Some Australians, including elderly people in residential care and people with disabilities, have more chance of flying to the moon than being able to access dental care, a Senate inquiry has been told.
The inquiry has also been advised that dedicated funding for dental services should be provided to Aboriginal Community Controlled Health Services.
Jason Staines writes:
For the past three months, a Senate select committee has been examining one of the most intractable and complex issues in Australian healthcare — the provision of, and access to, dental services.
It is not a new issue, of course, and this latest effort forms part of a history stretching back more than a quarter of a century. At its heart is a system where Australians pay more for worse outcomes, with Aboriginal and Torres Strait Islander people, those on low incomes and the elderly bearing the brunt of poor policy decisions.
The latest inquiry’s interim report describes a system where access to quality care is limited by income and geography, with implications for wider healthcare and even economic outcomes.
Australians are paying more for dental care than people in many other countries, but with poorer health outcomes, and access to dental services remains deeply inequitable. People experiencing poverty, disabled people, prisoners, Indigenous Australians, older Australians and those in care are most impacted by deficiencies in the current system.” — Select Committee into the Provision of and Access to Dental Services in Australia, interim report.
Better dental outcomes have a flow-on effect to the rest of the healthcare system, and the wider economy.
As the interim report notes, the Grattan Institute estimates there are some 750,000 general practitioner consultations each year for dental problems, costing taxpayers up to $30 million annually.
Meanwhile, the Australian Institute of Health and Welfare estimates that in 2020–21, there were about 83,000 hospitalisations for preventable dental conditions. Finally, the interim report notes that Australians take an estimated 2.4 million days or half days off work or study because of oral disease, putting the total cost of reduced workforce participation at $556 million per year.
From the submissions received to date, the committee has compiled a list of areas where the Federal Government may act, although since this is only an interim report, these are not recommendations. Rather, they will form the basis for further inquiry as the committee continues its hearings and prepares its final report, due to be delivered by 28 November 2023.
Integrating oral healthcare
An important distinction – as mentioned by the committee – is the difference between dental care and oral care since mouths are more than just teeth. The committee noted there were several ways of integrating oral healthcare into the system, from dental hygienists as part of the primary healthcare system, to enlisting the help of pharmacies.
Problems in the mouth are usually seen exclusively as dental problems because teeth are very visible and important for appearance and function. But what about health? The mouth has more than teeth in it. Blood vessels, nerves, salivary glands, tongue, soft tissues, and soft palate. Who looks after them?” — Former member of the Australian Dental Association (ADA), Dr Patrick Shanahan.
According to Dr Lesley Russell, Adjunct Associate Professor at the University of Sydney’s Menzies Centre for Health Policy and a Croakey columnist, better integration is a key reform, but will involve significant changes before it can happen.
“This is what should be done, but [we] need major changes in cultures and attitudes. Start with training dental and medical professionals together,” she said.
Expand Medicare
Covering dental care under Medicare would not be cheap.
As the interim report notes, the Grattan Institute estimated in 2019 that including dental in Medicare would cost the government an extra $5.6 billion a year. According to health policy expert and Croakey contributor, Charles Maskell-Knight, the cost to the federal government would be significantly higher.
“The simplest way costing a universal Medicare-like scheme is to assume that the whole population would begin to access services at the same rate and cost as the insured population – that is, about $600 per capita annually,” he said.
“On this basis, a universal Medicare-like scheme would have a total cost to government of about $16 billion – or $5 billion more than current total expenditure from all sources on dental services,” he said.
Better policy
According to the committee, there is a definite leadership role for the Commonwealth in terms of better administering oral and dental healthcare, and in working with the states and territories to deliver better outcomes. One reform would be shifting oral cand dental care to become part of the primary healthcare system.
Such coordination and reform could be driven by a Chief Dental Officer who would “support oral healthcare reform that integrates oral health within the wider healthcare system”.
Rural and remote outcomes
As with other areas of healthcare, rural and regional Australians face greater obstacles in accessing care when it comes to dental and oral health.
The committee highlighted proposals to improve access, including increasing student-led services and expanding water fluoridisation in remote areas.
Rural and remote areas particularly suffered from workforce issues, with a lack of initiatives to support recruitment and retention.
Public dental
A truth universally acknowledged by submissions to the committee was that state and territory public dental services are incapable of meeting demand due to a combined lack of funding and staffing.
Along with confusing referral pathways and untenable waiting lists, a visit to the dentist for some groups – such as those in residential care or the disabled – was akin to flying to the moon, according to Seniors Dental Care Australia in its submission.
Priority groups
The interim report notes that Australia’s National Oral Health Plan 2015–2024 identified priority populations as those who are socially disadvantaged or on low incomes; Aboriginal and Torres Strait Islander people; those living in regional and remote Australia; and people with additional and/or specialised health care needs.
Addressing the dental healthcare needs of these groups would go a long way towards achieving better outcomes, particularly Indigenous communities, where outcomes are significantly worse compared with other Australians.
However, “improving oral healthcare in Indigenous communities is a ‘wicked problem’, complicated by demographic, structural, linguistic and cultural, and economic factors”.
An important element of any solution, according to submissions, is the involvement of local communities. Derbarl Yerrigan Health Service Aboriginal Cooperation in Western Australia recommended that access be enabled through dedicated funding of services delivered by Aboriginal Community Controlled Health Services.
Where to from here?
The select committee’s interim report acknowledges there is unmet community demand for better access to dental services, yet for a quarter of a century policymakers have chosen to describe the problem, rather than take action.
According to Russell, one of the key obstacles to reform is an embedded perception that oral health is not essential. If anything is going to change, she says, that attitude will need to go.
“No-one – politicians, policymakers, private health insurers, healthcare professionals, even the public – sees oral health/dental services as an essential part of healthcare. So we need to change the culture,” she said.
• Jason Staines is a Canberra-based freelance journalist.
See Croakey’s archive of articles on oral health.
