Time to revamp Quebec's public dental plan, critics say
Labour dispute shines spotlight on what services are provided under RAMQ, province's health insurance program
The public dental plan doesn't do enough to cover the needs of those who need it most, some say, as the conflict between the province's dentists and the government drags on.
Quebec's association of dental surgeons, which represents 4,300 dentists in the province, says that if no deal is reached by Aug. 25, its members will pull out of the provincial health insurance program, RAMQ. They have been without a contract since 2015.
The government has already signed a decree that would prevent that from happening, but the dentists say they will challenge it in court.
The dentists say Health Minister Gaétan Barrette wants to make changes that will lower their annual income. They earn, on average, $180,000 a year.
The labour dispute is shining a spotlight on dental care provided by the government to those who are not covered by private insurance plans.
More people, more services should be covered
RAMQ covers basic dental care for children under 10 and people on social assistance who haven't worked for 12 straight months. That means low-income earners and those with unstable jobs aren't covered at all.
The public plan should be broadened to include those people and also seniors, said Cathy Inouye, a community organizer at Project Genesis in Montreal's Côte-des-Neiges neighbourhood.
"In general, the government has the capacity, and they have the responsibility to make sure that people's basic health care needs are met, and your oral health is a major part of your health."
The public plan should also cover procedures such as root canals and gum grafts for adults, she said. People who can't afford to have that work done can end up living with excruciating pain.
Inouye said she was told a story about a man who was homeless. He found somewhere to live but needed a gum graft. He was informed that it would cost $1,500 and contemplated going back to live on the street so he could pay for it.
"There are not many places for people to turn. There are a few clinics, sometimes an emergency room, but there are limits to what they will do there as well," she told CBC Montreal's Daybreak.
In a statement, the government did not address the issue directly due to the ongoing negotiations.
"We want to reach an agreement as quickly as possible, to the satisfaction of both parties, to benefit the most vulnerable people," it says.
System is 'ludicrous,' order president says
Barry Dolman, president of Quebec's order of dentists, says the fact that oral health isn't considered part of general health doesn't seem right.
"It doesn't make any sense. Imagine if your ears weren't covered. I mean, that's how ludicrous the system is right now."
He said the issue has become one of "political expediency," and that right now, in a pre-election period, it looks good for the government to tell dentists they can't have more money.
Dolman pointed out that even for children 10 and under, preventive care, such as cleanings, sealants and fluoride, is not covered.
He gave another example — if someone had an abscess and went to a hospital, it would be drained, and the patient would be given antibiotics.
But the hospital wouldn't treat the actual problem — the tooth — because extraction isn't covered for everyone.
Dolman said dentists do a lot of work under the radar that is free. The order even set up a foundation so people in desperate need of care can access it.
He said he is frustrated because the order has been trying to get the government to modernize access to care, to no avail.