The Political Economy of Dental Hygiene in Canada Executive
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The Political Economy of Dental Hygiene in Canada Executive Summary 1. Oral health care issues have been generally neglected by governments in Canada. 2. This report unequivocally recommends that provincial governments eliminate regulations that prohibit or inhibit the direct access to dental hygienists by the public. This legislative change would end the monopolistic gatekeeper privileges of dentists. 3. This reform does not entail any new government funding of oral health care, yet it will have significant and far-reaching impacts such as a) Greater access to oral health care for several population groups with worrisome levels of unmet need for oral health services b) Lower costs for patients due to the competition resulting from the new regulatory dispensation; studies suggest reductions of about 20 to 40 per cent. c) More opportunities for integrating oral health care with other health care services d) Substantial increase in the prevention and earlier detection of oral disease, and in oral health promotion e) Greater equity in income and opportunity between male- and female-dominated professions f) More experimentation and innovation in cost-effective oral health care delivery systems g) Greater and genuine freedom of choice for consumers 4. Limiting the comparison of dentists and dental hygienists to the overlapping scopes of practice of the two professions, the evidence supports the following conclusions: a) Dental hygienists are much better educated and trained in their scope of practice than are dentists for the services falling in the dental hygienists’ scope of practice. b) Dental hygienists provide a high quality of care. c) Dental hygienists pose no additional, and possibly lower, risk to patients than dental practices. d) Fee levels of independent dental hygienists could be significantly lower and are unlikely to be higher than the same services in dental practices. e) The overall costs for patients will be lowered with direct access to dental hygienists. 5. Dental hygienis ts should be accorded genuine primary caregiver status for services within their scope of practice. This requires private or public insurance plans to cover their clients for their choice of either dental hygienists’ or dentists’ services. Insurance plans should treat the two professions fairly and essentially equally. 6. There is no demonstrable benefit to the public for preserving or strengthening the dental monopoly. On the contrary, there is much evidence that the dentists’ monopoly privileges generate numerous and substantial costs to society. Governments should have to justify how maintaining or strengthening the dentists’ privileges serves the public interest better than does the reform proposed in this report. 7. The proposed reform to permit dental hygienists to initiate care is much more effective than other possible reforms such as enforcing Canada’s com-petition policy, extending Medicare to cover oral health care services, or introducing or expanding categorical public insurance plans.