In Quebec, the universal health insurance plan covers only a few dental procedures for certain very specific and limited groups of the population.
Posted at 2:00 p.m.
Recently, opinions expressed in the media have brought to light this lack of access to care and the original solutions that make it possible to circumvent this barrier.
However, it is not only a question of a beautiful smile. As a dental resident, I witness situations where patients for whom dental care is a prerequisite for essential medical care are faced with the added financial burden of paying for that care.
This is the case of patients for whom an organ transplant is imminent (kidney, heart, liver, etc.) or who require heart valve surgery. The medical literature is clear on this subject: prior dental care minimizes the complications associated with infectious problems. This is not a theoretical risk.
Dental examinations in hospitals are covered by the Régie de l’assurance maladie du Québec (RAMQ). However, if this examination reveals the need for dental care before the operation, the cost of this care must be assumed by the patient, unless the latter is covered by the social assistance program.
For the patient without insurance who is unable to immediately pay for this care, which is nevertheless required by his condition, the dilemma is significant. It adds to the burden of illness the stress of making harrowing budgetary choices or resorting to relatives or crowdfunding. For clinicians, it implies the obligation to set up a file for each case, to take steps in order to have access to non-recurring, limited and exceptional sources of funding. Moreover, the efforts made by these clinicians are commended in this regard. But this solution is fickle, uncertain and unsustainable in the long term.
Faced with this difficult situation and this two-tier level of care, some patients postpone their operation with all the consequences that this entails for their health and quality of life. In short, issues of equity and the use of resources are raised.
Ultimately, it’s about providing all the care deemed essential and required by the patient’s state of health, regardless of their ability to pay. Isn’t that the very essence of the universal health insurance system that sets us apart from so many other states?
Is inability to pay so common? Unfortunately yes. This is an observation that Louise Leduc reports in her article entitled “When the most deprived rely on charity”.
The status quo has a cost. We know that in several situations, a dental intervention at the appropriate time would make it possible to avoid serious post-operative infectious complications which will have to be taken care of by the health system. These complications involve the services of many teams of specialists, prolong the duration of hospitalization and lead to significant financial costs, not to mention the harm caused to the patient.
In Quebec, no study has been carried out to properly document the phenomenon; this would be a preliminary step to any global funding decision.
In a healthcare system in search of optimization, shouldn’t we explore less expensive alternatives to increase the quality of life of patients?
Let’s open up the discussion on medically required emergency dental coverage. In a universal health care system, it is high time to look at the big picture.