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An overview of universal dental schemes

Ongoing reports of poor dental health outcomes and growing concerns that financial barriers are impeding access to affordable dental care continue to fuel calls for reform in the area of dental health. As part of its agreement with the Greens, the Government promised major dental reform but deferred significant action. It funded a number of dental internships last budget and established a national dental advisory council, to provide advice on priorities for dental reform for the upcoming budget. Although this body has presented an interim report to Government, the Minister has indicated she will await the final report before announcing a particular course of action. Meanwhile, the Minister also announced she would direct $165 million in savings from the means testing of the health insurance rebate to dental care.

Proponents of dental reform have differing views though on the best approach to dental reform. Some, like the Greens advocate a universal dental scheme along the lines of Medicare. Others, including the Australian Dental Association, argue in favour of a targeted, means-tested scheme directed to low income earners and vulnerable groups. This Parliamentary Library paper, Dental reform: an overview of universal dental schemes, looks at the international experience of one of these dental reform options—universal dental schemes.

As the paper notes, defining what constitutes a universal scheme is not straightforward. Schemes like Medicare that are characterised as being universal, in practice have limits on their universalism. Although the paper found that few countries provide universal dental care as a right, a number appear to provide some level of government funded dental benefits, either to the broader population or to specific groups. Each of these schemes is briefly described. The schemes vary considerably in scope, funding sources, resources, services and dental benefits. Some schemes offer dental cover to the broader population, but resource constraints result in either a limited the range of services, or problems around timeliness and availability of services. Others require that certain users make a contribution to the cost of dental care, or restrict eligibility for free services to specific groups, such as children, the vulnerable or the elderly.

The paper also reports on the dental health status in the few countries that operate subsidised dental schemes, and compares these with some which do not operate such schemes, including Australia. Few comparative data on dental health outcomes are available. But the number of decayed, missing or filled teeth (DMFT) in 12 year olds is commonly reported across the OECD, so this survey data was chosen for comparison. The paper found that based on this survey data there appeared to be wide variation in dental health outcomes across all those countries identified as operating some form of subsidised dental care.

Australia, with an average of 1.1 DMFT in 2004 (most recent data available), compared well to the average of 1.4 across the OECD. But the number of DMFT reported in Australian children was higher than in the UK, Germany, Denmark and Sweden, which all reported among the lowest rates overall. Higher rates of DMFT were reported in Poland, Turkey and Greece, countries which operate some form of universal or subsidised schemes.

Such wide variation in the dental schemes operating across different countries substantially limits our ability to make meaningful comparisons on the effect of specific funding arrangements on dental health outcomes. Nevertheless, it would appear that the best dental health outcomes tended to be reported in those countries which direct dental benefits specifically to children. However, a range of factors, are also likely to be influencing dental health. These include an individual's overall health status, socio-economic and demographic profile, quality of nutrition, affordability and accessibility of dental services, and the availability of water fluoridation.

While there is little doubt that the national advisory council's final recommendations and the Government response will be keenly anticipated, the way forward on dental reform is not clear and will continue to be contested.