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infectious diseases
influenza
international medical graduates
journal articles
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medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
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primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
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social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
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#CTG10
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cultural safety
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social and emotional wellbeing
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alcohol
consumer health matters
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food and nutrition
gambling
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Should dental reform aim to benefit dentists – or the community?

A recent policy forum in Canberra highlighted some of the shocking inequities in oral health and in access to dental services, as reported at Croakey by the National Rural Health Alliance.

In the article below, Dr Tim Woodruff, vice president of the Doctors Reform Society, argues that the dental lobby is a major barrier to equitable reform.

***

A four-point plan for advancing equitable dental reform

Tim Woodruff writes:

The recent one day Oral Health Policy Forum in Canberra gathered together a variety of oral health professionals along with members and representatives from a variety of professional and consumer groups with a strong interest in improving oral health.

The hope was that this would be an opportunity to find common ground and explore ways of advocating for the necessary changes to address the appalling state of oral health throughout the country and the grossly inequitable access to oral health services due to both geographical and financial barriers.

The question raised was “Why has dental health been getting the brush off?”

One might argue that in a cost constrained world it is just too expensive.

Then one has to ask how it is that the first steps towards a very expensive National Disability Insurance Scheme (NDIS) have been taken. It’s a long road to implementation but the commitment is there.

In addition the cost of not having a comprehensive oral health system tends to be ignored in such arguments.

Lastly it’s worth considering that according to the Henry Tax Review, “Australia is a low tax country by OECD standards” and we have the 3rd lowest spending to GDP ratio of all 30 OECD countries.

It is a myth that we can’t afford the NDIS and another myth that we can’t afford proper dental care. It requires political will and leadership.

But the Canberra forum demonstrated another major obstacle to dental reform.

Many of those present are seeking a commitment to a universal access dental scheme.

One group which believes that a universal access scheme will not work is the Australian Dental Association (ADA).

The ADA raises quite reasonable concerns about the failure of various Medicare add on schemes to prevent the perpetuation of the inverse care law ie that those who need the most get the least and those who need the least get the most.  It does not recognise that Medicare itself is plagued by that same rule and that a fee for service dental scheme with copayments would like Medicare, fall into the same trap.

Instead, it proposes a targeted approach to disadvantaged Australians complete with a cap on how much government funding is permitted each year, supplemented by private insurance and copayments `as a means to have people appreciate that there are significant costs associated with their treatment, ’(1)  and that use of such copayments be determined by the dentist.

This should all sound familiar. It is like Medicare but even more restricted. At least with Medicare there is no yearly cap on expenditure and one doesn’t have to fit arbitrary criteria of disadvantage to qualify.

Medicare has been fantastic for improving access to health services but, after 25 years of fiddling around the edges with safety nets and programs, it remains characterised by significant financial and geographical barriers to access.

There are many contributing reasons for geographical barriers but the reason for financial barriers is simple. They are permitted, and in the case of access to pharmaceuticals, they are mandated by the Federal Government despite the evidence that they reduce access to care by the most needy.

Copayments for dental care will be no different, whether they are those envisaged by the ADA’s plan or optional copayments under a fee for service Denticare as promoted by some of those hoping for a universal access scheme.

In 1975 Medibank was introduced by the Labor Party despite the vehement opposition of the Australian Medical Association (AMA).

A universal access scheme was regarded by that organisation as anathema partly because it was perceived to threaten the control and power of the doctor by making him (usually) dependent on government funding.  They have fought ever since to maintain their power to determine who will be bulk billed, who will pay a copayment, and how big that copayment is.

The ADA is subtler but their alternate proposal demonstrates that this is mainly about the threat to the independence of the profession. Capping access to funds and requiring copayments does not give the impression that the patient is the main concern.

To move oral health policy forward towards a universal access scheme, we need to recognise that the ADA will put its members’ interests first.  Individual practitioners will continue to provide great and generous service to individual patients.

The ADA’s primary interests however, concern the maintenance of income, independence and power and it will not support a system that threatens those interests.

The National Advisory Council on Dental Health set out short-term options for the Government. The public option covers children and a capped means tested adult service for $2.5 billion per year. The fee for service option covering the same groups costs $8 billion.

The public option sets the scene for the development of a universal access scheme. The fee for service option sets the scene for a Medicare style dental scheme with all its financial and geographical barriers to equity.

To move forward, we need to:

1. challenge the perception of inadequate funds
2. encourage political leadership
3. recognise the ADA as primarily protective of its own interests just as reformers since 1975 have regarded the AMA
4. plan a system with an emphasis on salaried public service free of the financial and geographical barriers so evident in Medicare.

• Tim Woodruff is vice president of the Doctors Reform Society

1.  “Dental Access” Proposal:  Proposal to the Australian government for a Scheme to assist disadvantaged Australians obtain improved access to dental care. 20 November 2009 http://www.ada.org.au/App_CmsLib/Media/Lib/1108/M329081_v1_Dental%20Access%20Proposal.pdf

 

Comments 4

  1. O'Brien Louise says:

    I believe the real answer is to get Colgate and Oral B to market their products directly to children in schools with marketing material that encourages children to brush and floss their teeth. If every child brushed and flossed their their twice a day, they will be likely have good teeth. Dentist are out to make as much money as possible and we have an oversupply of dentists in Australia which is why the government is now paying for children’s dental care.

  2. O'Brien Louise says:

    Dentists providing the government funded dental services must only charge the scheduled fee.

  3. lohyn roman says:

    You talk as if dental decay is something that you can catch from someone or something that can come out of the blue and is totally unexpected. It’s not. Dental decay is almost entirely self inflicted and if you don’t deal with the cause, almost certainly bad diet and lack of proper care, ie brushing and flossing, then the problem will just continue. I can’t see why the taxpayer should reward self neglect and ignorance. If you actually want to achieve something then make brushing and diet education part of the primary school curriculum. That would actually do something useful so it safe to assume it will never happen. Tim Woodruff’s smear about fee for service is just a cliched reflex from someone who thinks the government, ie the taxpayer, should always fix everything and that nothing is ever someone’s personal responsibility. You want to see how this system would work out then go and have some dental treatment done on the NHS in the UK. Presumably after dentistry then why not make physio a universal entitlement or chiropractic or a range of any other health services, massage….all these things contribute to well being, why not them as well? Gym memberships paid for by the government make more sense than Tim Woodruff’s suggestion, unless you really hate the private care sector in which case his comments make sense. As for Louise’s comment about dentists being out to make as much money as possible – how shocking – you set up practice, spending $500,000 to $1,000,000, employ several staff and then you want to make as much money as you can. How outrageous. Dentists should instead follow the example of politicians and the heads of our public service who constantly insist on being paid less. What a stupid comment!

  4. aardent says:

    First of all, demonize dentists as money grabbing and then force them to accept a lower fee than the service actually costs. No mention has been made of the dentist generosity in accepting a lower fee, rather just let us nail the bastards. Well done. If a dentist has 80% overheads for a 5 day week, then he/she earns their income on Friday only.
    Why don’t you say “all tradesmen calling at a house will only charge $50”? Most tradies actually charge $120 for the first 10 minutes.. accountants charge $350 per hour and lawyers more but under your Dictatorship everyone “must charge only the scheduled fee”. Under my Fuhrer-ship, all employees, including you will earn $20 per hour. How does that fit?
    Yes, I am a dentist with a staff payroll of $500,000 …. all earning over $35 per hour; 2 at the front desk, 1 doing admin and 1 chair side, so I have to earn $140 per hour just to pay the staff ……… and worse, the patient has missed their appointment. Me in bed with government or insurance? No, I am leaving my noble battered profession because it has all become too hard.
    Dr Julian Perth

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Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
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quality and safety of health care
rural and remote health
screening
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TGA
trauma
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Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
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Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
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Web 2.0
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Royal Commission
Social determinants of health
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Justice Reinvestment
NBN
Newstart
poverty
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17