Dental-care double standard: hygienists ask for equal pay under federal plan

OTTAWA — The Liberal government is guilty of a double standard when it comes to how much practitioners will be reimbursed under a new federal plan, the Canadian Dental Hygienists Association is charging.

Last week, Health Canada released a guide for how much it will pay providers under the national dental-care plan, which is expected to provide oral health coverage for millions of low- and middle-income families. 

Reimbursement rates vary from province to province, but they show the federal government plans to pay significantly less for a cleaning that happens at a private hygiene clinic, as opposed to in a dentist’s office. 

“Ideally, we do believe that a dental hygienist in business for herself should be paid the same as a dental hygienist that’s working in a dental office for the same procedures,” said Donna Wells, the association’s manager of professional practice. 

“The same pay for the same procedures.”

As it stands, the difference is more than 20 per cent in some cases, she said. 

The dispute is just the latest in a series of complaints from dental-care providers who warn low reimbursement rates and high administrative burdens threaten the success of the program.

Health Canada did not immediately respond to a request for comment, and has so far repeatedly refused to specify how many providers have signed on to the program, except to say that it is in the “thousands.”

The program is a key pillar of the Liberals’ political pact with the NDP, and is expected to offer government-sponsored coverage to uninsured families with an annual income under $90,000 per year. 

It’s expected to cost $13 billion over five years, and benefit nearly nine million Canadians.

The hygienists’ association raised the issue of how much less Health Canada planned to pay them weeks ago, and Wells said they were surprised to see the discrepancy persist in the guides released last week.

“The word discrimination does cross our minds, it has entered our conversations,” Wells said. The hygienist workforce is 97 per cent women, she said. 

Suggested fees released by provincial dental and hygienist associations often advise that independent hygienists are paid less for the same services, but the federal plan widens the gap significantly, she said. 

For instance, in Manitoba, the program will pay a dentist’s office $62.80 for a unit of cleaning, but an independent hygienist would be paid only $49.04.

Independent hygienists have all the same costs and overhead as a hygienists’ department in a dental office, Wells said. Those who offer mobile services have travel costs instead. 

The lower reimbursement means patients will either need to pay out of pocket or hygienists will need to absorb the cost.

“That’s not fair to the patient. It’s also not fair to the dental hygienist to be expected to cover that cost for his or her business,” she said. 

Holland said last week that he expects “huge participation” in the program from dental-care providers, and has plans to change the enrolment process to lessen administrative burdens.

He also said recently that the program is not going to be perfect out of the gate, but that it will evolve over time. 

This report by The Canadian Press was first published April 15, 2023.

Laura Osman, The Canadian Press