By Carlos Quiñonez, Western University; Noha A. Gomaa, Western University; Paul Allison, McGill University; The Conversation
A 2023 technical brief developed by Canada’s dental associations notes that if employers walk away from these benefits en masse, CDCP costs could increase by $3.5 billion by 2025. (Pexels Photo)
Justin Trudeau’s resignation raises questions about the future of the Canadian Dental Care Plan (CDCP).
Proroguing Parliament until late March will have an impact. While existing spending for the CDCP will continue, the supplementary estimates tabled last fall that were waiting for parliamentary approval — about $317 million and $1.5 million respectively in new spending for Health Canada and Statistics Canada — will now be pushed to when Parliament reconvenes.
At that point, the government will face an automatic confidence vote and, if the government falls, the new spending will be lost at least for the short term as Canada moves into an election campaign.
In the unlikely scenario that the current government remains in power after Parliament resumes, it will be under a new leader following the March 9 Liberal leadership convention. That person might have a different vision for the CDCP or for new spending overall.
A prime minister’s resignation can foster a re-examination of policies and programs. With that in mind, we’ve outlined some possible scenarios that include what a new Liberal leader might do, or a new Conservative government if the Conservatives win a majority government as public opinion polls suggest.
1) Keep CDCP as is
This is arguably unlikely given the natural tendency for a new leader or government to reshape existing policy or programs in their image. Maintaining the status quo is an option, though, as programs like the CDCP generally have a built-in review period, so a new government could wait for such a review to take place and then consider changes moving forward. A new government will likely have other priorities to address, and choose to leave the CDCP to a later date.
2) Get rid of it
This is the starkest option. In this regard, the CDCP’s potentially escalating costs may be its greatest existential risk. For instance, in 2022, the federal budget proposed $5.3 billion over five years and $1.7 billion ongoing for the CDCP. In 2023, it was $13 billion over five years and $4.4 billion ongoing.
Some also point to the risks the CDCP holds for the employer-sponsored dental benefits market that the majority of Canadians access for care. A 2023 technical brief developed by Canada’s dental associations notes that if employers walk away from these benefits en masse, CDCP costs could increase by $3.5 billion by 2025.
At the low end of the brief’s estimates, a 10 per cent “de-insurance” risk could add $385 million by 2025. While these numbers could be inflated to prove a political point, costs will certainly be a concern for any new decision-maker when it comes to the CDCP.
There is also a political calculus. Governments tend to “impose losses,” such as program cuts, early on in their mandates. Yet this is balanced against the political risks of imposing losses in relation to health care, as well as the old adage that once you give something to someone, it’s hard to take it back.
In this light, scrapping the CDCP seems to be an extreme decision, especially as it targets low- and middle-income Canadians during a time when many have trouble meeting their day-to-day expenses. What’s more, seniors are in the mix, and this is a group with significant influence over some, if not all, political parties.
3) Let it die on the vine
Governments can erode programs to failure — whether by design or happenstance — simply by incrementally cutting funding over time. This can also be achieved by changing program eligibility, placing new financial or coverage limits on services or freezing what a program pays. This final measure steadily lowers program fees in relation to dental associations’ suggested fee guides, which increase yearly with inflation and/or other cost pressures.
This has happened before to public dental-care programs in Canada and elsewhere in the world. Canadian governments entered a state of retrenchment in the late 1970s and early 1980s, and this picked up steam with federal cuts to health and social transfers to the provinces and territories in the 1990s. Some programs disappeared altogether or were redesigned in ways that eroded eligibility, coverage, and/or provider reimbursement.
Over the past decade and longer, dental care in the United Kingdom’s National Health Service has been starved into crisis. That’s a possibility for the CDCP.
4) Change it
The CDCP could be redesigned in various ways. One possible option is to stop its phased implementation where it sits, meaning to refrain from expanding it to 18- to 64-year-olds, which was to happen in 2025. This would leave Canada with a national program targeting children, seniors and those qualifying as having a disability.
Another option is to place new eligibility, financial and service limits on the CDCP. This poses risks to government/dentistry relations and to the program itself if not done carefully, as it was these very issues — professional concerns over fair remuneration, services covered and administrative rules — that created significant consternation over, and had the potential to derail, the CDCP’s implementation.
The CDCP could be devolved to the provinces and territories. Provinces like Alberta and Québec may prefer this option given jurisdictional and other concerns.
But what would be devolved? If it’s just dollars, then there would be no guarantee that individual provinces and territories will use the money for dental care, especially amid other pressing health-care concerns. Earmarking these dollars, along with devolving the administration of the CDCP, would have to be considered to stave off this risk. That would probably require prolonged and complex negotiations.
Finally, there may be creative approaches to program design. Reducing the service basket while paying at or as close to 100 per cent of dental associations’ suggested fee guides is an option. Another is a variation on what dental associations have suggested in their technical brief: an oral health-care spending account that provides a recurring fixed amount of dollars over a fixed amount of time, with patients and clinicians free to decide how to best use the funds.
This could also be paired to an “essential” basket of services. Doing the work to define this basket would answer a longstanding question in oral health-care policy — what oral health care is “medically necessary” — and could be the basis for national standards in oral health care, which would be a welcome policy outcome.
To us, the oral health-care spending account approach — with or without the “essential” basket — is interesting because it could significantly lessen what is upwards of 75 years of adversarial relations between governments and dentistry concerning public dental-care programs.
All speculation
All the above is speculation, and inevitably there will be twists and turns in the months ahead for the CDCP. For our part, responsible decision-making means avoiding knee-jerk reactions.
Let an evaluation of the program take place and, in the meantime, concentrate on what has been learned in the CDCP’s short run. Namely, millions of Canadians have already benefited or will soon benefit from the CDCP — there are more than three million approved applicants and 1.2 million have received care. Furthermore, what can arguably be considered fair remuneration has led to more than 20,000, or about four in five, dentists participating in the program.
Canada needs investments in oral health care. Politics and economics aside, the CDCP is an essential step forward in Canadians’ oral health care. Continuing it in some form is the right thing to do.
Carlos Quiñonez, Vice Dean and Director of Dentistry, Schulich School of Medicine & Dentistry, Western University; Noha A. Gomaa, Assistant Professor, Schulich School of Medicine & Dentistry, Western University, and Paul Allison, Professor of Dental Public Health, McGill University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
