Federal Budget 2019/20: Oral health priorities from the health and community sector

Jennifer Doggett writes:

In the lead up to next week’s Federal Budget, Croakey is previewing some of the most important issues in the health portfolio and highlighting the bids from health stakeholder groups in their pre-Budget submissions

See here for the previous post on Budget bids for action on climate change and health issues.

Today’s issue is oral health.

Oral health is one of the standout areas of policy failure in Australia’s health system.  As regular Croakey contributor Dr Lesley Russell has written: Nowhere are the growing inequalities in health between poor and rich, rural and urban, Indigenous and non-Indigenous, highlighted more than in dental health.

There is no physiological reason why the mouth should be excluded from Medicare. Oral health is intimately related to overall health and dental problems can both cause and be caused by health problems elsewhere in the body.

There are also many reasons why it makes sense to include oral health within Australia’s universal health system. One compelling reason is the fact that dental problems, if untreated, can lead to more serious (and more expensive) health problems down the track.  In fact, oral conditions are the third highest reason for acute preventable hospital admissions with more than 67,000 Australians hospitalised each year.

A key barrier to access to dental care for many Australians is cost. Dental services have among the highest out-of-pocket payments (as a proportion of total costs) of all mainstream health services, with individuals contributing 58% of the total annual spend of around $10 billion.

Many Australians cannot access the dental services they need to remain healthy. 30% of Australians avoid going to the dentist at all due to cost, unavailability of services and other barriers.  Among those who do go, 20%are unable to proceed with recommended treatment because of cost.

Neither Federal nor State/Territory governments have dealt satisfactorily with this issue. The Federal Government’s main subsidy of dental services comes via the private health insurance rebate which is provided to less than half the population (and even with insurance consumers still have to pay over 50% of dental costs).

State and Territory governments are responsible for public dental services but these are woefully under-funded and waiting lists for general treatment can go as high as three and a half years in some parts of the country. As a result, middle aged and older adults with health care cards are twice as likely as other Australians to have had all their teeth extracted.

For all these reasons, action on oral health was a high priority for a number of health and community sector stakeholder groups in their bids for Budget funding.  These are summarised below

Australian Healthcare and Hospitals Association

Key points from the AHHA submission

Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment.

Oral conditions are the third highest reason for acute preventable hospital admissions with more than 63,000 Australians hospitalised each year. Out-of-pocket costs for dental care are greater than any other major category of health spending, having greatest impact on those eligible for public dental services.

Australia’s National Oral Health Plan 2015–2024 outlines a blueprint for united action across jurisdictions and sectors to ensure all Australians have healthy mouths. Translation of the National Oral Health Plan into practice has been slow, and requires all jurisdictions and sectors to work together to maintain and improve the oral health of Australians.

Specific Recommendations

The AHHA is calling for:

• $500 million per year for the National Partnership Agreement on Public Dental Services for Adults, with state and territory funding levels maintained, and the term of the agreement extended to 31 December 2024, aligning with the term of the Child Dental Benefits Schedule.
• Funding allocations (above) to reflect the cost of providing care in rural and remote areas, smaller jurisdictions and to groups with higher needs.
• The agreement (above) must require states and territories to increase access to fluoridated water supplies. Fluoride varnish programs should be provided to high risk children, particularly in non-fluoridated areas.
• Actively promote the Child Dental Benefits Schedule to eligible families.
• Incorporate oral health assessments into health assessment frameworks, particularly those at risk, for example children and older people.
• Appoint an Australian Chief Dental Officer to provide national coordination of oral health policy.

Australian Council of Social Services

Key points from ACOSS’s Budget Priorities Statement

People already pay 60% of the total spend on dental care through out-of-pocket costs.  For people on low incomes, this is unaffordable and many go without much needed dental treatment. 63,000 people are hospitalised each year for preventable and treatable oral health conditions.

The lack of public dental care not only incurs a cost in our broader health system; it impacts on people’s ability to live their lives, including to eat well, undertake paid employment, and participate in their communities.

Despite being a significant component of health expenditure, the PHI rebate has failed in its promise to take pressure off public hospitals by increasing use of private health insurance. Abolition of the PHI rebate could save a net $3.5 billion, with total savings of $6 billion offset to a degree by an anticipated increase in demand for public hospital services should the rebate be abolished.

Specific Recommendations

ACOSS is calling for:

• Funding for the National Partnership Agreement on Dental Health to be lifted progressively in partnership with the States, so that the number of adults treated within five years is doubled.
• Abolition of the Private Health Insurance (PHI) Rebate, with half the savings redirected to public health programs
• Abolition of the Extended Medicare Safety Net, with savings redirected to public health services

The Victorian Healthcare Association

Key points from VHA’s submission

Oral health is an important determinant of overall health and wellbeing with poor oral health connected to a range of chronic conditions including obesity, cardiovascular disease and Type 2 diabetes. There are long waiting times for access to public dental services, in some cases up to two years in Victoria, while the high cost of care was last year identified by over half a million people as the reason they did not access care. This leads to delays in people receiving treatment resulting in further deterioration of dental health and compounding the issue. In 2015-16 there were 67,266 potentially preventable hospitalisations for oral health problems and almost one-third of these were children under the age of nine years.

Poor oral health has the second highest disease expenditure in Australia. The benefits of inhibiting poor oral healthcare from developing into other costly medical issues are clear from the disease expenditure and preventable admissions, with a national approach required to limit the need for avoidable hospitalisation. With the Australia’s demographics getting older, and nearly 20 per cent of adults aged over 65 having no natural teeth and a three-quarters having a chronic disease, it is important that steps are taken to limit this growing burden on public health services.

Specific Recommendations

VHA is calling for:

• Funding and support for the active promotion of the Child Dental Benefits Schedule to eligible families, so the public health system benefits from a preventative approach to poor oral health.
• Creation of an Aged Pensioner Dental Benefits Schedule, with similarities to theChild Dental Benefits Schedule, to lessen the impact that poor oral health, which lead to more acute conditions, has on hospitals.
• Recognition that continuation of funding based purely on outputs will only encourage providers to focus their services on delivering greater outputs. A portion of funding needs to be quarantined to reward services that achieve great outcomes for clients including preventative work.
• Return funding for public dental services through the National Partnership Agreement (NPA) on Adult Public Dental Services to at least 2016 levels.
• Support for longer term funding agreements (e.g. five to seven years) that match demand for services and enable providers to plan for and develop more innovative service provision.