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Stalemate looms over closure of chronic disease dental scheme


It is looking increasingly unlikely that the Government will move to close down the popular, but costly to the budget, chronic disease dental scheme (CDDS) before the end of the year. This is despite increasing pressure on the Government to meet its commitment to return the budget to surplus in 2012–13 and the subsequent savings closure of the scheme would deliver. During recent Senate Estimates hearings in October, the Secretary of the Department of Health and Ageing indicated that while it remains the government's intention to close the scheme, continuing opposition to its closure in the Senate means it is unlikely it will move to do so.

As the scheme can only be closed by a legislative instrument—which can then be disallowed by either chamber—the government cannot act with certainty without Parliamentary approval. Both the Greens and the Coalition opposed efforts to close down the scheme when legislative efforts to do so were brought before the Senate in 2008 (see this background note for more detail).

Under the scheme patients with a chronic condition who are being managed by their GP can access up to $4250 worth of dental treatment under Medicare, if their dental condition is impacting on their illness. The scheme so far has treated more than 780 000 patients at a cost to Medicare of some $1.9 billion since it was introduced in the last few months of the Howard Government.

The Government has long been concerned about the rising cost of the scheme, alleged episodes of rorting and that it may not be well targeted, previously describing the CDSS as a failure. It has promised to replace it with a new Commonwealth Dental Health Program (CDHP) to be delivered through the states and territories via public dental clinics. This scheme would deliver some 1 million services targeting those on low incomes, as well as the chronically ill, indigenous Australians and children.

But the level of funding proposed for the CDHP (some $290 million over 3 years) is substantially less than what is currently spent annually on services under the CDDS, raising questions over whether the proposed funding for the CDHP will be sufficient. Delivering more dental services through existing public dental infrastructure will be challenging without a significant expansion of the public dental workforce, possibly leading to even longer public dental waiting lists.

Dental health is increasingly seen as important for overall health and wellbeing, with poor dental health being associated with a range of chronic and serious conditions, including cardiovascular disease. Further, there is increasing evidence to show that even those with insurance are finding cost to be a significant barrier to seeking regular and timely dental treatment. As well, treating preventable but advanced dental diseases through hospitalisations is more costly than prevention and ties up increasingly valuable hospital resources. This makes the issue of how best to fund and promote good dental care in the longer term a significant policy challenge.

There have been a number of policy proposals to improve access to affordable dental care. In 2009, the National Health and Hospitals Reform Commission recommended the Denticare Australia scheme to provide a basic package of dental services through either the public or the private sector and part-funded by an increase to the Medicare Levy (see this Parliamentary Library background note for more details). The Greens also advocate a program called Denticare, but their scheme would involve expanding access over 5 years to a range of dental services through Medicare, giving priority to disadvantaged groups.

But as the CDDS experience shows, such fee for service arrangements can be costly to fund. Arguably, Medicare is not optimally designed to fund prevention programs; it is best suited to fund treating episodes of illness. The National Oral Health Plan, released in 2004 by the Australian Health Ministers Conference recommended a population health approach to dental care with engagement across both the public and private sector and all levels of government. The Plan includes targeting at-risk groups, such as those on low incomes, the elderly, indigenous Australians and children and placed a greater emphasis on preventative activities.

Ultimately, adopting a mix of funding options, including some level of private health insurance, may need to be considered when it comes to funding dental care.

Last budget, the Government announced it would establish a Dental Advisory Council to provide advice on progressing dental reform. Although the Council has yet to officially report, press reports suggest that among other options, it favours keeping a more targeted CDDS. Attempting to close the CDDS with no viable alternative in place, and with continued Parliamentary opposition over an issue where Labor has been previously seen as an advocate—affordable dental health—means the Government is unlikely to press for the closure of the CDDS. But reforming dental health funding longer term and improving access to oral health care will remain a challenge in a tight fiscal environment.