Croakey readers are invited to join us for a webinar, Tackling Oral Healthcare Inequities, from 5-6pm AEST on Monday, 8 April.
The webinar is part of our #Medicare40Years project and also marks Global Public Health Week. We acknowledge and thank the webinar sponsors: Public Health Association of Australia, Oral Health Special Interest Group; Deakin Health Economics; and the Violet Vines Marshman Centre for Rural Health Research.
Below, Tan Nguyen, spokesperson for the National Oral Health Alliance and co-convenor of the Public Health Association of Australia’s Oral Health Special Interest Group, and Jessica Nguyen, a biomedicine graduate, map out the policy environment for oral health, identifying some glaring gaps and dangerous passes.
Tan Nguyen and Jessica Nguyen write:
Three months after the 2023 Senate Select Committee on Access and Provision of Dental Services in Australia was tabled on 30 November 2023, it is disappointing the Australian Government has not provided a formal response to its recommendations.
Although major oral health inequities are not new, there is reason to be optimistic given the scope of the most recent dental inquiry explored system level issues and potential solutions, rather than dwelling on inadequate funding by all governments for public oral healthcare.
Importantly, the dental inquiry provided a much-needed platform and voice for Australian consumers, including a survey with an incredible response from 17,544 people, which brought into sharp focus the barriers that many people experience when trying to access dental services. Other contributors included Deakin Health Economics.
The Greens have a longstanding health policy to bring dental into Medicare. They championed the dental inquiry, which was chaired by Greens Senator Jordan Steel-John.
However, as a minor party, the challenge for reform advocates has always been to influence the Australian government of the day.
Dental reform is politically unappealing because of the experience with the Medicare Chronic Disease Dental Scheme, which operated from 2007 to 2012. The scheme was poorly targeted, and raised concerns about public funding for the provision of low value care in private practice.
Funding arrangements for public oral healthcare
The Australia Government has made some progress in increasing healthcare expenditure on oral health, such as the means-tested Child Dental Benefits Schedule.
In the 2022/23 Federal Budget, Labor Government signalled strategic work is underway on oral health policy with the Minister for Health’s announcement of funding commitment for public dental services under the Child Dental Benefit Schedule until 2026.
The 2023/24 Federal Budget has also seen an unusual but positive deviation to a two-year funding commitment for public dental services for adults to 2024/25, which has typically been an annual renewal cycle, but has excluded indexation.
These funding arrangements through the Federation Funding Agreement are directed to service outputs called Dental Weighted Activity Units. Although the state and territory governments contribute to funding for public oral healthcare, it is variable across the country and have different eligibility criteria. The performance target to achieve 100% service delivery does not provide opportunities for broader oral health system reform.
No state or territory governments provides sufficient public oral healthcare funding for the level of need, with typically dental waiting lists of up to three years. Of the 36 percent of the Australian population eligible for public oral healthcare, only about one-third have accessed it in any given year.
The funding mechanism for public oral healthcare is also based on a schedule of dental services, which has never been subjected to critical evaluation for its cost-effectiveness. Further work is needed to determine what dental services are essential for oral healthcare so scarce resources are spent wisely.
Clinical leadership for oral health
In its current formalised structure within the Department of Health and Aged Care, oral health reform is within the remit of the Chief Allied Health Officer. This contrasts with many other member countries from the Organisation for Economic Co-operation and Development.
For example, an evaluation of the Office of the Chief Dental Officer of Canada, established in 2005, demonstrated that it provided valuable function by filling a national level gap that existed prior to its creation. In 2024, Canada is introducing its most significant investment in public oral healthcare under the Canadian Dental Care Plan expected to benefit up to nine million people.
In Australia, there is a lack of clinical leadership for oral health and no Australian Chief Oral Health and Dental Officer. Oral health is insignificantly mentioned in the National Preventive Health Strategy 2021–2030 and the National Health and Climate Strategy.
Clinical leadership for oral health is a necessary enabler for improving population oral health, as demonstrated with equivalent roles across the states and territories. They form the National Dental Directors Group.
As an informal structure, the National Dental Directors Group does not have authorising powers for oral health policy-decision making at the national level, but are consulted for policy advice.
As the Australia’s National Oral Health Plan 2015-2024 is nearing expiry, there is a renewed call for the Australian Government to demonstrate bold leadership and responsibility for effective oral health reform.
Such reforms need to extend beyond funding agreements for public oral healthcare, and should include matters like models of care, health workforce (not just dental practitioners), intersectoral evidence-based policy design and population health initiatives such as a 20 percent sugar-sweetened health levy on manufacturers, and funding to expand community water fluoridation.
Two steps forward, one step back
In its 2024/25 Pre-Budget submission, the National Oral Health Alliance (NOHA), consisting of 12 peak bodies including health professional and consumer organisations, called for the Australian Government to take responsibility for oral health, and provided a Roadmap to Universal Access to Affordable Oral Healthcare.
To date, NOHA has been unable to meet directly with the Minister for Health and Aged Care to discuss matters concerning priority for oral health. However, NOHA has been advised the Health Chief Executives’ Forum established the National Dental Reform Oversight Group to provide opportunities for oral health funding reform options, expected in early 2024.
It is clear that the Australian Government has largely focused on oral health funding reform, and has very limited interest on other matters pertinent population oral health at this stage.
A missed opportunity includes the explicit exclusion of dental practitioners from the independent Scope of Practice Review. This would have provided a critical enabler to consider how to strengthen primary healthcare practitioners to deliver effective oral disease prevention, not just dental practitioners.
There is merit for registered non-dental health practitioners to access billing rights to preventive dental services currently listed in the Child Dental Benefits Schedule and various other government funded dental programs.
Note from Croakey: This article was updated on 26 March, in response to reader feedback, to provide greater clarity around funding for the Child Dental Benefit Schedule.
Author details
Tan Nguyen is an oral health therapist and health economist. He is the co-convenor for the Oral Health Special Interest Group, Public Health Association of Australia, and Casual Research Fellow from Deakin Health Economics.
Jessica Nguyen is a graduate with Bachelor of Biomedicine (Honours), University of Melbourne.
The perspectives are those solely of the authors.
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Croakey is seeking sponsors for further #CroakeyLIVE webinars as part of the #40YearsMedicare project. Please contact us for more details: info@croakey.org
