Canadian Dental Care Plan

This May, the Canadian Dental Care Plan (CDCP) will begin covering a portion of dental care costs for eligible seniors. Up to nine million uninsured Canadians, or a quarter of the population, will qualify for the plan by 2025. The government has committed $13 billion to the CDCP over the next five years, a massive government investment that represents the most centralized, comprehensive oral health care policy in Canadian history. 

In many ways, the relationship between dentists and the CDCP is like any other private insurance policy. From the perspective of the provider, the upsides are very similar: it is not restrictive, participation in the plan is entirely voluntary, and providers can end their participation at any time if they wish to do so.  

Further, just as when private dental insurance was introduced, the CDCP will significantly increase the number of patients able to access dental care, a shared benefit between patients who seek care and providers who wish to grow their practices. The CDCP expands the pie by increasing the per capita dental spend.  
The CDCP and private insurance plans both face similar challenges, primarily the administrative complexity inherent in their management. Additionally, patients under the CDCP may opt to adhere to the plan's guidelines to avoid incurring additional fees, even if this means disregarding the recommendations of their oral healthcare provider. 
These downsides are already familiar to dental practices and can be lessened by sharpening processes and improving communication. Overall, it is evident that the CDCP was designed to feel very much like private insurance. 

But the CDCP isn’t private insurance. It is a public plan, and with that comes unique challengesThe first is the fee guide. Provincial dental associations set their own fee guides that inform private insurance plans. In order to be responsible to taxpayers, the CDCP has published its own guide that recommends fees below what is recommended by provincial associations. Their fee guide is much more in line with existing provincial fee guides (reimbursing up to 90% of the recommended fee) than past public programs, but for some practices this difference is enough to disincentivize their participation in the plan.  

For many practices, balanced billing tips the scale in favour of participating in the CDCP. If the cost is fully understood, expected, and within the means of the patient receiving treatment, there’s no reason why the patient’s experience with the CDCP wouldn’t be positive. The patient receives the same quality of care at a much lower price and doesn’t have to deal with the hassle of switching offices. The provider is fully compensated, retains a patient, and participates in this historic initiative to improve access to care.  

Many providers will find the CDCP complements their business models. Practices currently accepting other public health plans will find that compensation through the CDCP better reflects the real cost of care. Practices that are under-capacity will find that treating new patients at 90% of fee guide is more profitable than an empty chair. And, practices that are busy but have patients who wish to avail of the CDCP will likely find it worthwhile by taking advantage of balanced billing. 

In short, there is nothing in the plan, as it exists today, that oral health care providers cannot successfully navigate. Why then do many providers, even those whose practices would benefit, hesitate to see CDCP patients? It is the politics around the plan that are difficult to navigate.  

The CDCP, because it is a public plan, represents a loss of autonomy in what is a primarily self-regulated industry. The past five years have been massively challenging for health care providers of all kinds, who have had to adapt to centralized public health measures regardless of whether they are public or private providers. Public providers have been particularly strapped for resources, to the point of compromised care, and private providers are wary of any step along that path.  

It is important to stay grounded in the present, and to focus on the particulars of the CDCP. The pragmatic reality is that the needs of nine million Canadians will always take precedent over the concerns of 20,000 dentists.  The dental market just got bigger. With government investment and the right approach, oral health care professionals can successfully ride this wave of change in the industry.