It’s just not enough. That’s what local non-profit and community assistance programmers are saying about the first dental fee guide to come out in Alberta since 1997.
Pushed by the provincial government, the Alberta Dental Association and College (ADA&C) updated the guide, which lowered prices by an average of 8.5 per cent. The recommended cost of a recall oral exam is now $65.
By comparison, the price of a recall exam in B.C. is $29.
Darryn Werth, senior director at Calgary Urban Projects Society, or CUPS, says the new pricing guide does nothing to help the most marginalized in our society, including those who are homeless.
He says that unlike our public health care system, where anyone can seek resources in walk-ins and hospitals, the dental system is out of reach for those most vulnerable.
“A public health policy is about physical health,” says Werth. “But, oral health is way off to the side — it’s not even part of the conversation.”
Denise Kokaram agrees. As program lead for The Alex dental bus, which provides no-cost preventive oral health services for youth and children, she says the new fee guide doesn’t fix the huge gaps in oral health access and equity.
The Alex dental bus program lead, Denise Kokaram, says, while the fee guide is a move in the right direction, it doesn’t help Calgary’s, and the province’s, most vulnerable groups such as the working poor. “It’s the biggest disease that we see in children. It’s one of the most prevalent diseases in adults,” she says. The Alex Dental Bus provided services at 41 identified high-need schools last year, and saw almost 1,600 children. The program has almost 200 people on a waiting list at any given time. Photo courtesy of The Alex.
She adds while it’s a step in the right direction, the working poor are among the most underserved and hardest to cater to, but tend to have higher decay rates, averaging about 50 per cent of all clients that come to The Alex.
“I think they’re the ones that are really falling through the cracks because there aren’t enough resources in place,” she says.
Exacerbating the issue is the fact that the working poor often don’t have an option for insurance coverage at all.
This means an individual or family can be above federal or provincial poverty lines on paper, but in reality, they have no additional resources available to support them.
“It’s different for everybody that has different situational things happening within their environment that put them into that sphere,” says Kokaram. “But, how do you clearly identify them?”
Albertans face highest dental costs in Canada
Albertans face the highest costs in Canada, confirmed by Alberta Health assistant director of communications, Robert Gereghty.
He says Albertans are concerned with the high costs of prices, which led to the recent review.
The Government of Alberta website states, “Dental fee guides increase transparency, which encourages competition and reins in costs over time.”
But at the end of the day, Alberta’s dentists don’t have to follow the fee guide and it is up to the consumer to shop around to find those dentists who do.
Communicating with the Calgary Journal through an email Q&A, he added that most dentists in other provinces have aligned their fees with the local guides.
Dr. Randall Croutze, CEO of the ADA&C, says the fee guide is created based on economic trends, including inflation and the consumer price index, as well as consultation with stakeholders.
He adds that while Alberta saw a decrease in the recommended cost for dental procedures, other provinces have seen an increase of “six to eight per cent to their dental fee guides.”
In addition, Croutze says Alberta’s average dental profits and costs are comparable to other provinces.
Meanwhile, Werth adds the average Canadian still needs to top-up costs out of pocket when they go through major dental surgery, but that same person could undergo massive body surgery and not worry about an after-service bill.
“We’re saying the two are different, and I’m saying the two are the same,” he says. “It’s about physical health.”
Poor oral and dental health can lower self-esteem and make it harder to find jobs and be successful in interviews. It can also lead to future long-term health problems, such as heart disease and respiratory illness.
And children have been more susceptible to dental issues like cavities and abscesses in both primary and adult teeth.
A contributing factor to poor dental health
Werth adds that in addition to economic strains, the increase in children requiring major dental restoration and extractions is a result of Calgary’s decision to reverse the fluoride treatment of the drinking water in 2011.
“Your health really does start at the mouth,” he says. “Everything that we take into our bodies to keep our bodies healthy comes through the mouth. So, that whole oral cavity needs to be cared for as a part of your full health of the body, and yet, it’s not.”
The lack of regulation of pricing with the dental industry, says Werth, creates a “Wild West” atmosphere, as dental clinics can set their own prices, despite the creation of a fee guide.
But, there are pockets of individuals within the industry that are starting to open up the conversation.
Kokaram is part of a collaborative group established this summer, called OH-CANA (Oral Health Collaborative Action Network of Alberta). The network’s goal is to improve the conversation about oral healthcare and think innovatively about how the industry can change.
With a provincial election looming, she says she would like to see what each party declares how it would improve access to dental health for working people making less money.
“These are the people whose backs our communities are built on,” says Kokaram. “They’re the backbone that we stand on and those are the backs that are being broken trying to make ends meet.”
Q&A WITH ALBERTA HEALTH
Robert Gereghty, assistant director, communications – media relations
Question from reporter: What was the motivation to change the fee guide?
Answer from Robert Gereghty: “Albertans told us they were concerned about the high cost of dental services. As a result, the Alberta government undertook a dental fee review, which found that Alberta’s high costs are the highest in Canada. All other jurisdictions have a dental fee guide. Prior to 2018, Alberta had not published a fee guide since 1997.”
Q: How is the fee guide used to persuade dentists to lower/change their prices?
A: “The intent of Alberta’s dental fee guide is to bring more transparency to dental pricing, give Albertans a tool to talk to their dentists about their cost of care and to bring dental fees in the province more in line with those across Canada.”
Q: How does Alberta now compare to other provinces in dental prices?
A: “The 2018 Dental Fee Guide suggests an average 8.5 per cent decrease in pricing for dental services. Preliminary data suggests a measurable shift in pricing towards those fees recommended by the 2018 Dental Fee Guide appears to be occuring while national average prices continue to increase, narrowing the difference.”
Q: The Government of Alberta website says the fee guide is to create competition between clinics, but with some of the highest prices in the country, and an established expectation by the citizens of higher prices, how does the recommendation do that without setting regulated standards?
A: “Similar to other Canadian jurisdictions, dental fees in Alberta are not regulated, and this has not changed with the re-introduction of a fee guide into the Alberta dental services market. In other jurisdictions, the majority of dentists align their fees with their fee guide.”
Q: Why aren’t there regulations backing up the new fee guide? Is there anything the government can do to hold the dentists/clinics to account?
A: “The Alberta government will continue working with the Alberta Dental Association and College to bring Alberta’s dental fees in line with those of other provinces.”
Q: What is the incentive for dentists to follow the fee guide?
A: “Albertans can ask their dentist how their fees compare to those recommended by the fee guide and seek out a dental services provider that best meets their needs.”
Q: How has the fee guide benefited Albertans? Has the fee guide effected significant change?
A: “Albertans can use the dental fee guide to help them save money on the dental services they need. Preliminary data suggests a measurable shift in pricing towards those fees recommended by the 2018 Dental Fee guide appears to be occurring.”
Q: What is the Ministry of Health and AHS looking at for the future to ensure continued transparency, affordable pricing and competition, especially with a provincial election around the corner?
A: “In the coming years, the Alberta government will continue to work with the Alberta Dental Association and College to bring Alberta’s dental fees in line with those of other provinces. To effect a continuing change in Alberta’s dental services market, the dental fee guide will be reviewed on an annual basis.”
Editor: Amber McLinden | amclinden@cjournal.ca