Canada is a laggard when it comes to providing public funding for dental care, ranking close to the bottom of OECD countries. However, the federal government’s proposed Canadian Dental Care Plan could change that.

In its 2023 budget, the federal government pledged $13 billion over five years to implement the plan, which will provide dental care to Canadian families without dental insurance and whose income is less than $90,000 a year. The plan is being introduced in phases: coverage was extended first to children under 12 years old at the end of 2022; children under 18 years old, seniors and those with disabilities will receive coverage by the end of 2023; and then all families that meet the income threshold by the end of 2025.

In addition to the Canadian Dental Care Plan, the federal government has also committed to spending $250 million over three years starting in 2025-26 to establish the Oral Health Access Fund to invest in programs that address oral health gaps and access issues among vulnerable populations.

This paper calls the plan a major step forward in reforming dental care but argues that the payer of last resort model the government has chosen to implement falls short and will result in inefficiencies, as well as failing to ensure equitable access to primary and preventive dental care. As Canada moves forward in implementing these new programs, the federal government must consider what its goals are in reforming dental care and how it can best achieve them.

The authors identify four broad policy goals that should guide the reform: universality, fairness, accessibility and accountability. They then assess the advantages and disadvantages of six possible options for achieving these goals:

1. a voucher or cash payment
2. a refundable tax credit
3. conditional transfers to provinces and territories, similar to those provided under the Canada Health Act
4. a program similar to the existing Non-Insured Health Benefit, through which the federal government directly provides insurance coverage to eligible First Nations and Inuit Peoples
5. conditional transfers via bilateral agreements negotiated with each province and territory
6. an arm’s-length, national agency, funded by the federal government and empowered by the provinces and territories