Socioeconomic Disparities In Dental Care

Price and socioeconomic status attributes to the disparities in health outcomes and utilization rate of dental services. The current oral health care model propagates and reinforces income inequalities through its financial structure. As mentioned above Canada’s oral health care is delivered mainly through private clinics, and therefore the vulnerable population experiences difficulty accessing care. Accessibility to dental care can be attributed to a number of factors as outlined below.

(1) LOW INCOME AND LACK OF INSURANCE:   A number of studies have linked poor oral health with low socioeconomic status. Affordability is identified as major challenge in accessing dental care. “For instance, 17.3 per cent of the whole population (i.e., approximately

6 million people) reports avoiding visiting a dentist in the last year due to the costs, and those living in the lowest income families report this as being a problem far more often than the highest income families (34 per cent vs. 9 per cent, respectively)”3.
Insurance and income are good predictors for the access and utilization of dental care.5 It is estimated that one third of Canadians do not have dental insurance, resulting in poor health and obvious inequalities.2 The past twenty years has seen major changes in dental insurances plans in terms of availability and quality.

Following the 1990’s recession as a means of cost saving companies changed dental coverage by “limiting of annual maximums and/or services, and/or through the introduction or expansion of deductibles, co-insurance or co-payments”5 Also, during this period availability of employment-based insurance decreased, as temporary and part time employment was increasing.5 This period of economic recession saw a marked increased in the cost and demand for dental service, yet wages remained stagnant for more than 20 years5.  In 1960 total per capita dental care expenditure was estimated at $6 and by 2008 it has increased to $50, a 730% increase.5

In 2009, dental insurance non-coverage was lowest among middle-income Canadians (48.7%). Also, this population reported experiencing the greatest barriers to dental care (34.1%), a 21.5% increased compared to 1996.5 “Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978.”3 Increase of lack of dental coverage is evident across most groups of Canadians, for instance no insurance for ages 16-11 and seniors (60-79) increase to 21% and 53%

respectivelively.6

(2) DECREASE GOVERNMENT FUNDING: The economic recession experienced in the 1980’s and 1990’s led to a reduction of public funding of oral health care.2 “Canada has undergone a period of economic difficulty in recent years. As a result, government began to look for areas where greater economic restraint could be exercised. Considerable pressures have been placed on health care programs because they represent relatively large expenditures. Dental public health programs are luxuries to politicians and nuisances to fee-for-service dentists. They are the last to expand when the budgets rise and the first to be cut when they fall”7
Since the 1960’s (Refer to Appendix A) public funding to dental care has been experiencing significant reduction. Dental care costs per capita have risen from $145.59 in 1975 to $398.90 in 2010. However, the share of public funds has lagged, rising from $10.82 in 1975 to only $19.54 per capita in 2010, 6 On the other hand, private sector spending practically tripled from $135, to $379 over the same time period.6 There is significant variation in per-capita figures across Canada, ranging from a low of less than $6 per person in Ontario to almost $350 a person in Nunavut in 2010”.6
In addition to reduced public funding, there is also variation in the social assistance available to vulnerable populations. There is no standardization in the care given to persons “deemed in social need”4. These variations include: Emergency coverage (relief of pain or infection), basic coverage (restorative and preventive); and a limited few, comprehensive coverage (restorative, preventive, and prosthetic)”8 The continuing variation in dental care is of concern as the most vulnerable populations dental care needs are not adequately addressed.

(3) LIMITED OR SHORTAGE OF DENTAL CARE PROFESSIONAL: It is common knowledge that many countries’ healthcare systems are experiencing shortage of qualified healthcare personnel, and Canada is no exception.

This shortage of dental professionals may be attributable to a number of reasons, namely migration and low enrollment of dental students. Canadians’ Aboriginal and immigrant populations are growing rapidly and both these populations are experiencing barriers to access dental care.

Across Canada some communities lack access to dental care because there is no oral health care provider in those areas.8 Rural and remote communities are particularly affected by shortage of dental professionals. In fact, these communities are served by only 13% of dentists or dental specialists.9 Communities that are experiencing a shortage of oral health care professionals, often rely on the service of physicians or nurses who may not have the required skills, knowledge and training in oral health care. 10. Dental service is often not available in most remote and rural communities across Canada, which means many residents would have to travel for long distances to access

care.