In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) investigates a topical issue – the need for health reform to promote better oral health.
Rachel Katterl writes:
Late last week the Brotherhood of St Laurence released their report End the decay: The cost of poor dental health and what should be done about it. This report reviews the state of Australia’s dental health, and the implications for oral health service delivery.
In recent times, oral health care has received increasing media attention due to the National Health and Hospital Reform Commission’s recommendations to establish a universal scheme for access to basic dental services, known as “Denticare”.
End the decay again highlights the importance of oral health in the wellbeing of Australians. Poor oral health has serious implications for population health, as it exacerbates numerous types of chronic disease, undermines efforts at good nutrition, and it may also affect individuals’ ability to participate in social and economic spheres of life.
These individual impacts cumulatively have significant implications for Australian society at large. Dental admissions constitute the largest category of acute, avoidable hospitalisations, with the direct and indirect costs totalling an estimated $2 billion per annum.
These trends towards acute exacerbations in oral health conditions also show significant inequities, with the most disadvantaged Australians being worst affected.
Almost fifty percent of Australians without private health insurance delayed a visit to the dentist in 2008 versus around 20% of Australians with private health insurance.
These delays inevitably result in an alarming statistic: almost 20% of low income Australians have no natural teeth (compared to less than 1% in the high income group). These delays appear to be due to the very high level of out of pocket expenses
Richardson and Richardson (the authors of the report) argue this tendency to treat dental health conditions once they are at the acute stage may be avoided with the introduction of universal dental insurance. Whilst this would increase the annual health expenditure by about 1.4% per annum, there are significant supply side constraints as Australia’s oral health workforce may be insufficient to service this demand currently.
Australian Dental Association president Dr Shane Fryer believes universal dental health insurance is not the appropriate response to these findings. “The creation of a universal dental scheme is not the panacea that will address the needs of those who need assistance”.
The Australia Dental Association rather advocates a targeted program that addresses the needs of the most disadvantaged in Australian society. Such a scheme would require means testing eligibility to target the 30% of people who are currently receiving insufficient dental care.
There are a number of benefits that may be garnered from means testing the dental scheme. These include constraining demand for dental services, which keeps the price of services lower. The net result will inevitably be a lower cost to the government.
Means testing will also avoid taxation income redistribution to people of high socioeconomic status. Evidence from other areas of primary care suggest Medicare is utilised at a higher rate by those in more advantaged areas because that is where the health care providers prefer to be placed. Means testing of the dental scheme may therefore inadvertently disadvantage those who need it most.
There are also drawbacks to means testing the dental scheme, which include difficulties in targeting the measure appropriately to access the high needs population, the decreased efficiency of the initiatives, and the political repercussions of developing a two-tier system of care.
Regardless of the shape of such a scheme, this report has come at a difficult time for the Australian Government. At a time when the purse strings are being tightened to make way for a budget surplus, a dental care scheme would likely be financed by an additional levy in the same way as Medicare.
Whilst there is undoubtedly a need, it is unclear whether Australians are willing to pay to improve access to oral health services.
• Rachel Katterl is Research Associate, Primary Health Care Research & Information Service
Richardson, B. & Richardson J. (2011). End the decay: The cost of poor dental health and what should be done about it. Brotherhood of Saint Lawrence: Fitzroy.
This report, which can be accessed at http://www.bsl.org.au/Research-and-publications/End-the-decay.aspx, appears in the 15 December 2011 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field.
Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php
Previous PHC RIS posts