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Health minister compares dentists' 'fears' on dental-care program to medicare rollout

OTTAWA — Dentists cannot participate in a national dental-care plan unless they know exactly how it will work, Heather Carr, president of the Canadian Dental Association, said Wednesday.

The federal health minister compared their fears to those prompted by the launch of national medicare in the 1960s. 

Carr, whose organization represents provincial and territorial dental associations, said the federal program needs to get it right before registered seniors can start using it next month.

"We need to know what we're agreeing to and what we'll be able to do for the patients in order to care for them," said Carr.

"I feel that we need to get it right from the beginning." 

The program, a key pledge in the Liberals' political pact with the NDP, is expected to provide dental coverage to uninsured families who earn a household income of under $90,000. 

Registration has been rolled out in phases, and eligible seniors 65 and older are expected to begin receiving coverage.

The Liberals are facing criticism for the program, expected to cost $13 billion over five years, in part because of the slow uptake of oral care providers.

Health Minister Mark Holland insisted on Wednesday that the government is working to address dentists' concerns by making it easier to participate without having to officially enrol, and expects to see "huge participation." 

"We're making it a lot easier for them (to) participate and we're having ongoing conversation and there's a negotiation, obviously," he told reporters on Parliament Hill, adding "thousands" have already signed up.

He likened this period of negotiation to the growing pains of setting up national medicare decades ago.

"It's reminiscent of some of the struggles that you had at the beginning of ensuring that everybody had medical care," Holland said. 

"If you remember back in the 1960s, there were a lot of questions and concerns and fears that doctors had about expanding that coverage. And so anytime you're expanding coverage and creating something new, there's going to be some challenges." 

Many dentists do not feel they have enough information at this point to sign up, said Carr, a practising dentist for 36 years.

The fact that they need to sign up in the first place is something oral care providers are not used to, she added, as dentists are used to dealing directly with patients. 

If a dentist wants to wait for more information before signing up, they could lose patients, said Carr.

"Your existing patient may not be able to see you anymore because there is no provision," she said, calling the overall design of the program "much more complicated than necessary." 

Groups representing dentists and hygienists have raised concerns about Ottawa's pay structure, saying the proposed fees are lower than what patients are currently being billed.

Dental associations have warned that some of their members are hesitant to participate in the program, citing billing concerns.

And in the meantime, patients are being told the dental-care program is completely free, Carr said, even though there could be "out-of-pocket expenses" in some cases.

"But we're not able to be clear about it," she said. 

Holland has characterized the proposed fees as "fair," but Dr. Carl Tremblay, president of Quebec's association of dental surgeons, sees it differently.

The minister is essentially asking his members to "subsidize" the federal program by offering reduced rates to people who are eligible, Tremblay said.

Ottawa is "basically asking us for charity," he said, vowing to "continue to charge our regular rates" and rejecting the notion they are trying to negotiate their rates with the federal government. 

Conservative Leader Pierre Poilievre has not yet taken a public position on the program; his office has not yet responded to a media inquiry. 

Holland said Nova Scotia MP and Conservative health critic Stephen Ellis has so far refused to meet to discuss the program.

This report by The Canadian Press was first published April 10, 2024. 

Stephanie Taylor and Michel Saba, The Canadian Press

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