is not Optimal: The minister said the plan covered what’s essential. I disagree:
1- Spacers for kids aren’t covered. It’s an unexpensive preventative appliance that prevents teeth impaction, jaw restriction which could lead to restricted airways, grinding, and future need for braces.
2- Only one cleaning a year is covered. some need 2, 3, or 4 a year.
3- Kids are covered for 7-10 minutes cleaning a year. It simply cannot be done
4- Fluoride is covered once a year for kids. Literature showed that high cavity risk kids need 4 application a year to be effective. (once a year is a total waste btw)
5- Polish once a year does not prevent cavities in kids. Literature proved we need 2.
6- Night guards are not covered. literature out of BC showed that more than 80% of adults grind their teeth in the last 4-5 years. Cracks are a major reason for tooth loss.
7- 80% of the root canals are caused by cavities and 20% or so because of cracks but the CDCP does not covere night guards or Root canal when the patient has other cavities. That makes no sense!
8- Root canals are not covered if the person has gum issues. But the plan coerage is not enough (once a year) to prevent gum issues.
We all know if its not covered, then the patient will not get the service.
The CDCP is not sustainable. I will have to be political here:
If you follow the math in my first comment ($13b divided by 5 years by 9 million= $288 per person per year). By the time we get the first complete assessment, xrays, cleaning, your bill is $700. Budget gone! How can the program cover fillings and dentures in addition to that?
The program is designed to collapse in 18 -24 months right in time for the first budget of the next government. Pollievre cannot keep it as is. He will have to either spend 5 times more to keep it or to cut it and look bad. That’s ticking time bomb.
The CDCP is not easily accessible. 90% of dentists refused to participate for fear of:
1- The terms and conditions of SunLife: intrusion, privacy violation, clawback…
2- The risk of undermining private insurance: many employers, small, medium, and big companies are discussing cutting their employee dental benefit so they could save cost. The ODA was just informed that RBC is negotiating with Greenshield to cut dental off their employees plan. So the 9 millions can become 25 millions. The government doesn’t seem to care.
3- The balance billing will not last. The same way it did not stay for physicians in the 1986. At the time their right to demonstrate was taken away as well! You should remember if you are old enough.
4- The unilateral contract is truly scary. we are not required to agree to anything when we submit private insurance claims. why a contract, and why unilateral that can be modified at any time
All we are asking is for the ministry to sit down with the dental association to discuss a well rounded basket of services that scientifically meet the needs of our population while respecting our autonomy. I urge everybody to contact their MP so we can design a long lasting public dental program.
Please feel free to comment. I will check back in a few days.
Reagrds
Paul Whillans says
Dr Sbaiti:
Initially allow me to thank you for your reasonable response. I wish all public discussions and discourse could be as civilized.
I too wish to hone my arguments with a few points.
First, I believe that you have misinterpreted/misstated the position of the Dental Associations. They have not said “No”. The Canadian Dental Association (of which all provincial associations are members…as such, you are as well) has said “.“CDA is committed to working with the federal government to maximize the CDCP, a once-in-a-lifetime opportunity to enhance Canadians’ access to oral health care,” .Clearly the CDA wishes the success of the CDCP; even if it means helping the CDCP to grow in their image. None of this can happen if dentists refuse to participate.
As an aside, I even old to remember, the Canadian Medical Association stating in 1962 that they were against any publicly funded health care system. Indeed Saskatchewan Doctors went on a 23 day strike to protest Saskatchewan’s publicly funded health care insurance plan….And look where we are today. I fear dentists are choosing to be today’s health care obstructionists.
With respect to “sustainability”….I would note that the government estimates of the cost to set up the programme are $13.5 billion over 5 years. However, there estimate is that the programme will cost $4.4 annually going forward. Using your methodology, this represents $488 per patient per year. According to the CDA, in 2015 the average Canadian spent $378.60 per year on dental care. Using the CPI, dental inflation calculator over the past 9 years, That cost has risen to $500.12. Certainly the planned $488 per patient cost of CDCP is well within the 80% coverage of the average $500 expenditures.
But all that is numbers………I am 71 years old. I am the 20th decile of income. I haven’t had a dental plan for 3 decades. As a result, I haven’t been to a dentist since 1992 (however ensuring that my children received any and all dental care that they need….priorities). Today, my molars are broken and I suffer toothaches periodically. I have no way of knowing the condition of my oral health.
I mention this to suggest that in my world, I may certainly agree that the CDCP is not “optimal” (of course I would prefer 100% coverage….even 120% would be better). But in your example, $700 initial assessment is a barrier for me, but $140 out of pocket is a great deal.
And as far as I can see the ONLY thing between me and dental care is you and your colleagues. I note that as of today (4 days before the launching of the CDCP), SunLife has identified only 2 dentists (of the dozens ODA listed) willing to participate in the CDCP.
How then is not the dentists that are the problem?
Eleanor Douglas says
After reading the comments preceding submission of our names, etc., I think that with the large percentage of people at or below the poverty line in Muskoka, financial assistance is desperately needed by the government to provide funds for dental care to needy families. The cost of living has increased too much for many poverty stricken families in Muskoka. Dental costs are prohibitive for these families and seniors with no private plan. It’s a very serious, sad situation. Fortunately, I have a dental plan, but my sympathy is huge for those who do have a plan.
Thomas R Spivak says
Thank you Paul Whillans, When I was a kid and in early in Muskoka a dentist office was a brick office between the cabinet shop and the real estate office and now they are million dollar edifices that look like they belong on the shore of Lake Muskoka.
Sorry dentists, you and Galen Weston are taking a bigger bite than deserved.