The Public Health Sudbury & Districts board has passed a motion urging the provincial government to raise reimbursement rates for the Healthy Smiles Ontario (HSO) program. The program provides preventative, routine, and emergency dental services for children and youth under 17 from qualifying low-income families in Ontario.
However, according to a briefing note presented to the board, the current reimbursement rates are significantly below industry standards. Dentists are only reimbursed about 40% of the actual cost of services, though this figure is still higher than the actual compensation. Due to these low rates, many dentists have stopped accepting patients under the HSO program.
Unlike other dental insurance plans, the HSO program does not allow dentists to bill patients for any unpaid balances, further discouraging participation.
At the board meeting on February 19, Dr. Mustafa Hirji, Public Health Sudbury’s medical officer, explained that the low compensation rates were a result of fiscal restraint by the provincial government. He emphasized that dentists treating children under HSO make less than half of what they would for patients with private insurance. As a result, the number of dentists accepting HSO patients has dwindled, with a referral list that has now been reduced to zero.
Board member Natalie Tessier expressed shock at the situation, emphasizing the importance of dental care as part of overall health care.
The low reimbursement rates are impacting the health of children, according to the briefing note. Untreated tooth decay and infections can cause pain, affect concentration, disrupt eating and sleeping habits, and potentially lead to more serious health issues.
Public Health Sudbury offers dental cleaning services for children under the HSO program and maintains a referral list of local dentists. However, after conducting a survey of local dentists this past summer, it was revealed that only 25% accept HSO as the primary coverage, while 23% accept a combination of HSO and the federal Canada Dental Care Program (CDCP).
Despite the possibility of combining HSO with the CDCP to offer more comprehensive coverage, 52% of dentists surveyed indicated they are no longer accepting HSO referrals.
The Public Health Sudbury board’s motion calls on the province to raise the reimbursement rates to align with the Ontario Dental Association (ODA) Suggested Fee Guide for General Practitioners, which would encourage more dentists to participate in the program. The board also directed Dr. Hirji to work with other local public health agencies to advocate for improved HSO funding.
Dr. Hirji hopes the motion will bring attention to the issue and encourage the provincial government to act. “Our goal is to get this on the radar of the provincial government,” he said. “We want to work with the other 20 local public health agencies and our dental community to push for a higher fee schedule.”
The Ontario Ministry of Health was contacted for comment, but no response has been received. However, Dr. David Brown, president of the Ontario Dental Association, confirmed that the current HSO reimbursement rate is actually 32% of the ODA’s recommended fee guidelines. This rate has not increased since the late 2000s.
Brown added that Ontario’s dental reimbursement rates are the lowest in the country, with most provinces offering between 70% and 90%. He also expressed concerns about sustainability, as dentists are already subsidizing the cost of the program out of their own pockets. “Dentists are reaching into their own pockets to keep these programs going,” he said. “The sustainability of these programs is a major concern.”
While the combination of the HSO and CDCP programs brings reimbursement closer to the customary fees, Brown warned that many families still do not qualify for the CDCP, including newcomers to Canada or those with minimal private dental insurance.
Brown hopes the government will address these concerns to ensure that all children have access to quality dental care. “We want kids to have all the advantages they can have growing up in a safe, healthy environment, which includes access to dental care,” he said. “Dentists have been fighting for this for years.”