Amanda Biggs
The main dental health spending measure announced in the
2015–16 Budget is for a one year National Partnership Agreement (NPA) on dental
services to replace the previously deferred National Partnership Agreement on
adult public dental services. $155.0 million will be provided to the states
and territories to support their provision of public dental services in 2015–16.[1]
Medicare funding for the child dental benefit scheme (CDBS) will bring the
total envelope of Australian Government funding for dental health this
financial year to around $200 million.[2]
Under the deferred NPA, $1.3 billion over four years was
promised to the states and territories for improving public dental services for
low income adults.[3] Although the Coalition
promised to honour the NPA in the lead-up to the 2013 election, commencement was
delayed by one year in last year’s budget.[4] While funding is now
partially restored for one year, future funding remains uncertain. The delayed
start to the NPA has been blamed for lengthening queues for public dental services.[5]
The nation’s current dental arrangements, split between the
Australian Government and the states and territories, have been described by
the Health Minister, Sussan Ley, as ‘fragmented’ with funding models that
increase risks of inefficiencies and service gaps.[6]
In her view, the Reforming the Federation process provides a ‘once-in-a-generation
opportunity for constructive reform’ to ‘ensure Australians get seamless access
to the services they need’.[7] She has foreshadowed a
series of reforms to dental funding arrangements to be pursued over the next 12
months.
The Budget also included a pause in indexation arrangements
for the CDBS, with savings of $125.6 million over four years forecast.[8]
Operating since 1 January 2014, the CDBS is a means-tested dental benefit for
children aged 2 to 17 funded through Medicare. Benefits are capped at $1,000 over
two years, indexed annually.[9] Pausing indexation will
bring the CDBS indexation arrangements in line with the paused indexation
arrangements for other Medicare Benefits Schedule items (announced in last
year’s budget). Further, the previously announced pause on indexation for
Dental and Allied Health Provider fees for veterans services will be extended
to July 2018, with savings of $69.6 million over four years.[10]
In addition, unspecified savings over five years are forecast from redesigning
some dental workforce programmes, including incentives to encourage dentists to
relocate to smaller rural centres.[11]
Poor oral health for some Australians continues to be observed
with the latest data finding one in three adults have untreated dental decay,
with higher rates for those on lower incomes.[12] Meanwhile, evidence of
links between poor dental health and poor health status have prompted calls for
greater action.[13] Generally, stakeholders
have reacted to the dental measures in this budget with some concern and
disappointment. In a joint
statement , the Consumer’s Health Forum and the Australian Healthcare and
Hospital Association point to the high unmet demand for dental services and the
cost barriers many consumers face. They argue that agreement on a new NPA must
be achieved urgently, as further delays in funding ‘will be extremely
disruptive to service provision and will have a negative impact on patients and
their health’.[14] The Australian Dental
Association (ADA) warns that waiting times for public dental services and
access difficulties will continue, but is also concerned about the pause in
indexation for the CDBS and veterans’ dental services, as well as reduced support
for the dental workforce. The ADA points out that many dentists already
cross-subsidise the cost of dental care through their participation in bulk
billing, but would find this harder to do under the indexation pause.[15]
This suggests that progress on dental reforms over the next
12 months will be keenly scrutinised. But whether this will resolve duplication
issues and arguments over responsibility for funding dental health remains to
be seen.
[1].
Australian Government, Budget
measures: budget paper no. 2: 2015–16, p. 107.
[2].
S Ley (Minister for Health), Abbott
govt to sink teeth into dental reform, media release, 10 May 2015.
[3].
The NPA was announced by the former Labor Government. W Swan
(Treasurer) and P Wong (Minister for Finance and Deregulation), Mid-year
economic and fiscal outlook 2012–13, p. 229.
[4].
Australian Government, Budget
measures: budget paper no. 2: 2014–15, p. 137. The Coalition’s
commitment to the NPA was outlined in The
Coalition's policy to support Australia's health system, August 2013,
p. 17.
[5].
G McArthur, ‘Public
dental patients in limbo’, Herald Sun, 24 April 2015, p. 2.
[6].
S Ley, op. cit.
[7].
Ibid.
[8].
Budget
measures: budget paper no. 2: 2015–16, op. cit., p. 100.
[9].
The CDBS is based on a calendar year, so the pause will cease in
December 2018. Australian Government, Portfolio
budget statements 2015–16: budget related paper no. 1.10: Health portfolio,
p. 84.
[10].
Budget
measures: budget paper no. 2: 2015–16, op. cit., p. 180.
Providers who treat veterans claim these payments as reimbursement for
services.
[11].
Ibid., p. 110. The budget measure Rationalising and streamlining Health
programmes, is forecast to realise savings of $962.8 million over four years.
[12].
Australian Institute of Health and Welfare, Oral health
and dental care in Australia: key facts and figures trends 2014,
AIHW, 2014, p. 5.
[13].
M Laverty , ‘Bite
on government to improve dental health’, Sydney Morning Herald, 16
March 2015, p. 16.
[14].
Australian Healthcare and Hospitals Association, Consumer’s Health Forum,
Dental
health funding a clawback on previous commitments, media
release, 11 May 2015.
[15].
Australian Dental Association, 2015-16
Federal Budget leaves a bad taste in the mouth, media release, 12 May
2015.
All online articles accessed May 2015.
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