Posted 06/09/2010 by Amanda Biggs
Calls for urgent action on dental care have been a feature of public debate in recent years and were raised yet again in the context of the recent Federal election. The issue remains high on the agenda, as evidenced by the recent
agreement between the Greens and Labor which included a commitment to improving investments in dental care.
These calls for action are supported by reports of:
- declining oral health status—one quarter of adults have untreated decay, with higher rates amongst the financially disadvantaged, rural and indigenous Australians
- financial barriers—one third of Australians report delaying or avoiding dental treatment due to cost
- service gaps, particularly in rural and regional Australia, and
- long waiting lists for state public dental services—reportedly 650,000 adults are on public dental waiting lists.
Debate persists over the best way to improve and fund dental services, how these should be delivered and who should be the main beneficiaries. But the patchwork of current arrangements for funding dental care, introduced by various governments over the years, and a lack of consensus on various dental options will make progress a challenge.
The states and territories fund and deliver most public dental services, but these are largely targeted at children or the financially disadvantaged and long waiting lists apply. Under the Commonwealth funded Medicare scheme, funding for most dental services has been excluded until recently, as explained in this
Overview of Commonwealth involvement in funding dental care. Traditionally, Medicare was limited to funding medical services so dental services which were mostly categorised as ancillary services, were beyond its scope. Thus, much of the cost of dental services in Australia has been borne by individuals—some $3.9 billion annually—with private health insurance and government sources meeting the rest.
But in recent years, Medicare arrangements have changed, so that a range of allied health services are now funded, including some dental services. The Howard government introduced these under its Allied Health and Dental Care initiative in 2004 (which was then expanded in 2007). This provides limited Medicare benefits for patients with a chronic condition whose poor oral health exacerbates their condition, provided they are being managed by a GP. While many chronically ill patients undoubtedly benefited from these new arrangements,
questions over misuse of funds, cost blowouts and over servicing cast doubt on the effectiveness and viability of the program—which has now cost over $1 billion. The Rudd government promised to close it and redirect the funds to the states in the form of a revamped Commonwealth dental health program, and a Teen Dental Plan.
While a means-tested voucher for a dental check-up was introduced for eligible teenagers, the Rudd government’s proposed Commonwealth dental health program remained stalled. Additional funds were to be directed to the states and territories to expand the capacity of their public dental services and target the financially disadvantaged and other priority groups including those with chronic conditions, children and Aboriginal and Torres Strait Islander people. But efforts to close down the Howard government program and redirect funding to assist the states were opposed by the Coalition, the Greens and the Independent Steve Fielding in the Senate, as explained in this
paper.
In late 2008, after months of consultation the National Health and Hospitals Reform Commission issued its final report which included a major recommendation on funding dental care. It proposed the establishment of Denticare Australia through which individuals would choose to either purchase subsidised dental insurance to cover a basic package of dental services, or rely on an expanded free public dental program. To be funded mainly by an increase to the Medicare levy which was estimated would raise some $4.1 billion annually, the proposal garnered a mixed response at the time, as outlined in
The proposed Denticare scheme—an overview. Some questioned its cost assumptions, whilst others were concerned over equity issues. So far, neither major party has indicated support for this scheme.
Not to be confused with the NHHRC proposal is the Greens
‘Denticare’ proposal. Under this scheme, estimated to cost $4.3 billion annually, non-cosmetic dental services would be covered by Medicare with the aim of providing all Australians with access to comprehensive basic primary dental care. But if this scheme were to be pursued, it would need to overcome the opposition many in the dental profession have expressed over entrenching dental care under Medicare. Other proposals for financing dental services such as vouchers and dental savings plans, may also need to be considered.
Whatever model of funding dental care ultimately prevails and whether or not these are targeted or universal in coverage, a number of challenges will remain. Not least of these will be dental workforce issues including an ageing workforce, shortages particularly among the public dental workforce and geographic maldistribution, particularly in rural areas. More broadly, an ageing population beset with more chronic diseases will increase demand for dental health services, while poor dietary choices particularly amongst the young will impact on their dental health. The cost of dental care, consistent with other health services, is also trending upwards, adding to cost pressures on individuals and future government budgets. These broader issues will need to be considered in tandem with any proposals for increased funding of dental care.
Image Sourced from: Health Promotion Board, Singapore, http://www.hpb.gov.sg/diseases/article.aspx?id=368