What we examined (see Focus of the audit)

Health Canada supports the oral health of First Nations and Inuit populations through various programs. The largest of these is the Non-Insured Health Benefits Program, which reimburses claims for medically necessary health services, including oral health services. Another program, the Children’s Oral Health Initiative, promotes oral health care and offers preventive oral health services for young children in about half of the eligible communities. These programs support the Department’s mandate to ensure access to health services for First Nations and Inuit populations.

This audit focused on whether Health Canada had reasonable assurance that its oral health programs for eligible Inuit and First Nations people had a positive effect on their oral health.

Why we did this audit

This audit is important because poor oral health can have a negative effect on overall health. Therefore, it is important for Health Canada to know if its oral health programs have a positive effect.

What we concluded

We concluded that while Health Canada provided Inuit and First Nations people with access to important oral health services, the Department did not demonstrate how much its oral health programs helped maintain and improve the overall oral health of Inuit and First Nations at the population level.

What we found

Effect of oral health programs on Inuit and First Nations people

Overall, we found that Health Canada monitored and analyzed the dental benefits paid for by the Non-Insured Health Benefits Program. However, the Department did not know how much of a difference it was making to Inuit and First Nations people’s oral health. Despite knowing for many years about the poor oral health of Inuit and First Nations people, the Department had never finalized a strategic approach to help improve it.

The Department delivered the Children’s Oral Health Initiative, which focused on prevention and helped some First Nations and Inuit children improve their oral health. However, departmental data indicated that both enrolment in the initiative and the number of services it delivered had declined. The Department did not know why.

These findings matter because Inuit and First Nations people have more unmet oral health needs than the rest of Canadians do. The Department spends more than $200 million per year on oral health services for these populations; a strategy would provide Health Canada with direction on how to meet their needs and help them to improve their oral health. Knowing what difference the programs are making would also help the Department find opportunities to improve the programs’ effect on oral health.

• Health Canada did not determine how much its dental benefit program was improving oral health

  Recommendation. Health Canada should finalize and implement a strategic approach to oral health for Inuit and First Nations people, along with a detailed action plan with specific timelines, and monitor implementation.

  Recommendation. Health Canada should develop a concrete plan to determine how much of a difference its oral health services are making on the oral health of Inuit and First Nations people. This plan should use all the relevant information the Department collects, and should include a collaboration among all of Health Canada’s programs involved in oral health.

• The Children’s Oral Health Initiative helped some First Nations and Inuit children maintain and improve their oral health

  Recommendation. Health Canada should improve its analysis of data, including the information that is collected and recorded in its dental database, so that its information on the Children’s Oral Health Initiative is accurate and comprehensive enough to contribute to the Department’s overall management of its oral health programs.

Program Management

Overall, we found that there were administrative weaknesses in Health Canada’s management of its Non-Insured Health Benefits Program. Health Canada’s service standards for making decisions on pre-approvals and complex appeals were not clear. We found that the Department was meeting its service standard for appeals 80 percent of the time, but we were unable to rely on the Department’s appeal database to determine this. We also found that Health Canada did not always inform clients and service providers promptly about some of the changes it made to its services.

Furthermore, despite a long-standing awareness of upcoming shortages in dental therapists in two regions, Health Canada has been slow in taking action to address this issue.

These findings matter because delayed or unclear communication can affect clients’ expectations about what oral health services are available to them and how long they must wait for decisions. Furthermore, without action on human resource challenges, delivery of oral health services could be affected.

• Health Canada’s framework for decision making did not include which elements should be considered when making changes to its list of dental benefits

  Recommendation. Health Canada’s process for making changes to its list of oral health services covered by the Non-Insured Health Benefits Program should

  • include which elements should be considered;
  • include requirements to document when and how decisions are made,
  • specify who has final approval for all such decisions, and
  • include quickly updating providers and clients on changes.

• Health Canada’s service standards for pre-approvals and complex appeals were unclear, but it met its service standard for appeals most of the time

  Recommendation. To improve its program management for the Non-Insured Health Benefits Program dental benefit, Health Canada should

  • clarify what its service standard for pre-approvals is measuring;
  • clarify the service standard for complex appeals; and
  • improve its data entry, so that it has accurate and reliable information in its appeal database.

• Health Canada was slow to take action on human resource challenges in two of its regions

  Recommendation. Health Canada should implement strategies to ensure that it has the human resources it needs to deliver oral health programs and related services to First Nations and Inuit populations over the long term. These strategies could incorporate the use of a variety of professionals and adopt practices from other regions, where applicable.

Entity Responses to Recommendations

The audited entity agrees with our recommendations and has responded (see List of Recommendations).

Related Information

Report of the	Auditor General of Canada
Type of product	Performance audit
Topics	Aboriginal Affairs Health
Entities	Health Canada
Completion date	26 September 2017
Tabling date	21 November 2017
Related audits	Report 4—Access to Health Services for Remote First Nations Communities, 2015 Spring Reports of the Auditor General of Canada

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