Abstract
Background: In Canada, most dental care is privately financed through employment-based insurance, with only a small amount of care supported by governments for groups deemed in social need. Recently, this low level of public financing has been linked to problems in accessing dental care, and one group that has received major attention are the working poor (WP), or those who maintain regular employment but remain in relative poverty. The WP highlight a significant gap in Canadian dental care policy, as they are generally not eligible for either public or private insurance.
Methods: This is a mixed methods study, comprised of an historical review of Canadian dental care policy and a telephone interview survey of WP Canadian adults.
Results: By its very definitions, Canadian dental care policy recognizes the WP as persons with employment, yet incorrectly assumes that they will have ready access to employment-based insurance. In addition, through historically developed biases, it also fails to recognize them as persons in social need. Our telephone survey suggests that this policy approach has important impacts in that oral health and dental care outcomes are significantly mitigated by the presence of dental insurance.
Discussion: Canadian dental care policy should be reassessed in terms of how it determines need in order to close a gap that holds negative consequences for many Canadian families.
Key words: Dental care, public policy, insurance, working poverty
Résumé
Contexte: Au Canada, la plupart des soins dentaires sont financés par les régimes d’assurance des employeurs; seule une petite partie de ces soins est subventionnée par l’État pour les groupes ayant besoin d’une aide sociale. Récemment, ce faible niveau de financement public a été lié à des problèmes d’accès aux soins dentaires; l’un des groupes les plus en vue à cet égard est celui des petits salariés, qui demeurent relativement pauvres malgré leur emploi. Le cas des petits salariés fait ressortir une lacune importante dans la politique canadienne de soins dentaires, car ces personnes ne sont généralement admissibles ni à l’assurance privée, ni à celle de l’État.
Méthode: Cette étude fait appel à plusieurs méthodes, dont un rappel historique de la politique canadienne de soins dentaires et une enquête téléphonique auprès de petits salariés canadiens d’âge adulte.
Résultats: Dans ses définitions mêmes, la politique canadienne de soins dentaires reconnaît que les petits salariés ont un emploi, mais présume à tort qu’ils ont facilement accès aux régimes d’assurance fournis par les employeurs. En outre, en raison de biais historiques, cette politique ne les reconnaît pas comme des personnes ayant besoin d’une aide sociale. Selon notre enquête téléphonique, ces orientations stratégiques ont d’importantes répercussions, car la santé bucco-dentaire et les résultats des soins dentaires sont significativement mitigés en l’absence d’une assurance dentaire.
Discussion: Il faudrait revoir la détermination des besoins dans la politique canadienne de soins dentaires, afin de combler une lacune qui a des conséquences négatives pour de nombreuses familles canadiennes.
Mots clés: soins dentaires, politique publique, assurance, petits salariés
References
- 1.Canadian Institute for Health Information. National Health Expenditure Trends, 1975–2005. Ottawa: Canadian Institute for Health Information; 2005. [Google Scholar]
- 2.Blackwell T. Extend dental coverage, doctors urge. Toronto, ON: The National Post; 2007. [Google Scholar]
- 3.Picard A. The Globe and Mail. 2007. Doctors’ orders: Expand medical coverage to long-term care. [Google Scholar]
- 4.Welsh M. The Toronto Star. 2007. He has a new smile; system still in decay. [Google Scholar]
- 5.Human ResourcesSocial Development Canada. When working is not enough to escape poverty: An analysis of Canada’s working poor. Ottawa, ON: HRSDC; 2006. [Google Scholar]
- 6.Bhatti T, Rana Z, Grootendorst P. Dental insurance, income and the use of dental care in Canada. J Can Dent Assoc. 2007;73:57. [PubMed] [Google Scholar]
- 7.Gullet D. A History of Dentistry in Canada. Toronto, ON: University of Toronto Press; 1971. [Google Scholar]
- 8.Social Science Federation of Canada. Historical statistics of Canada. Section B: Vital Statistics, Table B82–92. Ottawa: Statistics Canada; 1983. [Google Scholar]
- 9.Naylor D. Health care in Canada: Incrementalism under fiscal duress. Health Aff. 1999;18:9–26. doi: 10.1377/hlthaff.18.3.9. [DOI] [PubMed] [Google Scholar]
- 10.Canadian Dental Association. A submission to the Royal Commission on Dominion-Provincial Relations. Ottawa: CDA; 1938. p. 14. [Google Scholar]
- 11.Canadian Dental Association. Health insurance. J Can Dent Assoc. 1943;9:227–29. [Google Scholar]
- 12.Canadian Dental Association. Health insurance bill at coming session. J Can Dent Assoc. 1948;14:158. [Google Scholar]
- 13.Canadian Dental Association. Fluoridation. J Can Dent Assoc. 1956;22:164–68. [Google Scholar]
- 14.Author unknown. Does Bill 320 affect dentistry? J Can Dent Assoc. 1958;24:415–16. [Google Scholar]
- 15.Government of Canada. Royal Commission on Health Services. Ottawa: Government of Canada; 1964. [Google Scholar]
- 16.Guendelman S, Angulo V, Oman D. Access to health care for children and adolescents in working poor families: Recent findings from California. Med Care. 2005;43:68–78. [PubMed] [Google Scholar]
- 17.Guendelman S, Pearl M. Access to care for children of the working poor. Arch Pediatr Adolesc Med. 2001;155:651–58. doi: 10.1001/archpedi.155.6.651. [DOI] [PubMed] [Google Scholar]
- 18.Williamson D, Fast J. Poverty status, health behaviours and health: Implications for social assistance and health care policy. Can Public Policy. 1998;24:1–25. doi: 10.2307/3551727. [DOI] [Google Scholar]
- 19.Williamson D, Fast J. Poverty and medical treatment: When public policy compromises accessibility. Can J Public Healt. 1998;89:120–24. doi: 10.1007/BF03404403. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Reesor M, Lipsett B. Employer-sponsored health and dental plans–Who is insured? Publication no. W-98–2E. Ottawa: Applied Research Branch, Human Resources Development Canada; 1998. [Google Scholar]
- 21.Sciadas G. The digital divide in Canada. Ottawa: Statistics Canada, Science, Innovation and Electronic Information Division; 2002. [Google Scholar]