Budget 2011–12: Dental health—modest steps towards reform
This Budget announced two new initiatives in dental health, in areas where reform has been seen to be long overdue and calls for it have been ongoing. These are the funding of voluntary internships for dentistry graduates and the establishment of a new National Advisory Council on Dental Health. Funding for 150 dentistry internships from 2013 mainly in the public dental health sector, at a cost of $52.6 million over four years, aims to address the chronic shortages in the public dental health workforce. The new Advisory Council is to be established in 2011–12, with total funding of $0.5 million. To be comprised of dental health experts, the Committee will advise the Minister on dental issues and prioritise areas for improvement and investment. In addition, this Budget includes a commitment that, ‘in line with the Government’s agreement with the Australian Greens’, dental health reform will be a major priority for the 2012–13 Budget.
Funding the dental internships will partly address a key recommendation of the National Health and Hospitals Reform Commission. In 2009, it proposed funding of $200 million to support 700 annual internships for dentistry graduates. The Australian Dental Association has also been advocating funding for a one year residency program for graduating dentists. It has welcomed this initiative.
The public dental workforce has long faced chronic shortages, which exacerbate waiting times for public dental services. Although dentistry students are required to undertake clinical training in public dental facilities, this measure is aimed at graduates who might otherwise move into private practice. Many in the dental and public health sectors will therefore welcome this initiative. However, as it will be voluntary it may do little to address the uneven distribution of the dentistry workforce. Around 78 per cent of dentists work in the major cities, meaning that people in rural and regional areas could continue to face barriers to affordable dental care.
The Budget also confirmed that the Government intends to close down the Chronic Disease Dental Scheme (CDDS) by December 2011.  Operating since 2007, dental benefits (up to $4250 over two years) have been available for those diagnosed with a chronic illness, whose dental condition is exacerbating their illness and who are managed under a General Practitioner care plan. Some $1.5 billion in benefits have been paid since the inception of the CDDS, well over the original budget estimate of $377 million over four years. The latest estimate indicates that spending is accelerating. Even if the scheme is closed later this year, expenses over the period 2010–11 to 2011–12 alone are estimated to be $1.6 billion.
The Government says that it must redirect funding from the CDDS in order to fund two other dental reform initiatives that were promised during the 2007 election: a Commonwealth Dental Health Program (CDHP) and a Teen Dental Plan (already implemented). The CDHP will provide the states with $290 million to deliver one million additional public dental services for the financially disadvantaged, targeting those with chronic conditions, Indigenous people and children. Without the redirection of funding from the CDDS the CDHP is likely to remain in abeyance.
Attempts in 2008 to cancel the CDDS were opposed in the Senate, despite reports of rorting and claims that the program is poorly targeted. Opposition to its abolition has spanned the political spectrum, with the Greens, the Federal Opposition and key Independent Senators voting against it previously. Arguments against closing the scheme include that it fulfils a real need for those who have chronic illnesses. The Australian Dental Association, although not a supporter of the CDDS, has expressed concern that without a replacement program in place many chronically ill patients who now rely on the scheme would face 'devastating consequences'. Others have argued that the CDDS could be made more sustainable, if the range of services was tightened and it was better targeted.
It remains to be seen if the modest dental initiatives announced in this Budget—and the promise of more to come—will be enough to persuade the Greens (who will hold the balance of power in the Senate from July this year), or the Independents who hold the balance of power in the lower House, that closing down the CDDS can be justified enabling funds to be redirected to other dental health programs. Nevertheless, introducing the CDHP remains Government policy, with the budget papers estimating that $94.3 million (from a total fund of $290 million) would be provided to the states this financial year to implement the program.  Whether this funding will be sufficient to provide enough services to meet demand is uncertain. In seeking to close the CDDS the Government would be delivering on a key election promise and supporting dental reform. However, another reason for closing down the CDDS is concern about the growth in expenditure in a fiscally tight environment.