Report to/Rapport au :
Ottawa
Board of Health
Conseil de santé d’Ottawa
Monday 19 September, 2011/le lundi 19 septembre 2011
Submitted by/Soumis par :
Dr./Dr Isra Levy,
Medical Officer of Health/Médecin chef en santé publique
Contact
Person/Personne-ressource :
Dr./Dre Vera Etches, Associate Medical Officer
of Health/Médecin adjointe en santé publique
Clinical
Programs/Progammes cliniques
Ottawa Public Health/Santé
publique Ottawa
613-580-2424, ext./poste 23675, vera.etches@ottawa.ca
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ACS2011-OPH-CP-0003 |
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SUBJECT: |
ACCESS TO DENTAL HEAlTH
SERVICES FOR ADULTS WITH LOW INCOMES |
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OBJET : |
ACCÈS À DES SOINS DENTAIRES POUR LES
ADULTES À FAIBLE REVENU |
That the Board of Health for
the City of Ottawa Health unit:
1. Approve that a letter be sent to the Ministry
of Health and Long-term Care, on behalf of the Ottawa Board of Health, advocating
that the Healthy Smiles program be expanded to cover the families of children
currently enrolled in the program; and
2. Direct
Ottawa Public Health staff to explore options for further expanding the
provision of preventive dental care and early-stage dental treatment to adults with
low incomes.
Que le Conseil de santé du Service de la santé de la Ville d’Ottawa
1.
donne son approbation afin que soit
envoyée au ministère de la Santé et des Soins de longue
durée, au nom du Conseil de santé d’Ottawa, une lettre recommandant que le
programme Beaux sourires soit étendu aux familles des enfants qui y participent
déjà;
2.
demande au
personnel de Santé publique Ottawa d’examiner des options en vue d’élargir
davantage l’offre de soins dentaires préventifs aux adultes à faible revenu et
que ces derniers reçoivent des traitements à un stade précoce.
Executive SUmmary
In October 2010, the Province of Ontario launched Healthy Smiles Ontario (HSO), a program that offers a full range of preventive dental services and early treatment for low income children, aged 17 years or younger. Ottawa Public Health (OPH) is requesting that the Ministry of Health and Long-term Care (MOHLTC) expand this program to cover the families of children currently enrolled in HSO.
Poor oral health has been associated with major health concerns. Lower income families and those with no insurance report that they are 3 to 4 times more likely to not obtain dental care than higher income Canadians. Expanding the current program in Ottawa could reach approximately 8,900 low-income adults. This could translate to cost-savings for the Province, given regular dental visits are cost effective. Every $1 invested in this preventive measure yields approximately $38 of savings in unnecessary dental treatment for families and the health care system.
Background
Oral health is a key component of overall health, as poor oral health
has been associated with major health concerns, such as diabetes, respiratory
and cardiovascular diseases. Although the oral health of most Canadians has
improved over the past 30 years, some groups continue to have limited access to
dental services and as a result carry a higher burden of dental disease. As
with many diseases, oral health problems and oral cancer are more prevalent
among those who experience barriers to accessing treatment, whether financial,
physical, socio-cultural, geographic or legislative.
For dental health care in
Canada, socio-economic factors determine dental care utilization and are
associated with poorer dental health outcomes. The Canadian Health Measures Survey,
2007-2009, reported that compared to higher income Canadian families, those from
lower income families have almost two times worse oral health outcomes as
measured by, among other things: the number of decayed (i.e. unfilled) and
missing (due to disease) teeth among adults and highest level of build-up,
stains, tartar and gingivitis. The
survey also found that almost 47% of lower income Canadians with natural teeth
require one or more types of treatment. However, lower income families and
those with no insurance report that they are 3 to 4 times more likely not to
obtain dental care than higher income Canadians. Canadians with lower income
face significant financial barriers to accessing dental health services. This
is largely due to two factors: 50% of lower income Canadians do not have any
dental insurance, and unlike most Canadians, lower-income Canadians do not have
workplace health insurance to cover dental services nor do they have the money
to pay for out-of-pocket dental expenses.
Benefit of regular
dental visits
Regular visits to a dental professional is one of the recommended steps
to maintaining good oral health. These visits, which include preventive
counselling and early identification and treatment of dental problems, are
cost-effective for the following reasons:
·
Every $1 invested in this preventive
measure yields approximately $38 of savings in unnecessary dental treatment for
families and the health care system;
·
Treating a dental
disease in its early stages is both less complex and less expensive than
waiting until it becomes a serious emergency, and;
·
People with
good oral health are able to eat better, have fewer days of missed work and
lost income, may have greater self-confidence, which results in better overall
health.
Provincial and Local Dental Health Programs
for Low Income Adults
Currently, the Province of
Ontario funds a limited range of emergency or urgent dental services for low-income adults who qualify for Ontario Works funding. In addition the
province cost-shares a limited range of denture services for adults eligible
for Ontario Works and Ontario Disability Support Program.
Dental Health Programs in Ottawa for Adults
with Low Incomes
OPH is one of the
few Ontario public health units directly offering dental care to clients; this
model has been chosen as a cost-effective way to handle dental needs of clients
receiving social support from the City. OPH offers access to dental treatment
for low-income adults at three dental clinics located throughout the City, which
have been in operation since 1970. In 2010, OPH assessed and treated 6,200 adults for
emergency dental services and assessed and treated an additional 1,500 for
specific dental issues such as denture services. OPH dental staff also provide oral health education to adults when they
present for emergency treatment, in order to try to reduce future urgent dental
health needs.
Currently, OPH, in
collaboration with the City of Ottawa’s Community and Social Services
Department, provide low-income adult residents with dental services through one
of three access points:
1. Essential Health and Social Supports program: Social
Services assesses low-income families and seniors to determine if they financially
qualify for access to OPH’s dental clinics. Services provided include emergency
examinations, fillings, extractions and denture services. This program is primarily
used by low-income seniors to access denture services.
2. Ontario Works: Adults eligible for Ontario Works
can access dental services at OPH clinics for emergency services (e.g.
treatment of pain, infection, fillings or extractions; and denture services).
3. Ontario Disability Support Program: Adults eligible
for Ontario Disability Support Program can receive basic level of services
(e.g. check-ups, cleanings and routine procedures) at private dental offices.
However, many patients express difficulty in finding a dentist that will accept
them under this plan, as the fees reimbursed are lower than dentists usually
charge.
Gaps in the provision of affordable,
accessible primary dental care for adults with low incomes
Despite a number of programs available, there are still many adults in
Ottawa who cannot afford the cost of dental treatment and therefore do not
access dental services. Overall, of low-income people living in Ottawa, there
are an estimated 53% of adults (aged 18 to 64 years) and 82% of seniors (aged 65 years
or older) that do not have dental health insurance to cover all or part of
their dental expenses.
In addition, adults eligible for Ontario Works receive emergency dental
care, however, general examinations, preventive care, counselling and other
primary dental services such as root canals, crowns, and bridges are not
covered. Unfortunately, for the majority of low-income patients, dental
problems often progress until the patient presents with a more serious
condition that requires intensive work at higher cost.
DISCUSSION
Enhancing Dental Programs for
Low-Income Families
In 2010, the Association of Local Public Health Agencies (alPHa) requested the Government of Ontario provide a dental program for low-income families, with a renewed focus on Ontario’s low-income adults.
In
October 2010, the Province of Ontario launched HSO program which offers a full
range of preventive services and early treatment for low income children, aged 17 years or younger. In 2011 alPHa requested
that the MOHLTC expand the eligibility criteria for HSO to include all children
from low-income families, including children whose family currently have some
form of dental benefits, as the requirement to initially pay out of pocket has
been recognized as a barrier to service.
Expanding the Healthy Smiles
Ontario Program to Include Families
HSO currently allows some educational outreach and oral health education to parents of children who are clients of the program. However, only a limited number of services can be provided by these means, and many needs remain unaddressed.
In Ottawa, it is estimated that expanding the current program to include families of HSO-eligible children could reach approximately 8,900 low-income adults. The estimated cost to the province to provide preventative and treatment services to the family members of children enrolled in HSO would be about $3 million based on the projected uptake of the program, and estimating $370/person for acute treatment and $300/person for preventive service. This is compared to the estimated cost of about $7 million to provide preventative and treatment services to all adults (ages 18-64 years) in Ottawa living on low-incomes of $20,000 or less who do not have dental health insurance.
As enrolment of the targeted number of children in the HSO program is projected to take about two years, the additional cost of serving adults of the HSO-enrolled children may be accommodated within existing budgets, or the additional funding required to serve the adults may be phased in over a number of years.
The provision of dental services, including preventive dental care, to adults with lower incomes should be strengthened, for the following reasons:
·
Dental health problems are caught
earlier which reduces the need for more extensive treatments;
·
Staff can efficiently reach a large
number of patients with preventive services;
·
Parents are grateful for the education
and counseling OPH provides because they are provided with the information and
skills to help themselves and their family take care of their dental health;
and
·
Helping parents can help the entire
family, since parents are major influencers of healthy habits for other family
members.
OPH has considered several approaches to strengthen the provision of dental services to low-income adults, which has resulted in the recommendations made in this report.
OPH will continue to
work with the HSO Working Group, including Community Health and Resource
Centres, and dental stakeholders, including the Ottawa Dental Society, to implement
an expansion of the HSO program.
LEGAL IMPLICATIONS
There are no legal impediments to implementing the recommendations in this report.
FINANCIAL IMPLICATIONS
There are no financial
implications with the approval of the recommendations contained in this report.
The Ottawa Public Health approved 2011 budgets contains $1.876 million which is
fully funded by the Ministry of Health and Long-term Care for the Healthy
Smiles Ontario program.
Ottawa Public Health staff will write and send a letter the Ministry of Health and Long-term Care, on behalf of the Ottawa Board of Health, advocating that the Healthy Smiles Ontario program be expanded to cover the families of children currently enrolled in the program. Ottawa Public Health staff will explore options for further expanding the provision of preventive dental care and early-stage dental treatment to adults on low incomes.
References:
·
Canadian Community Health Survey,
2008-2009
·
Canadian Health Measures Survey
2007-2009
·
OAPHD:
Proposal for Improving Access for Dental Care for Low Income Residents of
Ontario: July 2008
·
Oral Health Problems and their Impact on
the Ontario Hospital System; Brant County Health Unit: July 2007
·
Rapid Risk Factor Surveillance System,
2010