Cassie Baxter set her alarm early to claim a head-of-the-line spot in front of Northern Dental Care. The dentistry had announced a Dentistry From the Heart event for Sault Ste. Marie residents in need of free dental services. Cassie, who gets by on a fixed income and has no dental benefits, had waited three months to have a broken tooth looked at. About a dozen or so people arrived well ahead of the 8:30 event time.
The line-up was a sundry collection of people -a senior woman who was surviving on a meager pension, an underemployed professional, a poor sap just laid-off by CN railway, a couple of minimum wage earners. None of them had dental benefits and none had an extra couple hundred bucks- as an entry fee for the routine cleaning, to put towards their smile.
The gathering of people were chattering excitedly about finally having toothaches, loose crowns, wobbly molars and broken teeth addressed by a dentist. Shortly after 8 a.m. someone from within the dentist office broke the news- the event had been cancelled. There weren’t enough dentists to participate.
Dr. Carlo Biasucci, is the owner of Northern Dental Care. Dr. Biasucci announced the Dentistry From the Heart event at the end of August 2015. The one-day initiative was to be held in November and meant as a gift for those in need who required basic dental services such as fillings or extractions. Unfortunately, despite best efforts, Dr. Biasucci hit a couple of snags when planning for the day.
In an email reply, Dr. Biasucci summarized the difficulties in planning for the event. “We had some challenges after organizing the event where two doctors had to be out of town which would have left only myself. We couldn’t predict the demand that well in advance so we decided to hold off until we had firm commitments. We will actually be holding the Dentistry From the Heart event in the near future as we now have three dentists who are willing to participate –all work with me at NDC, including myself. We did have one doctor from outside of our practice interested and if he is able to participate that will be four dentists in total. We hope to make this event something we do at least annually.”
A quick look at the numbers below suggests that a significant percentage – possibly upwards of 25%, of Sault Ste. Marie’s population experience low-income, poverty or unemployment. For the majority of these folks dental care becomes a luxury –not a necessity.
According to the 2011 National Household Survey 22,730 individuals in Sault Ste. Marie are drawing annual earnings at the low-income cut off level. The number of people living in low-income households is 10,685. This discrepancy can be attributed to individuals drawing low-income earnings but living in a household where additional income is generated either by a partner or otherwise.
As of June 2015 Ontario Works (OW) reported a caseload in Sault Ste. Marie at 2,159. When expanded to include all person in those households it is found that 3,418 people are living in homes reliant upon support from Ontario Works. The Ontario Disability Support Program (ODSP) reports that 3,743 caseloads are carried in Sault Ste. Marie. The number refers to single individuals and family units. The total number of individuals living in homes reliant upon support from ODSP is not reflected in this number.
Information gathered by the Algoma Workforce Investment Corporation shows a 9.8% unemployment rate in Sault Ste. Marie during the month of May 2015. That’s 3,600 folks unemployed in a labor force consisting of 36,735individuals.
A quick internet search shows upwards of 50 dentists providing services in Sault Ste. Marie but options for folks without dental benefits finding a doctor to provide affordable oral health care is a disheartening experience.
In Canada, provisions for oral health care is not included in the Canada Health Act.
Some dental care requirements can be accessed through OW or ODSP though it is often at the discretion of the service provider. According to Ministry of Community and Social Services (MCSS), where a municipality chooses to provide dental services to adults, OW policy states that an Administrator may approve costs related to:
- emergency dental care (i.e., dental services which are necessary to relieve pain or for medical or therapeutic reasons); and
- dental care which supports the person’s employability or participation requirements (e.g., orthodontic and denture services).
MCSS also clarifies that administrators also have the discretion to determine the distinct services and treatments that may be provided under these parameters. Therefore eligible dental services and treatments for Ontario Works adults vary across municipalities. OW dental benefits, including mandatory and discretionary, are cost-shared with municipalities (the province currently contributes 91.4 per cent, which is expected to increase to 100% as of 2018).
Regarding dental care coverage through the Ontario Disability Support Program (ODSP), MCSS provides ODSP recipients, their spouses and dependent children with access to basic dental care (e.g. examinations, x-rays, fillings and extractions). The plan also includes the Dental Special Care Plan (DSCP) where ODSP clients, their spouse and children under the age of 18 and children whose parents receive Assistance for Children with Severe Disabilities (ACSD) on their behalf, may be eligible for additional or more frequent services in situations where their disability, prescribed medications or medical treatment directly affects their oral health.
Dental Expenditures for Ontario (2013-2014):
- MCSS provided $100.1 million for eligible clients on ODSP and Assistance for Children with Severe Disabilities (ACSD), which helped a total of 225,350 children and adults on ODSP and ACSD access dental services.
- Through Ontario Works, and based on discretionary decisions administered at the municipal/local level, $19.3 million was provided for eligible children whose parents are Ontario Works or whose guardians are Temporary Care Assistance (TCA) recipients. This portion is cost-shared with municipalities, of which the province contributed $16.7 million. $24.5 million was spent on dental care under discretionary benefits, of which the province contributed $21.2 million.
Dental Expenditures for Sault Ste. Marie (2013-2014):
For the year 2013-2014, $216,300 was paid out by the province and municipality to cover dental services for recipients of OW in Sault Ste. Marie. The City was responsible for $29,200 of that final bill.
- $73,400 for eligible children whose parents are Ontario Works or whose guardians are TCA recipients. This portion is cost-shared with municipalities, of which the province contributed $63,500. (9900)
- $142,900 was spent on dental care under discretionary benefits, of which the province contributed $123,600. (19300)
*Because ODSP is delivered provincially, MCSS was unable to further breakdown dental expenditures by municipality.
Dental services for youth 17 years and younger in Sault Ste. Marie can also be accessed at Algoma Public Health through the Healthy Smiles Ontario program. Services are also offered to OW recipients who are 18 years and older. Dental hygienists can provide assessments and preventative services- cleaning, topical fluoride and oral health education. Following assessment the client is issued a form to access treatment services by a provider of their choice
However, making it past the ‘administrator’s discretion’ is just the first hurdle when seeking out dental service through Ontario Works. Finding a dentist to take on the burdensome loss of your caseload is the next obstacle.
Dr. Biasucci is familiar with the criticisms from the general public regarding the inaccessibility of dental care in Ontario.
“All government plans are very limited, and most (OW, ODSP, Children In Need of Treatment) pay about half of the current fees. A comment we often hear is that ‘it’s all about the money’ – the reality is that the average dental practice has an overhead of 75%, so every dollar that comes in, 75 cents goes to pay the bills. If a plan pays 50 cents of that dollar, it’s a loss – how many people would pay to go to work? So the shortfall comes from dentist’s willingness to see patients in their office at their discretion, and all of us do. We just don’t openly accept those plans because if there were too many, something has to give…because this issue has been ongoing for as long as I have been in practice, we decided to take part in Dentistry From the Heart and the event that we are going to be holding,” writes Biasucci.
As of January 1, 2016, the following 6 publicly funded dental programs will be combined into the new Healthy Smiles Ontario program for youth aged 17 or younger from low income families, making it easier for eligible youth to receive timely oral health care. As of April 1, 2014, the government expanded eligibility for the existing Healthy Smiles Ontario program, making approximately 70,000 additional children and youth from low income families eligible to receive timely oral health care. The integrated program will be launched under the Healthy Smiles Ontario umbrella brand and will launch in January 2016.
While Dr. Biasucci remarks that the consolidation of plans is noteworthy he points out that there is long way to go before dental care is accessible to people of all income levels.
“There is no comment on whether the reimbursement rates will change. I hope they will,” writes Biasucci. “Including dentistry under the healthcare umbrella will not be feasible due to the sheer cost, and if the fees are grossly undermined to accomplish that, then it’s a mess – in healthcare most physicians practice in clinics or hospitals where all the equipment and overhead is paid by the taxpayer, in dentistry, it’s all paid for by the dentist – it’s completely different, it’s basically private healthcare.”
Information provided through MCSS indicates that the Ministry of Health and Long-Term Care (MOHLTC) will be monitoring service delivery of the Healthy Smiles Program. A statement from MCSS provides that MOHLTC is not increasing remuneration for fee for service provider fees at this time, the ministry is making program improvements to enhance the experience of participating providers including improved administration and a single fee/service schedule. MOHLTC will also be working actively with stakeholders and dental providers in the community to maintain and increase provider participation in the new integrated program.
“In the interim, dentists do take the access to care issue seriously and the city emergency call system is designed to see everyone who is having an emergency regardless of ability to pay,” commented Dr. Biasucci. “There are many ideas like public clinics being talked about. Who knows where it will go.”
And what of Cassie’s broken tooth? She’s planning on either tying her tooth to a knob and slamming the door or hoping to make a special payment arrangement with her family dentist. But in the meantime Cassie would like Sault Ste. Marie to come together to address the need of increasing accessibility to dental services.
“There’s a lot of events for children which is great for kids but there isn’t much in the way of support for adults,” notes Cassie. “As a City we should be looking at what the barriers might be and finding a way to bring those down. Let’s see what we can do to help this process along and get things happening.”