March 11, 1999

To:Budget Committee

From:Shirley Hoy, Commissioner of Community and Neighbourhood Services

Subject:Weekly update on Negotiations with the Ontario Dental Association Report

Purpose:

To inform the Budget Committee on the progress of negotiations with the Ontario Dental Association.

Source of Funds:

Not Applicable

Recommendations:

That the Budget Committee receives this report for information.

Background:

On February 19, 1999 the Ontario Dental Association (ODA) deputed at the Budget Committee on the Public Health proposal to harmonize dental services in the new City. At that time the Budget Committee directed staff to meet with the ODA and to share information that would allow the ODA to develop and submit a proposal to utilize private dental offices to harmonize dental treatment services across the new City according to the January 19, 1999 Report to the Board of Health, "Harmonization of Dental and Oral Health Services".

To date staff have shared the following documents with the ODA:

1) "Report of the Project team to Recommend Restructured Dental Services in Toronto,"

2)The ARA Report on the Management Review of the Public Health Division.

3)A list of the procedure codes and frequency from the former City of Toronto and the procedures performed in the former City of North York program for 1997.

4) A copy of the structured survey used by the project team to gather information on different delivery program models.

In addition the ODA was informed that Public Health is unable to provide utilization data, cost per claim and cost per client, information the Ontario Dental Association is requesting. These instruments are not the best method to obtain consistent, comparable cost-analyses of six different program constructs with six different data collecting systems. The dental treatment program information is not yet available in a consolidated form.

Comments:

Staff met with representatives of the ODA on March 3, 1999 to review the report on Restructured Dental Services, to clarify the information contained in the report and to answer any questions the ODA had.

The ODA was reminded that programs that the Social Services and Public Health divisions were legally mandated to administer and deliver were not to be considered by the ODA for harmonization. The only program that is under consideration is the dental treatment program with a current budget of $3.6 million.

The representatives from the ODA repeatedly questioned whether the costs of the dental treatment programs as stated in the reports were the full costs. Staff pointed out to references in the report that stated quite clearly that the costs of corporate services such as legal, purchasing, human resources were not included in the cost analyzes and usually did not form part of any proposal that were being presented to Council. These costs are assumed to be germaine to the operation of the City. The ODA was given a cost-estimate of 10% for these services.

The ODA requested a spread sheet or a budget document with line by line details of the costs of the dental program. It was explained to the ODA that this was not available as the six different municipal Public Health budgets were not yet consolidated, and the level of detail they are requesting was not readily available.

The ODA stated in the meeting that the use of RVU'S as a comparative tool was not valid. Yet when questioned could not provide any reasons for the lack of validity in using Relative Value Units to compare the costs of different program models. Staff further explained that the calculations in the report on cost per RVU were done using simple mathematical operations, and included all program costs.

The ODA was informed that their proposal should be submitted to public health staff by March 9 so that it could be included in the report back to Budget Committee.

The following information has also been sent to the ODA since the meeting of March 3, 1999

a) A copy of the review completed by the ICEs consultant

b) A copy of the article "Oral Health and family characteristics of children attending private or public clinics"

Conclusions:

Staff will be compiling the reports requested by the Budget Committee for the Budget Committee meeting of March 29, 1999 and will include proposals received from stakeholders by Tuesday, March 9, 1999. It is hoped that the ODA will submit a proposal in a timely fashion for inclusion in the report.

Shirley Hoy, Commissioner

Community and Neighbourhood Services

Contact Name:

Dr. Hazel Stewart

Tel: (416) 392-0442

Fax. (416) 392-0713