
For Albertans, saving on dental fees is starting to feel like pulling teeth.
Earlier this year I’d written about how Alberta had finally decided to go back to using a dental fee guide after spending 20 years without one. Last week, the Alberta Dental Association and College (ADA&C) released one to the public. Smiles were short-lived, however, as dentists were sent back to the drawing board by the province’s Ministry of Health when their best offer turned out to be an overall 3% savings.
For years insurers and other groups have criticized rising dental costs in the province, which ultimately drive group insurance premiums upward, which ultimately take a bite of employees pay.
Historically, insurers used their own claims experience to set dental fee reimbursement levels in the province. They would also use claims data from the Canadian Life & Health Insurance Association (CLHIA) as a benchmark. However, no one wants to have plan members see their claims capped so traditionally insurers would allow for a buffer zone between the benchmark for general practitioners, something along the lines of 20%.
Conscious of rising costs, insurers, plan sponsors and industry stakeholders have tried to encourage participants to shop around. In 2012, Sunlife had launched a dental fee finder to help plan participants shop around. Manulife published a dental guide of their own, the latest version being this one.
But shopping for a dentist turned out to be easier said than done as the CBC reported in 2016. Not only did price vary drastically from one dental office to another, many practitioners were reluctant to give their fees over the phone.
The bell tolled on rising dental fees when a 2016 report by the CLHIA showed that dental fees in Alberta had risen 56% over the last decade. The Alberta Blue Cross estimates that dental fees are roughly 26 to 32% higher than other provinces. So, it was with a sigh of relief that the insurance industry welcomed the news that the ADA&C would once again publish a dental fee guide.
The guide, which was released August 17th was set to be effective September 1st. However, it’s never a good sign when a dental association releases a guide to the public without advising the ministry it is supposed to be working with ahead of time. Or fail to invite them at the press conference.
To understand why the ADA&C may be in a bind over dental fees one has to consider that while dentists are not obligated to apply these rates (they are free to charge less or more), setting prices and releasing the guide to the public will have a downward pressure on what dentists can charge. Even with a 3% reduction on average costs, some dentists will earn less as a result, particularly those that charged in the higher range. I think we can all agree that anyone would rather have a root canal than be expected to continue doing the same amount of work for a pay cut.
The good thing in all of this is that Alberta’s dental guide, however slim the savings were on its first draft in twenty years, is being released to the public. In other provinces, such as Quebec, the dental fee guide is also made pubic although not readily available to the public. Not surprisingly, Quebec also claims it is suffering from rising dental costs.
Another topic of discussion has been the splitting of the dental association from the college, based on the perception the the ADA has prevented dentists from advertising their rates, limiting patients ability to shop around. No doubt this is one of the “tools” the Ministry referred to as belonging to their toolbox to coax the ADA&C to revise their numbers.
But even with a revised dental fee guide, with a steep saving, will it be of any use for the laymen? This is the main argument used in provinces where the guide is not readily available to the public. First, because the fees listed in a fee guide are just a suggestion. Dentists are not obligated to apply them. Otherwise it would be price fixing. And depending on the materials and techniques used, the same operation could vary greatly in costs. Second, the guides may be easy to understand to one skilled in the art of dentistry but quite unintelligible for the layperson. How then could you compare costs appropriately?
While consumerism is not necessarily always compatible with health spending, a fair degree of transparency is required if we are to equate dollars spent to better health outcomes, in this case, oral hygiene and dental health.
Still, current developments in Alberta are certainly positive overall. At least now they have a fee guide to go by, and by the looks of it dentists are willing to make the savings more in line with popular expectations. Only time will tell if these developments will translate into benefit plan savings for employers in the province or those with divisions there.
