Thank you very much.
My name is Wanda Fedora. I am the president of the Canadian Dental Hygienists Association, and I want to thank you for the opportunity to address you here today.
The Canadian Dental Hygienists Association represents 19,000 dental hygienists across Canada. We are positioned eighth in the size of professional groups in this country. CDHA and the non-insured health benefits program of the first nations and Inuit health branch share the common goal of better oral health for first nations and Inuit peoples. Our desire is to work collaboratively with NIHB to reach this goal in a cost-effective manner.
Currently, dental hygienists in private business cannot be paid on a fee-for-service basis for NIHB clients, since there are no policies and procedures in place to allow reimbursement unless a dental hygienist is employed by a dentist. This clearly discriminates against dental hygiene business owners and it gives dentists a considerable competitive advantage.
Historically, the NIHB requirement for dentists to submit invoices for dental hygiene services was in keeping with the provincial or territorial dental hygiene legislation, which required that dentists supervise dental hygienists. However, the majority of dental hygienists live in provinces where legislation now enables them to establish private businesses and to work without dentist supervision, including dental hygienists in Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario, and Saskatchewan. This legislation enables dental hygienists to compete for services now in the marketplace.
CDHA wants to encourage the federal government to share the benefits of this competition. Approximately 94% of NIHB clients live in these seven provinces; therefore, dental hygienists in private business have the potential to provide services to the majority of NIHB clients.
Private dental hygiene businesses present an outstanding opportunity to address first nations and Inuit organizations' calls for improved client choice and access to care in rural, remote, and northern communities where other oral health professionals are non-existent or scarce. Access to care is critical, given that dental decay rates for first nations and Inuit people of all ages range from three to five times greater than in the non-aboriginal Canadian population.
Dental hygienists can improve cost-effectiveness and program efficiencies in NIHB dental services and improve access to care in a number of other ways. As of October 2008, the pan-territorial dental therapist workforce had a 67% vacancy rate. Dental hygiene business owners could partly resolve the health human resource shortage issue here.
Although the causes of severe dental decay are multi-faceted, having direct access to dental hygienists can help to reduce tooth decay. This can contribute to reduced NIHB flight expenditures associated with oral surgery, and, surely more than that, prevent suffering and pain.
A number of children receive orthodontic treatment through NIHB. Some orthodontists do not have dental hygienists on staff, so NIHB clients either receive no dental hygiene services in this case or orthodontists perform the dental hygiene service themselves. In the first instance, a lack of dental hygiene services can result in decayed teeth, which mar costly orthodontic treatment. The second instance does not make the best use of the orthodontist’s expertise or NIHB's finances, since the orthodontist’s time is spent performing a service that a dental hygienist is qualified to perform. Dental hygienists could coordinate services for children undergoing orthodontic treatment and ensure that adequate dental hygiene services are in place prior to and during that treatment.
NIHB also owns, operates, and supplies dental clinics in a number of rural, northern, and remote towns. Dental hygienists could increase service efficiency at these clinics by providing triage and treatment services and screening clients prior to their appointments with the dentist.
In response to a desire to improve business practices, increase competition in dental services, create cost-effective dental services, and improve access to care, a total of 29 dental health benefit plans across Canada are now paying dental hygienists directly for their services. This list includes other federal government dental plans, including that of Veterans Affairs Canada and the federal pensioners dental plan.
NIHB must follow the leading standards set by these dental insurance plans. One of the most important procedural changes that NIHB can make is to include dental hygienists in their service provider roster. This will put an end to the government's discriminatory practice, increase access to care, support NIHB efforts to magnify existing program benefits, realize additional cost and program efficiencies, and stimulate the development of small dental hygiene businesses.
Today we call on the federal government to amend federal program spending policies and procedures within the first nations and Inuit health branch non-insured health benefits program to enable dental hygiene business owners to provide services to NIHB clients on a fee-for-service basis.
I thank you for your time and I invite questions.