A new dentistry clinic in downtown Toronto is providing cheaper care by only offering basic procedures and streamlining administrative work online – a model that is being hailed for providing greater access to lower-income people but questioned for its viability in the for-profit sector.
Dentistry For Everyone opened last month and aims to improve access to care by undercutting industry-standard costs by roughly 30 per cent for basic treatments such as cleanings, fillings, extractions and simple root canals.
“We save on the overhead, preparation, instruments and materials because we only have what we need to provide those core services,” said Karim ElMofty, co-founder of the clinic, noting that patients also handle insurance, payments and scheduling themselves by using a website that reduces overhead costs.
“We pass on those savings to our patients.”
While similar low-cost care is sometimes offered by not-for-profit dental clinics, academic experts say this is the first time they’ve seen a for-profit clinic to try to significantly undercut industry costs by using this model.
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Ottawa, meanwhile, is preparing to roll out the Canadian Dental Care Plan (CDCP), a funding program for lower-income Canadians. The federal government has said that roughly one-third of Canadians are unable to access dental care because they don’t have insurance.
But Dr. ElMofty said access to dental care can also be an issue for insured and high-earning Canadians. In a survey commissioned by his clinic, more than half of respondents said they had insurance but weren’t able to get the full cost of their care covered. Forty-three per cent of respondents earning more than $100,000 per year also said they’d like to get more dental work done but can’t afford it.
Reaction to the clinic among academic experts was mixed, with some applauding the attempt to improve access to dental care, while others were concerned about clinics potentially trying to compete on cost.
Charges for dental care are set by each individual provider, but there is a suggested fee guide published each year by professional associations in each province.
Dentistry For Everyone charges much less than the suggested fees set by the Ontario Dental Association. For example, they offer dental exams with X-rays at $49, as opposed to the ODA-suggested $200 to $300; cleanings start at $150, compared with the suggested price of $220 to $250; and a small filling will cost $130, compared with $190. It also is one of very few dental offices that publish their fees.
By providing cheaper basic procedures, Dr. ElMofty hopes clients will save more money by accessing care now to avoid more complicated dental issues down the road.
Lesley Byrne, director of communications for the Royal College of Dental Surgeons of Ontario, said the organization supported “any delivery model that increases access to care and where the dentists follow our standards and provide safe, effective and ethical care.”
The ODA says its fee guide is simply a suggestion and recognizes that there are different cost inputs to consider between different dental practices. It says the final price is up to each office to decide.
“The reason we have a suggested fee guide is because there’s no right answer to every situation,” said Dr. Brock Nicolucci, president of the ODA.
He said one reason many offices don’t publish their rates is because the cost of each procedure can vary widely depending on each patient’s case and the administrative work required in more complicated work.
Sonica Singhal, a University of Toronto professor and graduate program director for dental public health, said she was concerned about a possible “race to the bottom” if more clinics in the for-profit sector try to compete on price to attract clients, as it could negatively impact the quality of care.
She said fee guidelines exist for a reason: to set a financially sustainable charge based on the cost of delivering those services, including overhead.
“This is health care, you can’t just bargain from one place to another,” Dr. Singhal said.
While she said she wasn’t questioning the integrity of Dentistry For Everyone, she would prefer to see systemic changes to break financial barriers rather than private-sector fixes.
But other experts welcome any attempt to break barriers to dental care.
“I do believe that basic services are something that need to be addressed – if you catch things early and focus on prevention, then it can be a cost savings beyond the discounted rate,” said Leeann Donnelly, an associate professor and director of community engagement at the University of British Columbia’s faculty of dentistry.
She said her main concern was whether certain demographics might struggle with using the company’s self-service website, such as the elderly and new Canadians who struggle with English.
“Time will tell if this model is successful … but anything that actually does help with access to care is a worthwhile venture.”
Ms. Donnelly added that issues around price transparency are something she often hears complaints about. Sometimes, dentists will only be able to give an accurate estimate of the cost of a procedure after an initial exam is done, she said.
Dr. Singhal and Ms. Donnelly both cited the coming CDCP as a source of relief for people who are struggling to afford dental care, but the final details of the program – which is expected to roll out by the end of the year – have not yet been released.
In the meantime, they said people struggling to access dental services can also seek out discounted care from non-profit providers, such as universities in their area, or enquire with their dentist’s office about payment plans or potential discounts based on their income.