25
Volume1 Issue3
|
I
ssues and
P
eople
suffer fromachronic shortageof care
providers and lengthywait-times.
Theyalsobelieve that competition
from theprivate systemshelps to
improve theefficiencyandquality
of care, byattractingcareproviders
throughhigher reimbursement fees.
33,34
Nonetheless, theoverall effect elevates
thecost of careanderodes confidence
in thepublic system,
34
whichprompts
some jurisdictions toprohibit
overlappingcoverage for physicians
andnecessaryhospital services and to
regulate the feesof physicianswhoopt
out of thepublicplan.
35
Reformof the
VeteransHealthAdministration in the
UnitedStateshasdemonstrated that
apublic systemcanguaranteebetter
access andbetter clinical outcomes
thanprivate systems.
36
Webelieve that
older people inCanadacanbenefit
from this experiencewhenapplied to
dentistry.
Solidarity inCare
Privatedental insurers inCanada
andelsewhere typically recognize
preventive services, extractions,
completedentures andprophylactic
removal ofwisdom teethas“basic”care
coveredby their insurancepolicies,
whereas rehabilitative treatments,
suchas endodontics, periodontics and
fixedprosthodontics, areconsidered
personal responsibilitiesnot covered
by the insurance.
37
However, there is
nouniversal consensuson the scopeof
basicoral healthcare for anyagegroup.
Whilemost dentists inCanadawould
consider endodontics, periodontics and
uncomplicatedfixedprosthodontics as
part of the routinebasiccare theyoffer
to their patients,
38
insurers’ influence
onpatients’ treatment decisions could
sometimes conflictwithprofessional
recommendations.
39
Furthermore, the
scopeof carevarieswithchanging
expectationsof thecommunity. But
theprovisionofmaximal benefit
to the least advantaged in society
is anessential principleof any just
andegalitariandistributionof health
care. Only thenwill the lesswell-off
havea reasonableopportunity to
access thenecessaryhealthcareof
acivilized society.
37
Wealso support
theprinciples that everyone should
be free to select their careproviders,
but that theprovisionof caremust be
monitored responsiblybya regulatory
body representingcare recipients,
careproviders andpolicy-makers. This
regulatory surveillance,whichexists in
all Canadian jurisdictions, shouldhelp
prevent unnecessary inflationof feesor
other abuses.
OvercomingPhysical
Barriers
RemoteCommunities
Dental services in rural areas are
limited,
40
largelybecausedental
professionalswithminimal personal
or professional experience in rural
dentistrygenerallyprefer to live in
urbancommunities.
41
Consequently,
elderlypeople in remotecommunities
facemajor barriers related to isolation
and transportation,whichpredispose
them to seriouspersonal andoral care
neglect.
42
Mobiledental clinicshave
servedmany remotecommunities and
long-termcare facilities throughout
Canada.
43-45
However, theyaredifficult
to staffandmaintain.
46
Universal dental
insurance for all Canadianswouldnot
necessarilybringoral care to remote
areas, but itwouldoffer afinancial
incentive for oral careproviders to
move to smaller andmore remote
communities andencourageelderly
people in remotecommunities to
access carewherever theyfind it.
SocialResponsibility
Government leadership inoral health
caredoesnot eliminate individual
responsibility toenableandpromote
basichealthcareequity. Auniversal
publicdental planmight appear to
someas a simple shift of inequity
from theolder population (15%) to
theworkingpopulation (85%).
Nonetheless, aside from fulfilling
the social responsibility tocare for
vulnerablemembersof society (as
Rawls argued) anyof us canbe
cast among the least advantaged
in societyandmight onedaybenefit
