Globerman: Why are ‘co-payments’ OK for dental care but not health care?

When assessing the Trudeau government’s new national dental plan, Canadians would be wise to reflect on how it differs — advisedly — from our ailing health-care system.

First, the dental plan is not intended to cover every Canadian — at least, not yet — and instead targets families with household incomes of less than $90,000; children; and uninsured seniors aged 87 and older. Gradually, the plan will cover all other uninsured Canadians, who will become eligible in 2025.

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Crucially, the federal plan won’t replace existing provincial and territorial programs that already cover some oral health services (although the provinces have not yet promised to continue funding those provincial programs after the federal plan goes into effect). Eventually, the federal plan is expected to cover up to nine million Canadians. In other words, even when fully implemented, it will only cover one-quarter of the population.

Second, families will contribute “co-payments” to help cover the cost of treatment. Specifically, families with household incomes between $70,000 and $79,999 will pay 40 per cent (out-of-pocket or through private insurance) of the cost of dental services such as cleanings, fillings and root canal treatments, while households in the $80,000 to $89,999 income bracket will pay 60 per cent. Families with household incomes below $70,000 are exempt from co-payments.

This approach stands in stark contrast to our health-care system. The Canada Health Act prohibits patient cost-sharing for services covered by provincial medical insurance plans. This prohibition distinguishes Canada from all other countries that provide universal health care, including countries that consistently outperform Canada on key indicators including wait times.

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In principle, cost-sharing encourages patients to be more prudent in their use of scarce health-care resources than they would be when the government covers all costs (as is the case in Canada). Of course, critics argue that cost-sharing will impose undue financial hardships on low-income families and patients with chronic conditions, which in turn might discourage those patients from accessing health-care services. But in fact, most countries with universal health care use co-payments, which are typically lower for lower-income families and essentially waived for vulnerable populations. It’s therefore curious that the Trudeau government sees wisdom in its co-payment requirement (conditioned on household income) for dental care but not for health care.

Finally, according to the dental plan, dentists will be able to bill the public plan while also treating patients covered by private insurance. Defenders of the health-care status quo in Canada have long argued that this type of “dual billing” will allow private insurers to woo away doctors from the public system and produce a two-tier health-care system that provides better and quicker care for wealthier Canadians.

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While a relevant concern, available evidence from other universal health-care countries suggests that the greater competition and additional investment accompanying a dual billing insurance system actually improves the efficiency of the public system and reduces wait times for all patients.

Federal Health Minister Mark Holland should tell Canadians exactly why co-payments and dual billing are good for his government’s national dental plan yet remain anathema for our foundering health-care system.

Steven Globerman is a senior fellow at the Fraser Institute.

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