Characteristics of cost-related avoidance of oral health services among people in Canada eligible for the Canadian Dental Care Plan.

Abstract

Background: Cost and lack of dental insurance coverage are major obstacles to accessing dental care in Canada. This study estimates the prevalence and explores the characteristics of cost-related avoidance of oral health services among a nationally representative sample of people in Canada aged 12 years and older who may qualify for coverage under the Canadian Dental Care Plan (CDCP).

Data and methods: Data from the 2023 to 2024 Canadian Oral Health Survey were used to construct a population-based cohort of CDCP-eligible individuals based on income and insurance status. The responses from 11,189 CDCP-eligible individuals in Canada who answered questions about avoiding visits to an oral health professional or avoiding recommended dental care because of the cost were analyzed. Generalized linear models were used to examine the association between sociodemographic characteristics and the outcomes of cost-related avoidance of oral health services.

Results: During the period from November 2023 to March 2024 - before the CDCP was available to help pay for care - 47% of CDCP-eligible individuals avoided visits to an oral health professional and 38% avoided recommended dental care in the past year because of the cost. Young and middle-aged adults, uninsured individuals (compared with those with public insurance), and individuals with an adjusted family net income of less than $38,800 reported greater cost-related avoidance of oral health services. After adjustments, dental insurance status (odds ratio [OR]: 5.78; 95% confidence interval [CI]: 3.74 to 8.94) and self-reported mouth problems (OR: 4.80; 95% CI: 3.87 to 5.96) had the strongest association with cost-related avoidance of dental visits in the past year. The same was true for cost-related avoidance of recommended dental care (OR: 3.15; 95% CI: 2.07 to 4.78 and OR: 5.11; 95% CI: 4.17 to 6.27, respectively).

Interpretation: This study identified cost as a significant barrier to accessing oral health care for nearly half of CDCP-eligible individuals. The findings suggest that the use of oral health services by CDCP-eligible individuals in Canada is largely influenced by their income and ability to pay out of pocket for dental care expenses, rather than their need for treatment, leaving many vulnerable to unmet oral health care needs. Establishing baseline estimates of cost-related avoidance before the CDCP became available to help pay for care is essential for gauging the success of easing financial barriers and facilitating effective program monitoring.