Funding UK Dentistry: Lessons from Canada
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- Published: Tuesday, 27 August 2024 09:27
- Written by Peter Ingle
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We now know that the promised discussions between the profession and Department of Health and Social Care are under way to try and make progress on NHS dental contract reform. The first meeting has taken place between Shawn Charlwood, Eddie Crouch, and Stephen Kinnock, Minister of State with responsibility for primary care.
One of the most pressing challenges they face is how to get dentists to stay, or even return, to NHS work. Not an easy task, when the available funds are restricted and expectations are high. A recent story from Canada may illustrate a low cost way of winning dental hearts and minds.
The Canadian Dental Care Plan is a dental insurance programme funded by the Government of Canada to provide dentistry services to uninsured Canadians that meet certain criteria. About 35% of Canadians do not have private dental care insurance, so would have to pay for treatment at the prevailing rates. As a result many have been unable to access dental care.
The plan represents a major expansion of Canada’s universal health-care system. It is expected to eventually cover one in four low- and middle-income Canadians without access to private dental insurance plans.
It is a recent innovation and had begun with a staggered rollout as specific age bands were invited to apply. Despite promised funding of $13 billion over the next five years there were problems finding dentists willing to work under the plan. A survey of licensed dentists in March 2024 by the Canadian Dental Association found that 61% would not register to provide service under it. The government opposed a proposal by dental associations to have patients pay dentists directly, and then be reimbursed by the plan insurance programme. Then in April 2024, the Canadian Government dropped the requirement for dental care providers to register for the programme, instead requiring only that they agreed to direct bill the insurer for services provided under the plan.
The number of dental clinics signing up was low at launch, prompting concerns about its ability to meet patient demand. Following changes to the plan made in July 2024, more than 70 per cent of dentists are now accepting patients under the plan, a steep increase over the 50 per cent participation rate reported just a month before.
The dramatic improvement is attributed to changes introduced in early July that allowed dental clinics to submit claims without having to officially register as a provider of the plan. The changes have offered clinics the option of accepting patients on a case-by-case basis, allowing them to keep current patients who otherwise would need to seek out clinics registered with the programme.
More than 6,500 oral health-care providers have chosen to take part in the plan since the rule change, with dentists, denturists and independent hygienists able to provide care to patients covered by the plan, and then to be reimbursed on a case-by-case basis.
A statement from the Canadian Dental Association said: "The federal government has addressed some immediate and short-term concerns, and we are committed to continuing our work with them to further enhance the CDCP for the future.”
After deciding to remove one universal UK benefit, the winter fuel allowance, our own government may find more of interest in the Canadian plan.
Applicants for the Canadian Dental Care Plan must have an adjusted family net income of less than $90,000, with co-payments required from those with a $70,000 to $90,000 income. Those wishing to benefit from the plan must be a Canadian resident, and have filed a tax return the year preceding coverage in the programme.
There is another lesson from the Canadian experience that may not be welcome to those in government who are banking on the increased use of DCP’s helping them to cut costs. The Canadian Dental Hygienists Association is not happy with the fee structure, which reimburses dental hygienists at a lower rate than dental clinics operated by dentists.
Image credit - Tharso Vieira under CC licence - not modified.
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