Employers in Ontario could see their dental coverage spending increase this year, due to an average 4.19 per cent hike in the Ontario Dental Association’s suggested dental fees for 2019.
According to the association’s president David Stevenson, this year’s average increase primarily stems from updates to infection prevention and control standards. The changes, implemented in 2017, require dentists to better record the infection prevention and control work they do.
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“There was significant change to recording and monitoring,” he says. Dental practices were required to implement documentation policies and update equipment, such as sterilizers, to record and hold data. Labour costs were also involved in implementing the new standards, adds Stevenson.
“I think there’s a very legitimate reason why, this year, there was a difference in the increase.”
Provincial dental associations’ annual fee guides act as a reference for dentists, who have the ability to set their own fees, as well as for insurance companies assessing dental claims.
The ODA determines its price increases each year by taking into account macroeconomic factors, such as the cost of living, inflation, Canadians’ disposable income and wages, says Stevenson. It also looks at changes in technology and the frequency dentists perform certain procedures, as well as surveying Ontario dentists to understand the cost of operating their practices.
In 2018, the association heard from dentists the cost of complying with the new standards, in addition to higher labour costs caused by a shortage in dental assistants across Ontario, contributed to an increase in the cost of running their practices, notes Stevenson.
“Even though [the change] happened a year ago, we needed that cost and expense data through our survey.”
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While this year’s increase is steep, he notes fees vary across different types of services and the association tries to keep preventative procedures to minimal or no increases. “We try to minimize the impact on the essential services to help people stay healthy and prevent larger expenses [for the patient] later on,” says Stevenson. “We have to be mindful of our costs, but we have to be especially mindful of the cost to the patient.”
Dental benefits are a rapidly growing part of employers’ overall benefits plan spending. According to the Canadian Life and Health Insurance Association’s 2018 life and health insurance fact book, the amount spent on dental benefits in Canada by group or individual insurance plans was $8.1 billion in 2017, up from $7.9 billion in 2016.
While plan sponsors may feel the pinch from higher fees, Robert Crowder, founder and president of the Benefits Trust, says he doesn’t expect that to translate into benefits plan changes. “What it means for plan sponsors is a bit of a shoulder shrug, in my opinion,” he says. “When [employers] see something like this, what are they going to do? ‘Sorry employees, we’re going to reduce your dental benefits because of infection prevention and control’?”
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Crowder says employers are finding it increasingly difficult to attract and retain talent, making them unlikely to pull back on coverage.
However, the Benefits Trust recommends that plan sponsors feeling the burden of increased dental spending this year look into implementing health-care spending accounts, which put the onus on the employee to spend their allotted money wisely, shop around for better rates or use prior year fee guides.
The company also suggests educating plan members about what their dental coverage includes, and how both the plan sponsor and member can suffer when members overuse or misuse services.
“The problem that arises is the consumer of the services is quite distanced from the payer of the services, so they don’t care,” says Crowder. “If you’ve got an average of a $200 dental bill with 80 per cent coverage, and the dental bill goes up to $208, are you really going to see a difference in your 20 per cent? You’re just happy that 80 per cent is being covered.”
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But the ODA’s fee guide increase is a substantial change from previous years. In 2018, for instance, the average increase was 1.86 per cent. According to Stevenson, the association’s average yearly rise over the past decade was around two per cent.
Other provinces have, on the whole, kept their fee increases lower this year. The Nova Scotia Dental Association told Benefits Canada its 2019 average increase was 1.97 per cent, while the British Columbia Dental Association reported 2.51 per cent and the Manitoba Dental Association raised its fees by 3.02 per cent. The Alberta Dental Association and College, which in 2018 implemented its first fee guide in 20 years, reported no suggested fee increases in 2019.
Stevenson says he doesn’t expect the ODA to raise its fee guidance a similarly high percentage next year.
“I think, moving forward, we’ll see some of these changes that came into effect . . . were sort of a one-off,” he says. “The increase we had for this year is reflected in that increase in demand on services. I don’t see that ongoing in the future.”