Dental insurance isn’t always enough

The CDCP doesn’t cover people with insurance. A new Faculty study shows that leaves a gap

By Diane Peters

The new Canadian Dental Care Plan offers coverage to people with lower incomes who don’t have dental health insurance.

It’s a game changer for dental public health in Canada and could transform oral health and overall health for millions.

But Sonica Singhal, U of T Dentistry assistant professor and graduate program director for Dental Public Health, knows that access to care is never straightforward.

“I had a hypothesis that some people are falling through the cracks. I wanted to dig deeper to see if it’s really a problem and what can be done about it,” says Singhal of the CDCP.

Since most private dental insurance comes with limits as well as co-pays of between 20 and 50 per cent, she worries that people with low incomes who have benefits experience barriers to care. These people are ineligible for the CDCP.

She recently published “Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study” in the journal BMC Oral Health.

To the best of the knowledge of Singhal and her co-author, Mona Abdelrehim, research associate with the One Smile Research Program at the Faculty, this is the first Canadian study to look specifically at attributes of people with private dental insurance, who face barriers to accessing oral health care.

The researchers looked at 17,789 people in Ontario who have private insurance, via the 2017–18 Canadian Community Health Survey. They assessed these people’s financial barriers to dental care and perceptions of their oral health.

While the majority of people with dental insurance regularly go to the dentist and report good oral health, they discovered that 11.5 per cent of people with dental insurance experience cost barriers to accessing dental care. Meanwhile, more than 20 per cent of those who make below $40,000 have barriers.

They found 5.7 per cent of people visited the dentist only for emergencies. Again, those with the very lowest incomes reported this more often: 13 per cent for people making between $20,000 and $39,999 and 17 per cent when they make less than $20,000.

The vast majority of the people in the study had reported good oral health, with just seven per cent overall saying it was “fair to poor” and 5.3 per cent “dissatisfied or very dissatisfied” with their teeth or denture appearance. The lower income brackets saw more people in these situations, self-reporting oral health that is much less than ideal, with the most worrisome being 15.2 per cent of those making less than $20,000 saying their oral health was not good.

The study analyzed how much demographics factor into access to care and oral health, too. “Young people who are earning less than $40,000 are among the most disadvantaged, even though they have private insurance,” says Singhal. “Young people might not be in the best jobs because they’re just starting out and are early in their careers.”

People with higher paying jobs may get access to more robust insurance programs, while the co-pays might also be a less of a problem because of their higher incomes. The study notes that while many people still have private dental insurance, the quality of coverage has declined in recent years in Canada, which puts low-income people at a disadvantage.

Singhal is satisfied that she found proof of her hypothesis that excluding all people with dental insurance from the federal program leaves gaps. She’d like to see her research — and other dental public health evidence-based insights into this new program — influence policy.

Her suggestion, she says, is quite simple: the government already sets out three different levels of coverage under the CDCP, offering different percentages of coverage based on income — so just add more. People in households making under $40,000 should gain access to the plan, whether they have dental insurance already or not. The way Healthy Smiles Ontario works in Ontario, there can be coordination of benefits with private insurance companies, where the CDCP can be the payer of last resort.

This is a small group of just seven per cent of respondents to the health survey, as insurance coverage is correlated to income. So it’s a not a big financial commitment for the government to fill this gap and support this at-risk group.

“Just make one more level. I think this study has built a really good case with compelling evidence for the government,” says Singhal.