This is the first in a series of analyses that will be cross-posted from the Commonwealth Parliamentary Library analysing the health budget.
In the article below, Amanda Biggs concludes that the dental reforms funded in the budget should be seen as a first step, and that more action will be needed to provide sustainable, longer term solutions.
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Dental reform: the job is only just beginning
Amanda Biggs writes:
This budget demonstrates that the Government’s long-awaited approach to tackling dental reform will be primarily through an injection of funds to state-run public dental services which target low income, concessional groups. Nearly $346 million over three years will be directed to treat patients on public dental waiting lists.[1]
In addition, the capacity of the public dental workforce will be enhanced by expanding to 100 the number of Voluntary Dental Graduate Year placements, at a cost of $35.7 million over four years, and introducing support for an Oral Health Therapist graduate year program, at a cost of $45.2 million.
Also announced is $77.7 million over four years in infrastructure and relocation grants to private dentists who re-locate to regional, rural and remote areas. In addition, some $10.5 million over three years is allocated to fund national oral health promotion activities and $0.5 million to support private dentists’ pro bono work.
Last budget, the Government flagged dental reform would be a major feature of this year’s budget.[2] This was in the context of reports continuing to highlight the poor dental health of some Australians, and the barriers to affordable and timely dental care, particularly for the financially disadvantaged. A recent report found that around one in three adults report avoiding or delaying dental treatment because of cost.[3]
Funding for a National Advisory Council on Dental Health (NACDH) was provided to advise the Government on dental priorities. Their final report outlining four policy options was released in February 2012.[4]
Briefly, these options were: for children, an individual universal capped dental benefit entitlement; for adults, a means-tested individual capped dental benefit entitlement; and for both groups, improved access to public dental services. Measures targeting specific at-risk groups, which would be expanded over time to include the broader population, were also proposed. The aspiration was that incrementally this would lead to a universally accessible dental scheme.
These budget measures are broadly consistent with the Minister’s initial response to the NACDH. In this, she indicated a preference for a dental scheme that targeted the financially disadvantaged; addressed workforce and infrastructure constraints; did not duplicate existing state dental services; was fiscally responsible; and relied on the closure of the contentious Chronic Disease Dental Scheme (CDDS), which provides capped Medicare dental benefits to chronic disease patients on referral from their GP.[5]
Although the Government declined to adopt a universal scheme as outlined in the NACDH report, it offers some hope for advocates of dental reform by describing its budget initiatives as ‘foundation measures’ and committing itself to a future phase of ‘significant dental reform’ in the next budget.[6]
Funding for the package will be partially met by re-directing $290 million from the never implemented and now abandoned Commonwealth Dental Health Program, which had been promised at the last election pending the closure of the CDDS.
So far, closing the CDDS has been blocked by the Greens, the Opposition and Independents in the Senate. The CDDS is contentious, partly because the cost of the scheme has blown out to $2.3 billion.[7]
A recent Medicare Australia audit reportedly found significant levels of administrative non-compliance from dentists participating in the scheme.[8] But efforts to recoup Medicare payments to these dentists have been controversial, prompting a Senate inquiry.[9] The Government remains committed to closing the CDDS ‘as soon as possible’.[10]
However, the timing remains uncertain and still relies on winning the support of the Senate, including the Greens.
So far the dental package has been broadly welcomed, including by the dental profession.[11] One dental reform advocate describes it as an important first step.[12]
But a number of concerns have emerged. There are concerns that the plan to reduce public dental waiting lists relies on the striking of a new funding agreement with the states, which may delay implementation.[13]
The Minister has indicated the agreement would require states to maintain their existing dental services, and provide information on treatment and waiting lists, to qualify for the funding.[14]
There are also concerns that the audit of dentists which found administrative non-compliance may jeopardise the ongoing cooperation of the dental profession in future government-run dental programs.[15]
Other stakeholders looking for a greater commitment to universal dental care expressed disappointment.[16] However, the Greens who also aspire to this goal broadly support the package.[17] At time of publication, the Opposition view on the package had not been articulated.
It remains unclear if the capacity building measures announced will reduce long public dental waiting lists, estimated at 400 000 nationwide, or correct the rural dental workforce shortage. Assessing progress will also be difficult unless national waiting list data collection is improved.
But the approach taken in this budget—primarily a short-term expansion of state-run public dental services which targets low income earners—still leaves many without access to affordable dental care.
Those who do not qualify for public treatment, but find the cost of private dentistry a barrier and those not eligible for services under the CDDS, may continue to delay seeking care.
Future dental reforms will need to build on these beginnings and provide for a more sustainable, longer term solution.
References
[1]. Australian Government, Budget measures: budget paper no. 2: 2012–13, Commonwealth of Australia, Canberra, 2012, pp. 172–175.
[2]. Australian Government, Budget measures: budget paper no. 2: 2011–12, Commonwealth of Australia, Canberra, 2011, p. 216.
[3]. J F Stewart and A C Ellershaw, Oral health and use of dental services 2008: findings from the National Dental Telephone Interview Survey 2008, Australian Institute of Health and Welfare, Canberra, 2012, viewed 9 May 2012.
[4]. National Advisory Council on Dental Health, Final Report of the National Advisory Council on Dental Health, Department of Health and Ageing, Canberra, 2012, viewed 9 May 2012.
[5]. T Plibersek (Minister for Health), Gillard Government welcomes options on dental care, media release, 27 February 2012, viewed 9 May 2012.
[6]. Australian Government, Budget measures: budget paper no. 2: 2012–13, op. cit., p.173.
[7]. Department of Human Services, Submission no. 201, Senate Finance and Administration Committee Inquiry into Health Insurance (Dental Services) Bill 2012 [No. 2], p. 2, viewed 9 May 2012.
[8]. A Biggs, ‘Calls to waive dentists’ debts to Medicare’, Flagpost, Parliamentary Library, Canberra, 19 April 2012, viewed 9 May 2012.
[9]. Finance and Public Administration Legislation Committee, Inquiry into Health Insurance (Dental Services) Bill 2012 [No. 2], referred 22 March 2012, viewed 10 May 2012.
[10]. Australian Government, Budget measures: budget paper no. 2: 2012–13, op. cit., p. 174.
[11]. Australian Dental Association, Dental health investment on the right path, media release, 7 May 2012, viewed 9 May 2012.
[12]. Australian Healthcare and Hospitals Association, Budget package will ease dental pain, media release, 7 May 2012, viewed 9 May 2012.
[13]. Consumers Health Forum, Great start – especially if we can just get the States and dentists on board…, media release, 6 May 2012, viewed 9 May 2012.
[14]. S Dunlevy, ‘Scheme puts bite on states’, The Australian, 9 May 2012, p. 7, viewed 9 May 2012.
[15]. E Bourke, ‘Dentists reluctant to back fresh dental plan’, ABC News Online, 7 May 2012, viewed 9 May 2012.
[16]. Australian Healthcare Reform Alliance, An excellent start on dental care – but we need a house (for everyone) of bricks, not straw, media release, 6 May 2012, viewed 9 May.
[17]. Senator R di Natale, Greens secure biggest reform for dental health in a generation, media release, 6 May 2012, viewed 9 May 2012.
