Potential Oral Health Impact of Cost Barriers to Dental Care
The 2007/09 Canadian Health Measures Survey (CHMS) reports that the majority of dental care in Canada is privately financed and delivered on a fee-for-service basis, with 62.6 per cent of Canadians paying for dental care through employment-based insurance, 31.9 per cent through out-of-pocket payments, and 5.5 per cent through public funding. In turn, public dental care programs in Canada are generally only targeted to those that meet strict income eligibility criteria, such as those on social or disability assistance. Even among those that are eligible, coverage is typically for basic services and is largely limited to children and adolescents, and in most cases, only emergency treatment is provided to adults.
The public's experience with the affordability of dental care continues as a topic of major interest to policy stakeholders in Canada. It is argued that a significant minority of the Canadian population is likely to experience financial barriers to accessing dental care, especially among those who do not have any form of dental insurance. One study reported that 26 per cent of Canadian adults deem dental care cost-prohibitive, with 35 per cent of them mentioning check-ups, cleanings and fillings as treatments they required but could not afford. A study in 2009 collected data from working poor Canadian adults and demonstrated that almost 30 per cent of these individuals had been unable to afford dental care in the past, with 12.6 per cent of them reporting a competing need, having to sacrifice other spending (e.g. food) to pay for care. In a national sample of Canadian adults, Locker et al. demonstrated that 30 per cent reported avoiding or delaying dental visits, and 32.2 per cent reported not being able to receive all the treatment that was recommended due to cost.
In recent years, international studies have begun to highlight the impact that cost-prohibitive dental care needs can have on the health and general well-being of individuals. A survey conducted in the United Kingdom found that of the 43 per cent of respondents who reported avoiding the dentist due to cost, 26 per cent reported suffering long-term tooth decay, and 13 per cent reported suffering a periodontal abscess as a result. An Australian study observed an inverse relationship between dental visiting frequency and Oral Health Impact Profile (OHIP-14) scores, which evaluates the consequences of oral conditions across various dimensions, such as functional limitation, physical pain, and psychological discomfort. Results showed that differences in mean OHIP-14 scores between groups with low and high dental visiting patterns was greater than two-fold, indicating worse oral conditions among those who were unable to visit a dentist in a given year. Canadian authors, Locker et al. used a more direct analysis, and demonstrated that those reporting cost barriers to accessing dental care also reported worse oral health outcomes after controlling for private insurance coverage, household income, sex, age and education. Their results showed that the extent and severity of OHIP-14 scores increased alongside the number of positive responses to cost barrier questions. Most recently, Ramraj et al. showed that over a third of Canadians require dental treatment, with those who report cost barriers to dental care being 2.7 times more likely to have an unmet dental care need.
Prior to the 2007–09 CHMS, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The availability of this new data provides an opportunity to explore these barriers and their potential consequences. Thus, the aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care.
Background
The 2007/09 Canadian Health Measures Survey (CHMS) reports that the majority of dental care in Canada is privately financed and delivered on a fee-for-service basis, with 62.6 per cent of Canadians paying for dental care through employment-based insurance, 31.9 per cent through out-of-pocket payments, and 5.5 per cent through public funding. In turn, public dental care programs in Canada are generally only targeted to those that meet strict income eligibility criteria, such as those on social or disability assistance. Even among those that are eligible, coverage is typically for basic services and is largely limited to children and adolescents, and in most cases, only emergency treatment is provided to adults.
The public's experience with the affordability of dental care continues as a topic of major interest to policy stakeholders in Canada. It is argued that a significant minority of the Canadian population is likely to experience financial barriers to accessing dental care, especially among those who do not have any form of dental insurance. One study reported that 26 per cent of Canadian adults deem dental care cost-prohibitive, with 35 per cent of them mentioning check-ups, cleanings and fillings as treatments they required but could not afford. A study in 2009 collected data from working poor Canadian adults and demonstrated that almost 30 per cent of these individuals had been unable to afford dental care in the past, with 12.6 per cent of them reporting a competing need, having to sacrifice other spending (e.g. food) to pay for care. In a national sample of Canadian adults, Locker et al. demonstrated that 30 per cent reported avoiding or delaying dental visits, and 32.2 per cent reported not being able to receive all the treatment that was recommended due to cost.
In recent years, international studies have begun to highlight the impact that cost-prohibitive dental care needs can have on the health and general well-being of individuals. A survey conducted in the United Kingdom found that of the 43 per cent of respondents who reported avoiding the dentist due to cost, 26 per cent reported suffering long-term tooth decay, and 13 per cent reported suffering a periodontal abscess as a result. An Australian study observed an inverse relationship between dental visiting frequency and Oral Health Impact Profile (OHIP-14) scores, which evaluates the consequences of oral conditions across various dimensions, such as functional limitation, physical pain, and psychological discomfort. Results showed that differences in mean OHIP-14 scores between groups with low and high dental visiting patterns was greater than two-fold, indicating worse oral conditions among those who were unable to visit a dentist in a given year. Canadian authors, Locker et al. used a more direct analysis, and demonstrated that those reporting cost barriers to accessing dental care also reported worse oral health outcomes after controlling for private insurance coverage, household income, sex, age and education. Their results showed that the extent and severity of OHIP-14 scores increased alongside the number of positive responses to cost barrier questions. Most recently, Ramraj et al. showed that over a third of Canadians require dental treatment, with those who report cost barriers to dental care being 2.7 times more likely to have an unmet dental care need.
Prior to the 2007–09 CHMS, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The availability of this new data provides an opportunity to explore these barriers and their potential consequences. Thus, the aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care.