Financial barriers in accessing dental care (an example of technical writing for a very specific group)

Social determinants of health frameworks have tended to diminish the role of health services, focusing more on living and working conditions, on the inequitable distribution of income, power and autonomy, and on the psychosocial consequences of such inequities. While these are fundamental to the health of populations and require immediate attention, it is still estimated that twenty-five percent of the differences in health status between advantaged and disadvantaged groups is to be found in differences in access to health care. Lantz et al, while recognizing that there is more to health than health care, state that access to care is a ‘necessary component of population health’. Braveman and Gruskin also consider health care ‘a key social determinant of health’. For dentistry, access to care may be even more significant, simply because of its effectiveness in immediately relieving pain and restoring function when dealing with common oral infections (e.g. toothache), and in its ability to prevent disease with relatively simple and proven modalities (e.g. fluoride varnish). To be sure, using data from a national population health survey in Sweden, Wamala et al demonstrated that access to dental care explained sixty percent of the socioeconomic differential in oral health of those aged 21 to 84 years, while lifestyle factors explained only twenty-nine percent.

In Canada, medical care is funded through provincially managed public insurance programs and free at the point of delivery, yet dental care is predominantly private with only approximately five percent of current expenditures on dental services coming from public programs. Data from national health interview surveys indicate that approximately half of the Canadian population 15 years and over is covered by employment-related dental insurance plans. However, there is substantial variation across individual plans in terms of which services are covered and the extent of deductibles and co-payments. Since this coverage is a benefit of employment in specific occupations or by specific employers, it is also not present in all employment circumstances and may be lost when people change jobs or retire. In terms of the public sector, only approximately five percent of the adult population has their dental care paid for by provincial government or municipal programs, usually as part of social assistance or welfare provision. Such individuals are usually, but not exclusively, from low-income groups. The remainder of the adult population, approximately forty percent, must then pay for care out-of-pocket, which from the point of view of access raises the issue of affordability.

Recent policy attention has been given to this issue, especially within the context of working poverty. Policymakers have argued that a significant minority of the adult population is likely to experience financial barriers in accessing dental care, especially when they do not have dental insurance, public or private. This study seeks to obtain information on the issue of affordability in general. Its importance lies in the fact that financial barriers are perhaps the most amenable to change by government policy and programs or professional intervention. The specific objectives of this study are to document the percent and characteristics of adult Canadians who encounter financial barriers to dental care, to assess the associations between income, dental insurance and financial barriers, and to assess the consequences of these financial barriers in terms of the use of services and health outcomes.