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View Darren Fisher Profile
Lib. (NS)
Mr. Speaker, it is an honour to be here while you are presiding over this meeting. I want to thank you for the opportunity to stand and speak today about the government's plans in this area.
With respect to the suggestion on how savings from changes to the tax system could be used, I am pleased to talk about the government's commitment to strengthen health care for Canadians.
The mandate letter of the Minister of Health includes a commitment to support Parliament in studying the issue of dental care so that we can better understand what the government's role may be in helping to improve access to dental care in Canada. This debate provides an opportunity for members of Parliament to share their views on this issue.
Across the country, many Canadians have coverage for dental care through private employee health benefit plans, while many are supported by government programs. According to the Canadian Institute for Health Information, $15.5 billion was spent on dental services in Canada in 2017. Of this, 54% was covered through private insurance plans, 40% was paid out of pocket and 6% was publicly funded by a variety of federal, provincial and territorial government programs.
We know that oral health is an integral element of overall health. By the time they are adults, 96% of Canadians have been impacted by dental decay. It is largely preventable and disproportionately and more severely impacts our most vulnerable populations, such as those living with a disability, those from low-income households, those in marginalized communities and seniors.
Twenty per cent of Canadians have moderate to severe gum disease. This number is amplified in older adults and those with lower incomes. Not only can this cause tooth loss and related problems with eating, speaking and social interactions, it has been shown to complicate a number of medical conditions. Further, the Canadian Cancer Society advises that in overall cancer incidents in Canada, oral cancer ranks ninth in men and 13th in women, and the trend line is increasing. About 5,300 Canadians will be diagnosed with oral cancer annually, and nearly 1,500 will die of it.
That is why the government welcomed the Standing Committee on Health's recent decision to study the issue of dental care in Canada and stands ready to support the committee in its work.
At a national level in Canada, good data on unmet dental care needs does not exist. We know that three-quarters of Canadians visit a dentist at least once a year, higher than the OECD average, and that wait times for dental care are among the shortest in the world. Approximately two-thirds of Canadians report no dental needs. At the same time, we know that approximately one-third of Canadians are uninsured and that approximately six million Canadians have reported avoiding a visit to the dentist because of cost.
To address data gaps, the Canadian government has partnered with Statistics Canada to design an oral health surveillance component for an upcoming cycle of a Canadian health measure survey, funded by the Canadian Institutes of Health Research and in collaboration with leading researchers from all 10 of Canada's university faculties of dentistry and experts from the United States and the United Kingdom. This work will provide key information for those developing oral health programs and policies for Canadians.
In addition to improving data on dental care, the federal government provides dental care services for certain groups of people through the non-insured health benefits program delivered by Indigenous Services Canada. The government provides dental coverage for recognized first nations and Inuit. In addition, the children's oral health initiative provides dental coverage for many first nations children and their parents.
Through Immigration, Refugees and Citizenship Canada, the interim federal health program provides coverage for emergency dental care services for some refugee claimants and protected persons. In addition, the federal government provides members of the Canadian Armed Forces, some veterans and inmates of federal penitentiaries with dental coverage.
Alongside these federal programs, all provinces and territories fund and manage their own dental care services, which cover medically necessary in-hospital dental services for all residents. Many provincial and territorial programs also cover some dental services for certain groups of people, such as children in low-income households, people receiving social assistance benefits, people with certain disabilities and senior citizens. However, specific eligibility requirements, types of services included and the financial coverage levels depend on the province or the territory.
Provincial and territorial health care programs, including those with dental coverage, are supported by federal funding through the Canada health transfer, or the CHT. The CHT is providing $40.4 billion to the provinces and territories in 2019-20. This will continue to increase each year in line with the growth rate of the economy, with a minimum increase of at least 3% per year. Over the next five years, CHT funding to provinces and territories is expected to exceed $200 billion.
In addition to direct federal spending on dental services and fiscal transfers to the provinces and territories, assistance for dental care is already provided through the federal tax system. About two-thirds of Canadians receive dental coverage from their employee health insurance benefits. The federal government supports these Canadians by not including the value of these insurance plans in the taxable income of employees.
Forty per cent of dental care costs are paid through out-of-pocket payments by Canadians. The federal government provides assistance with these costs through an income tax credit called the medical expenses tax credit. This is a non-refundable tax credit for eligible medical expenses that can be claimed by taxpayers if the expenses exceed 3% of an individual's net income or $2,352, whichever is less, in the 2019 tax year. An additional refundable medical expense supplement is available for working individuals with low incomes and high medical expenses.
In addition to support for dental care, the federal government improves the oral health of Canadians at the national level through health promotion, disease prevention and professional and technical guidance. In the area of health promotion, and in consultation with the national oral health professional community, last year the government incorporated oral health considerations into the Canada food guide and into its ongoing information campaigns.
In terms of prevention, the government has worked with the University of Saskatchewan and the University of Alberta to produce user-friendly online information on proper teeth cleaning for infants, children, adults, seniors and pregnant women, as well as for caregivers supporting older adults living with dementia at home. The government has also partnered with the University of Manitoba and collaborated with many key national health professional organizations to produce the Canadian caries risk assessment tool, which will now enable Canadian health practitioners to confidently assess their preschool patients and take the steps necessary to prevent early childhood caries and guide those patients into the appropriate care approaches.
The government has also worked with the Canadian Agency for Drugs and Technologies in Health to produce comprehensive knowledge products for community decision-makers on water fluoridation. Community water fluoridation remains a safe, cost-effective and equitable public health practice to prevent tooth decay.
In the areas of professional and technical guidance, the government collaborated with leading Canadian researchers in the areas of the oral health effects of cannabis and vaping to develop knowledge products for Canadian oral health practitioners to consider as they care for their patients who may be using these substances. The government has also partnered with McGill University to create and launch the Canadian Dental Connection website for rural and remote communities seeking oral health practitioners, and provide online training modules for these practitioners on cultural competency and trauma-informed care.
To support the improvement of the oral health of Canadians and fulfill our international responsibilities, the government works with partners and stakeholders nationally and globally, including organizations in the professional, regulatory and educational domains, such as the Canadian Dental Association and the Canadian Dental Regulatory Authorities Federation. We have also collaborated with international health and dental organizations, such as the World Health Organization, and oral health authorities around the world.
These initiatives demonstrate that our government is playing a constructive role in supporting access to dental care for Canadians. We look forward to participating in the study of dental care to be conducted by the House of Commons Standing Committee on Health, of which I am proud to say I am member.
However, we know that dental care is only one aspect of the health care system for Canadians. The government has a strong interest in improving the health care system so that it can meet the needs of Canadians now and into the future. With an aging population, increasing rates of chronic disease and cost pressures tied to new drugs and technologies, our system must adapt if it is to deliver better care and better outcomes at a cost that is affordable.
Our government is committed to strengthening health care, including improving access to primary care, mental health services, home and palliative care, and implementing national universal pharmacare for Canadians. These commitments build on our actions over the last several years to improve access to mental health services, home and palliative care, and prescription drugs.
Our joint work with provinces and territories has been particularly successful and provides a good model for future joint work on health care. Federal, provincial and territorial governments reached an agreement on a common statement of principles for shared health priorities in 2017, which outlines key priorities for federal investments in mental health and addictions, as well as home and community care.
The common statement reaffirms our shared commitment to report on results to Canadians through common indicators; to improve the affordability, accessibility and appropriate use of prescription drugs; to support health innovation; and to engage with regional and national indigenous leaders on their priorities for improving the health outcomes of indigenous peoples. Under this agreement, federal investments of $11 billion over 10 years are being used by provinces and territories to address specific needs in our health care system, such as increasing the availability of home and palliative care and helping youth access needed mental health services.
We will continue to build on this progress as we work to implement the commitments outlined in the mandate letter of the Minister of Health, including improving access to primary care, setting national standards for access to mental health services, and continuing to make home and palliative care more available across the country. In this respect, the government looks forward to learning more about the challenges faced by Canadians in accessing dental care and will actively participate in the study of this important issue by the House of Commons Standing Committee on Health.
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