Ottawa’s new dental care benefit offers lessons for health-care reform

Health-care reform remains a top issue for Canadians, behind only affordability. Canadians understand that simply throwing more money at health care won’t produce better results and that more fundamental changes are needed. Some insights on reforms can be gained in how the federal government designed its new national dental care plan.

According to an Angus Reid poll released in August, 66 per cent of respondents believe “there are bigger challenges that money can’t fix” in health care. Interestingly, 51 per cent of respondents indicated that the gains from Ottawa’s $46.2 billion injection of health spending will at “best” be “marginal.” Simply put, Canadians understand we need real changes in how health care is financed, regulated and delivered if we’re to achieve better results.

The data from international comparisons support these opinions. In 2020, among wealthy industrialized countries with universal health care, Canada ranked first (13.3 per cent) for the share of its economy spent on health care (adjusted for the age structure of the countries since age heavily influences health-care spending). In other words, as a proportion of all the goods and services produced in the economy in a single year, Canada was the highest spender on health care.

That spending, however, has not translated into comparable health results. Available data covering 2020 ranked Canada 28th of 30 countries on access to physicians, 23rd of 28 countries on hospital beds, 26th of 29 countries for MRIs, and last (among 10 countries) on wait times for specialist and surgical care.

Moreover, according to the latest annual measure of Canadian wait times, the median wait in 2022 for a patient from the time they visited a family physician to actual treatment by a specialist was 27.4 weeks—almost triple the wait time recorded in 1993 (9.3 weeks) when results were first published.

There are lessons from the Trudeau government’s new national dental benefit, which provides tax-free payments (of up to $1,300 over two years per child) to eligible families with children under the age of 18, and with household income below $90,000, and persons with disabilities. Currently, the program aims to provide resources directly to parents to help with the costs of their children’s dental care, though the Prime Minister’s Office has indicated intentions to extend the plan over time to cover more Canadians.

In Budget 2023, Ottawa estimated the cost of the program at $13.0 billion over five years starting this fiscal year (2023-24).

The lessons for health reform exist in what the Trudeau government did not do with its dental care benefit. It did not eliminate private insurance as was effectively done when universal health care was introduced. It did not nationalize dental facilities to minimize the private sector’s involvement in the delivery of dental care. And it did not bureaucratize the pricing of dental services. Instead, it left the existing dental care market largely untouched and simply provided eligible families with a cash transfer to allow them to purchase dental care in the existing market.

This basic design, which allows the market, even in a limited sense, to function, is the common approach in many high-income industrialized countries such as Switzerland that provide universal health care. That includes allowing private providers (i.e. physicians and hospitals) including entrepreneurs to figure out the best way to service patients, allowing prices—to varying extents—to be set through the interaction of health-care providers and patients, and allowing the entrepreneurial process to drive innovation while subsidizing health-care access for lower-income and vulnerable citizens.

Moreover, Canada itself has limited but successful experiences with harnessing the productive power of private providers within our universal health-care system. Consider, for instance, that Quebec in 2022 outsourced more than 1-in-6 day surgeries to private providers.

Or consider Saskatchewan’s Surgical Initiative (SSI) from 2010 to 2014, which used private clinics to deliver some publicly-funded surgeries at an average cost of 26 per cent less than comparable government facilities. The result was a dramatic drop in wait times for Saskatchewanian patients from 26.5 weeks in 2010 (longest outside Atlantic Canada) to 14.2 weeks in 2014, the second-lowest in the country.

Lessons abound, both within and outside of Canada, detailing the nature of the needed reforms in health care to deliver better results, and there’s increasing evidence Canadians are not only open to but supportive of such reforms.