The government’s Indigenous dental health program is ignoring the role its policies played in causing Indigenous-non-Indigenous dental health disparities.
Starting in 2016, a Cree child’s struggle to get braces became national news . Thirteen-year-old Josey Willier from the Sucker Creek First Nation suffered from chronic pain from her crooked teeth. Her dentist said that she needed braces to avoid more expensive and invasive surgery in the future, but the federal government, which administers the program that provides dental benefits for First Nations and Inuit people, denied her claim. The family took the government to court, and the government spent $100,000 on lawyers defending its decision to deny the $8,000 procedure. Finally, just before the Federal Court of Appeal was to decide the case, the government settled with the family. In July 2018, the government expanded eligibility for orthodontic treatment.
Even with this step forward, the Non-Insured Health Benefits (NIHB) Program constantly frustrates both patients and service providers, remains inefficient and inconsistent, and fails to address the underlying causes of poor oral health among Indigenous people. These issues have been recognized for decades — by the Auditor General of Canada and others — and action is badly needed. The need is all the more pressing because First Nations and Inuit people in Canada are much more likely to have cavities, lose their teeth prematurely and suffer from orthodontic problems than their non-Indigenous counterparts. Predetermining failure
First Nations and Inuit people have experienced many and varied difficulties with the dental benefits provided by the NIHB Program. Many of the Indigenous people who rely on the NIHB Program say that it is often extremely hard just to find a dentist and that, when they are available, dentists often charge additional fees or ask people to pay up front. What’s more, services that many insured Canadians take for granted are subject to an unpredictable process called “predetermination”: permission has to be received from Health Canada before treatment can go ahead.
The predetermination requirement has caused people considerable distress. As the Assembly of First Nations (AFN) put it in 2005, “The current system of predetermination for many routine dental procedures causes a prolongation of illness, lacks in compassion and adds considerable cost to the program, particularly if clients have travelled long distances.” Predetermination means that people often need to make a second trip to the dentist — which is both frustrating for the dentist and inconvenient for the patient. The AFN reported that William Descalchuk, a First Nations man living in Alberta, complained that he had been waiting a month for approval to treat an infected molar and, due to ongoing pain, had resorted to extracting it himself.
It’s not just patients who have problems with the program. Service providers complain that the process for receiving payment and approval is much more onerous than with private insurance companies. Some providers have opted out of the program, which means that many patients have to pay directly for dental treatment. Given the disproportionately low incomes of many First Nations and Inuit people, this makes it impossible for them to access care . In Nunavut , the predetermination process has been found to act as a serious deterrent to service provision. But, given the difficulties in receiving approval, many dentists in Nunavut have done the work — only to be later denied compensation. In 2014, Peter Doig, president of the Canadian Dental Association, told Windspeaker magazine that the NIHB covered only 86 to 88 percent of treatment costs, meaning that dentists needed to either bill the patient for extra costs, lose money on doing the work or reject the […]
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