Filling the Cavities: Improving the Efficiency and Equity of Canada’s Dental Care System

Ensuring that all members of the community, including the poor, have access to urgently needed healthcare is a central objective of Canadian social policy. Yet, in the current system, there are many population groups in which individuals have difficulty accessing even urgently needed dental care. Moreover, the number of Canadians unable to access dental care is likely to grow rapidly in the next decade as the babyboom generation retires and loses insurance coverage, and the number of Canadians working in the gig economy, where benefits such as employersponsored health insurance are rare, rises. Lack of access to dental care may lead to substantial reductions in quality of life due to both the discomfort of oral pain, and the embarrassment associated with having bad breath or bad teeth. Furthermore, there is research to suggest that poor oral health may be a disadvantage in the labour market and also that there may be a link between oral health on the one hand, and heart disease, strokes, and certain forms of cancer, on the other. Untreated oral health problems also are responsible for a not insignificant amount of visits to primary-care physicians and hospital emergency rooms. We believe provincial governments should take inspiration from other countries and start moving toward some form of universal dental insurance coverage; in doing so they should also consider ways in which the dental services sector could become more competitive and efficient. Policy initiatives along those lines could yield major payoffs, in terms of both equity and efficiency. A straightforward way of creating universality would be to gradually expand existing public plans until they covered everyone in the population. However, universality does not necessarily mean that everyone must be insured through the same plan. As an alternative, we explore a mixed model with competition between private and public insurance. In our proposals to improve public dental coverage in Canada, we further scope out possible stumbling blocks in developing a broader public insurance plan, for example, controversies over what should be covered, and how public payment models and regulation could encourage more efficient service delivery.