Oral Health Care for Guaranteed Income Supplement Recipients. December 5, Doreen Khamo. Brynn McCredie. Dorraine Mitchell.

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1 Oral Health Care for Guaranteed Income Supplement Recipients December 5, 2016 Doreen Khamo Brynn McCredie Dorraine Mitchell Binaya Nyaupane

2 pg. 2 Executive Summary In Canada, many of us pride ourselves in having universal healthcare. A downfall of this current system is that it does not include dental care; resulting in many people having to pay out of pocket to maintain their oral health. Shouldering this cost is especially difficult for people who are in the low income bracket, specifically our aging population, which is the fastest growing group in Canada. As a result, many people within this demographic frequent hospital emergency rooms and/or physician offices to seek help. Sadly, statistics show that in every 9 minutes a person in Ontario arrives to the hospital emergency department or physician offices with dental problems. However, the underlining problem is not resolved, as in most cases patients are only prescribed pain relievers or antibiotics. This is a significant expense to our healthcare system. One way that the government can address this problem is by providing an annual financial topup for Guaranteed Income Supplement (GIS) recipients who are experiencing oral health problems. This will ensure that this population can afford appropriate and necessary dental care necessary for their continued wellness and quality of life. Context and Importance of the Problem In Canadian public policy the care for our lips, tongues and throats are fully covered by public funding, excluding our teeth and gums. When Medicare legislation was created, oral health was not deemed essential in maintaining overall health. There was also a belief that caring for our teeth was a personal responsibility. However, there is an increasing body of evidence that shows a link between poor oral health and chronic health conditions (i.e. cardiovascular disease, respiratory diseases, diabetes and Alzheimer s disease). Furthermore, untreated tooth decay, tooth loss and gum disease results in psychological and social challenges. The majority of dental care in Canada is privately financed, with 51% paid through employment-based insurance plans

3 pg. 3 and 44% through out-of-pocket expenses; the remaining 5% of national dental care expenses are for publicly-funded programs. Many recipients of Old Age Security (OAS) and Guaranteed Income Supplement (GIS) are not having their basic needs met because they are unable to afford essential services. It has been shown that many low-income OAS/GIS recipients have poor oral health due to the financial costs associated with seeking medical treatment. Unfortunately, forgoing medical treatment because of its prohibitive costs is associated with an increase in dental-related emergency room and physician office visits. Between the years of 2012 to 2014, dental visits to emergency rooms and physician offices in Ontario alone cost our healthcare system approximately $38 million per year for a problem that is not treated. In 2014, it was reported that 60,416 visits to the hospital emergency rooms were dental-related in Ontario. This number will continue to rise if our current healthcare system continues to utilize a bandage approach for solving dental care needs for low-income populations. This predominately includes prescribing pain relievers and/or antibiotics to address their needs rather than identifying and solving the underlying problem. There have been a few independent efforts to help low-income seniors access dental services. However, many of these programs offer stringent eligibility requirements; long waiting periods (8-12 months); inaccessibility concerns; and minimal advertisements within communities. The creation of a universal program will aid in helping to combat the aforementioned pitfalls associated with many of these independent agencies. By not considering the root causes of this problem our healthcare system will continue to incur significant costs. In addition, the demands on our already congested and strained hospital emergency rooms will increase due to dental related visits. Low-income seniors are a vulnerable and segregated segment of the population who in some cases are forced to sacrifice their dignity

4 pg. 4 as they age. Approximately 78.3% of Canadian seniors still have some of their teeth which means a higher requirement for dental services is necessary. This population is known to be more susceptible to illnesses and diseases due to lack of proper healthcare, and poor oral health only increases the prevalence of diseases common to the older populations, creating more healthcare demands. By not considering this problem it further perpetuates a vicious cycle of financial strains on our healthcare system and the deterioration of an already vulnerable and fragile populations health and dignity. Critique of Policy and Recommendations According to Statistics Canada, the senior population is by far the fastest growing group in Canada. In 2013, 1 in 9 seniors who lived in Canada were living in poverty (Broadbent Institute, 2015). Currently those who depend entirely on OAS and GIS received only $17, a year. Data from Statistics Canada has shown that the Low Income Measure for seniors who are single is $22,000 a year thus putting OAS and GIS recipients well below ($5,000) the Low Income Measure cut-off lines. The financial assistance that is required for basic needs cannot be met with this minimal income. What is even more shocking is the comparison between the increase in GIS to the Consumer Price Index. Between the years of 1984 to 2011 the Consumer Price Index increased by approximately 74%. OAS/GIS levels only increased by 7% for couples and 15% for singles during that same time-period (Broadbent Institute, 2015). The current GIS levels are too low and are not providing the assistance necessary for our aging population. Dental care has become increasingly unaffordable and low income seniors are a cohort that increasingly needs this service. The Canadian Academy of Health Sciences reported that access to quality dental care is a barrier for seniors with low incomes. Poor dental health and tooth loss often occurs with age, and these problems are associated with malnutrition and other

5 pg. 5 systemic health problems (Review of Oral Health Services in Ontario: Final Report, 2014; Hase, 2010; Kraglund & Cooney, 2008). The Canadian Health Measure Survey (CHMS) from found that dental coverage was associated with whether dental care was sought out. Over half (53%) of seniors aged who participated in this study stated that they had no dental coverage through insurance or government programs. Access to coverage is as a significant barrier for this population in accessing the care necessary for their overall wellbeing. The federal government needs to provide adequate financial assistance to low-income seniors so that other larger, systemic health problems can be prevented and treated. Our policy recommendation is to provide a dental top-up for GIS recipients who are experiencing significant oral health problems. This top-up would be provided based on financial need with proper medical documentation from a recognized healthcare provider stating the dental service requested is deemed medically necessary. The dental top-up is calculated by matching the percentage of GIS that each recipient receives. The maximum dental top-up amount that would be provided to an individual would be $600 annually. In order to arrive at the dental top up amount for each eligible GIS recipient, it is necessary to calculate two separate percentages between single and spouse/common law GIS recipients (see below for calculations). The calculation to determine the dental top up percentage for single seniors is (GIS received) x (0.69). The calculation to determine the dental top up percentage for spouse/common law is (GIS received) x (1.15). Calculation: Percentage of GIS and Dental Top Up 600 / (Max. GIS a single senior can receive) = / (Max. GIS a spouse/common law can receive) = 1.153

6 pg. 6 The OAS Actuarial Report (2016) states that there is a total of 2,106,000 GIS recipients. Of that amount, approximately 900,000 are single GIS recipients. From this group the average payout to a single GIS recipient is 65% of the maximum $ per month. To arrive at the maximum dental-top up amount based on GIS received, a factor of is used. This amount can be applied to all single GIS recipient payouts to arrive at their dental top-up amount. Also, approximately 1,206,000 are spouse/common law GIS recipients. The average GIS paid out to this group is 65% of the maximum $ per month. In this case, to arrive at the maximum dental top up amount based on GIS received, a factor of is used. This amount can be applied to all spouse/common law recipients to arrive at their dental top up. If all eligible seniors were to apply for this dental top, the maximum cost of this program would be approximately $820,806,000 (see calculations below). Calculation: The Maximum Cost of this Top Up (If all eligible seniors were to apply) Single 900,000 x x x 0.65 = approx. $350, 811, 000 Spouse/Common Law 1,206,000 x x 520 x 0.65 = approx. $469, 995, 000 Total: $ , 000 Conclusion Access to dental services should not be restricted to people who have the privilege to pay out of pocket or who have private dental insurance. Redirecting funds already being spent in our healthcare system towards a GIS top-up for dental care is a strategic and innovative move to not only better our healthcare s financial practicality, but also strengthen our population s overall health. Oral health issues need a comprehensive approach that includes promotion, and treatment for our aging population. In a country as prosperous as Canada, our universal healthcare system

7 pg. 7 is internationally known to be one of our many signature traits. Offering a dental top up to GIS recipients symbolizes our collective strength as a nation to care for the well-being of those who were once the backbones in helping build the foundation in which our nation presently stands.