Recent proposal revamps Australian oral healthcare system
MELBOURNE, Australia: Australia is facing several challenges when it comes to oral health. Access and education are among some of the most significant issues, not to mention cost, and a more modern health system might be the way forward. In an interview with Dental Tribune International, Grattan Institute Health Program Director Dr Stephen Duckett spoke about a recent proposal his team developed for a universal dental care scheme for Australia.
In the proposal titled, “Filling the gap: A universal dental scheme for Australia”, Duckett and contributing authors Matthew Cowgill and Prof. Hal Swerissen said of the current system: “State public dental schemes vary in terms of who is eligible, the extent of co-payments, and the amount of funding provided per eligible patient. The result is a postcode lottery, where a person’s access to public dental care depends on where they live. And people who are eligible for public dental services are confronted with excessive waits—often well over a year—for basic oral health care.” Australia has a federal health system, in which both the national (Commonwealth) government and state governments have health responsibilities.
The proposal that Duckett and his team put forward would be phased in over ten years. It would involve a mixture of public and private provision, and payment would be according to a national fee schedule. As part of the scheme, there would be tight monitoring requirements for participating practices and patients would be able to choose freely from accredited dental clinics. The authors suggest that both public and private providers should be eligible to participate.
Speaking about cost and implementation, the authors said: “It would be impractical to move to a universal scheme overnight. The net cost would be large—around $5.6 billion in extra spending per year—and the oral health workforce would need to be expanded. So, the Commonwealth should announce a road map to a universal scheme, including plans to expand the workforce, followed by incremental steps towards a universal scheme.”
Despite the high cost, which Duckett said was the main factor opposing the scheme, the team predicted that individual states would save around 85% of the budget that they currently spend on oral healthcare. The report also forecasts that there would be an increase in eligible children using the service from 37.1% to 50.0% and that eligible adults would be as likely to visit the dentist as high-income people of the same age would.
Education and job creation
Speaking about the lack of oral health education in Australia, Duckett said, “This is certainly true. We partly recognise that, in proposing the monitoring of practices, preventive orientation would be part of the conditions of participation. We also proposed an emphasis on public oral health education.”
Speaking about job creation, Duckett said, “The scheme would involve a significant expansion of public spending and thus a significant expansion of jobs. We also contemplated in our funding, and in the way in which we priced the national fee schedule, that the employment expansion would be in all categories of the oral health workforce,” explained Duckett.
In a 2018 Dental Tribune International article, it was revealed that the Australian Dental Association and Australian Health Policy Collaboration (AHPC) at Victoria University had released a national oral health report card. According to that report, more than 90% of Australian adults had experienced caries in their permanent teeth.
In the article, Prof. Rosemary Calder, Director of the AHPC, said: “In 2015 to 2016, there were 67,266 potentially preventable hospitalisations for oral health problems and almost one-third of these were children under the age of 9 years. Worryingly, there’s a growing number of children in this age group who are being admitted to hospital for dental health reasons.”
Future of oral health care in Australia
As alluded to in this recent report, most Australians pay for dental care straight out of their own pockets. This means that patients who are not able to afford treatment either wait until it is too late for any kind of restorative treatment or go to the hospital emergency department.
To combat this issue, Duckett and his team suggested: “The first step is for the Commonwealth to take over funding of existing public dental schemes, fund them properly to the tune of an extra $1.1 billion per year, and enable private-sector providers to deliver publicly-funded care. Coverage should then be expanded—first to people on Centrelink payments, then all children. After that, the Commonwealth should take the final step to a universal scheme, ideally within a decade.”
Many Australians suffer from preventable oral health issues, and the current system puts a strain on states and health institutions whose time could be better served working on other areas. Consequently, it might not be too long before a change comes. Speaking on the possibility of the proposed scheme being taken up, Duckett said, “The first few stages of our scheme are inevitable; it’s only an issue of timing.”
The Grattan Institute is an Australian public policy think tank that was established in 2008. It has no connection to any of the country’s political parties, and its primary goal is to contribute to the discussion around Australian public policy.