Oral health care's contribution to catastrophic spending in Canada: a descriptive study

Oral health care (OHC) in Canada is largely financed through employer-sponsored insurance and out-of-pocket (OOP) payments and is generally excluded from its system of universal health coverage, although public financing will increase substantially with the introduction of the Canadian Dental Care Plan (CDCP). We generate estimates of catastrophic health expenditure (CHE) in Canada and assess the contribution of OOP spending in OHC on CHE between 2010 and 2019.

We examined the Survey of Household Spending from 2010 to 2019 by year and in pooled cross-sections and followed the WHO/Europe methodology to determine CHE. Spending OOP in OHC was compared to medicines, medical products, outpatient care, diagnostic tests, and inpatient care. We assessed CHE and the share of OOP spending annually, nationally, provincially, across income quintiles and presence of private insurance including oral health coverage.

Estimates in CHE dropped from 5 % (2010) to 3.4 % (2019) and was more common among lower income groups, those without private insurance and Québec residents. Oral health care was the second highest contributor to CHE (after medicines) especially among the lowest income groups. Having private insurance yielded a higher share of OOP spending among lower than higher income groups.

From 2010 to 2019, OOP spending in OHC was the second-highest contributor to CHE in Canada. Further monitoring is warranted to ensure financial protection is achieved for OHC after the full implementation of the CDCP.