Finance Committee on April 18th, 2024

[The Chair, Liberal, Peter Fonseca]

We are back, everyone.

With us now, from the Canadian Association of Public Health Dentistry, we have Dr. Amrinderbir Singh, president. Welcome.

From the Saguenay Port Authority, we have the president and chief executive officer, Carl Laberge.

We will start with Dr. Singh, please, for opening remarks.

[Dr. Amrinderbir Singh, President, Canadian Association of Public Health Dentistry]

Thank you, Chair and committee.

Good afternoon, everyone. My name is Dr. Amrinderbir Singh. I'm the current president of the Canadian Association of Public Health Dentistry. I'm also an assistant professor and the director of inclusive community outreach at the College of Dentistry, University of Saskatchewan.

I am extremely honoured to be invited today to represent the Canadian Association of Public Health Dentistry, which I'll refer to as CAPHD, as a witness before the House of Commons Standing Committee on Finance in view of its study of Bill C-59. The CAPHD is the national voice for dental public health in Canada and exists to support members, government, institutions and agencies dedicated to improving oral health and assuring oral health equity for Canadians.

First of all, on behalf of CAPHD, I would like to applaud and acknowledge the tremendous efforts made by the federal government in the latest phase of the development of the Canadian dental care plan. This unprecedented initiative will enable many of our equity-deserving Canadians to access much-needed oral health care, potentially improving their overall health and well-being while decreasing the burden of oral disease in Canada.

The CAPHD promotes and advocates for equitable oral health care for all Canadians. We will continue working with the government, partner organizations and our membership to support the CDCP and advocate strongly for its uptake and utilization across Canada.

The CAPHD is closely following the phased rollout of the CDCP and eagerly awaits early reports regarding plan enrolment and utilization. Our association believes that it is critical for the CDCP to remain responsive to the evolving needs of Canadians. Continuous evaluation of the CDCP will be important for informing data-driven policy adjustments, and interdisciplinary collaborations will be vital for enhancing the CDCP's effectiveness. As the plan matures, the CAPHD looks forward to more emphasis on preventive services for caries and periodontal diseases. This includes upstream services that increase oral health literacy, such as oral health education and counselling and the encouragement of interventions addressing the microbiology of dental decay and gum disease.

To encourage more health care providers to support the plan and increase access to care for underserved Canadians, the CAPHD proposes alignment of the CDCP fees with the existing provincial fee guides in the future. We believe that harmonized compensation rates will encourage more providers to participate in the plan.

Additionally, the CAPHD would like clarification on how health care providers can coordinate benefits for individuals eligible under more than one public insurance plan, be it federal, provincial, territorial or municipal. This clarification is essential to streamline the processes for health care providers and ease the financial burden for eligible individuals, which aligns with the CAPHD's preference for minimizing out-of-pocket expenses for patients.

By addressing these key areas, the CAPHD aims to encourage greater provider participation in the plan and support a sustainable model of care. Success in these endeavours is contingent upon the active involvement of health care providers, equity-deserving communities and high-risk populations. The CAPHD commits to advocating for enrolment strategies that actively engage all crucial stakeholders and promote provider enrolment within its membership. These collaborative efforts may enhance the plan's reach and impact and support Canadians in accessing the oral health care they need.

However, I would like to take this opportunity to emphasize that access-to-care barriers are complex and multi-dimensional, especially for rural and remote communities and high-risk population groups. If I may, I will extend that to include inner-city areas. Hence, in future planning, we urge the government to consider investing more resources to address the access-to-care barriers.

Again, the CAPHD expresses profound gratitude for the recognition of oral health’s vital role in the overall well-being of all Canadians. The CDCP has the potential to contribute towards increasing our population health significantly in the forthcoming years. By prioritizing oral health, we anticipate a notable reduction in the overall burden of disease, thereby alleviating pressures on our health care system.

Thank you.

[The Chair, Liberal, Peter Fonseca]

Thank you, Dr. Singh. There will be a lot of time for members' questions.

We're now going to hear opening remarks from the Saguenay Port Authority.

Mr. Carl Laberge, go ahead, please.

[Carl Laberge, President-Chief Executive Officer, Saguenay Port Authority]

Hello, Mr. Chair and members of the Standing Committee on Finance.

To begin, thank you for inviting me to appear before you today.

As a Canadian port authority, the Port of Saguenay is recognized as one of the 17 largest and most strategic ports in the country. It plays a crucial and growing role in Canada's supply chain, with its strategic location at the heart of the corridor formed by the Saguenay, the St. Lawrence and the Great Lakes.

We are a young port with great development potential. In addition to our strong maritime capability and strategic location, we are currently working to develop one of the largest industrial and port zones in the country, with more than 3,000 acres of land earmarked for major industrial projects related to our port activities.

We are working with the governments of Canada and Quebec to attract development projects to Canada in order to develop new and innovative industry sectors. In this regard, our region is particularly well positioned for promising projects, including those directly related to Canada's critical minerals strategy, thereby contributing actively to the global transition to clean energy.

As you probably know, the Saguenay River is a key commerce corridor in eastern Canada. We are making it a hub that is productive, prosperous and above all sustainable for the Canadian economy, since it will be powered by renewable energy forms.

The Port of Saguenay therefore offers a unique opportunity to support growth of the Canadian economy that is both responsible and sustainable.

Through the National Trade Corridors Fund, or NTCF, the Government of Canada is supporting us in that process.

I would also like to commend the excellent co-operation we have received from the team of Pablo Rodriguez, the Minister of Transport. We have received financial assistance to develop new strategic infrastructures in the port, including the electrification of transshipments, which directly improves the appeal of our site.

Our transshipment capability has been improved, but our growth is now limited by our ability to meet shipping demand. Our shipping infrastructure currently has just one berth. As a result, ships requiring transshipment operations that last several days monopolize all port facilities, creating a bottleneck.

We applied to the NTCF for funding to improve our shipping infrastructure. Specifically, we want to build a new berth to reduce waiting times for ships that enter our port and thereby boost our productivity and the increase the flow of goods.

The Quebec government has already confirmed its participation in this new dock project by announcing last November its contribution of $20 million. Now, we are still waiting for the reply to our funding request under the NTCF.

Today we wish to reiterate the crucial importance of investing in our port infrastructure through this essential program.

I will also use this opportunity to speak to you briefly about the request to increase our borrowing limit, as set out in our letters patent.

As you know, Canadian port authorities have borrowing limits that are regulated by the government and that are generally lower than their potential and real needs. This limits access to funding and as a result undermines their ability to attract private capital, requiring us to make massive investments in our infrastructure if we want to stay competitive and innovative.

In June 2023, the Port of Saguenay therefore submitted an application for a supplementary letters patent to increase its borrowing limit in connection with its major ongoing infrastructure projects, which are funded by the NTCF. We have still not received that supplementary letters patent.

We have major projects under way and have committed all of our liquid assets so as not to delay the schedule and investments or stop our work. We are waiting for the additional funding we need, which must first be authorized with the issuing of a supplementary letters patent.

I would like to mention that we were told that our application has been favourably recommended, but it is still being analyzed by the Department of Finance.

Those supplementary letters patent are essential to our organization and for the development of our infrastructure.

We are running out of time. The processing time for our request, which we consider unreasonable and excessive, could undermine our organization and the project's success.

Nonetheless, we are hopeful that with your support we can prevent delays and continue developing the Port of Saguenay and our community and continue to contribute to an effective supply chain throughout Canada.

Thank you for your attention. I will be pleased to answer your questions.

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Laberge and Dr. Singh.

At this time, we're going to move to our first round of questions. It will be six minutes for each of the parties.

We are starting with MP Morantz for the first six minutes.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

I want to thank our witnesses for being here. We've had many hours of very important discussions today on a variety of issues.

I'd like to start with Dr. Singh.

Dr. Singh, when it comes to the Canadian dental care plan, my understanding is that a very small number of dentists are interested in providing care under the plan. Is that your understanding as well?

[Dr. Amrinderbir Singh]

That is, yes.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Do you know why that is?

[Dr. Amrinderbir Singh]

It involves information. I have been following the news and listening to any releases from the provincial associations. From our understanding, with any change there may be a bit of hesitation. I think I'd be making assumptions right now. I don't clearly know why there is a hesitation.

From the population health standpoint, our goal lies in promoting the uptick and utilization of the plan at all levels.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Have you discussed this plan with any dentists who may have expressed their concerns to you?

[Dr. Amrinderbir Singh]

I have talked to dentists. There are mixed views. There are dentists who are really passionate about community health and see the great benefits of this plan, especially for patients who were never able to afford dental care. Some of the hesitation, anecdotally heard, was about the unknowns as the plan rollout was happening. Not all the information was out at once, so my understanding is that this may have created some hesitancy.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

What would be an example of an unknown?

[Dr. Amrinderbir Singh]

It was the phased rollout of the plan, as planned by the government. We did not have all the details all at once. The details are now coming out, and we are becoming more and more aware. For example, yesterday, a news release said that dentists may not need to enrol in the plan and they're automatically enrolled. That is just one example of the clarity in the process that is coming out.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Some dentists may not want to participate because they think they would have to enrol, and now it's coming out that maybe that's not necessary. Is that what you're saying?

[Dr. Amrinderbir Singh]

That would be my assumption.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Are there any other reasons they've given you for concerns around providing care under the program?

[Dr. Amrinderbir Singh]

In my opening, as an association, I mentioned having better alignment of the fees with the provincial fee guides. That may be one of the reasons. I don't want to use the term “incentivize”, but again, if providers are compensated at the similar level as the provincial fee guides, that may be one solution to address this.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

Is there a significant level of increased administrative work within private dental offices that could be an issue for some dental offices?

[Dr. Amrinderbir Singh]

I cannot comment on that. I'm not aware of the level of administrative work that is required, ultimately, when the claims are being made. I am sorry, but I'm not able to comment on that.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

One of the policies that our leader, Mr. Poilievre, has put forward is something we're calling a national blue seal program. It's to try to address the problem where professionals come to Canada from other countries and they have trouble getting licensed here. What we've proposed is a 60-day pathway to testing so they're not waiting forever. There are many qualified doctors, dentists and nurses in the country who are not practising their professions.

Would you support an effort like ours to try to get more dentists and dental hygienists licensed who come from other countries?

[Dr. Amrinderbir Singh]

I definitely would. We are well aware of the shortage of oral health care providers in Canada at all levels, be they dentists, dental assistants, dental hygienists or dental therapists.

I think this initiative has the potential to address those barriers significantly, especially when I think about rural and remote communities and about the CDCP, with the potential increase and influx of patients. If the providers, who may be going to rural and remote communities, see a sudden influx in the cities, I worry that may create a disparity and an even further shortage of providers in rural and remote communities if we don't address the number of providers in our country.

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

I have one last, very quick question.

What about the opportunity for a young dentist just graduating from dental college who wants to build a practice? Is this an opportunity for dentists who are just starting their practices to perhaps build a practice more quickly?

[Dr. Amrinderbir Singh]

To understand that correctly, would it be through working in rural and remote areas?

[Marty Morantz, Conservative, Charleswood—St. James—Assiniboia—Headingley, MB]

I mean anywhere, just by agreeing to provide care under the Canadian dental care program. I can see a young dentist coming out of dental college without any patients. They might look at this as an opportunity to build a practice.

[Dr. Amrinderbir Singh]

I definitely would think so. However, I do not think there is that.... There is need for care everywhere. This would just enhance it.