2012: the year the mouth became part of the body?

Friday, 10 February 2012

The publicity given to Tony Abbott‟s recent acknowledgement that dental care ought to be part of Medicare will be welcomed by those who have long believed that the Australian health system looks like a bit of a goose on the matter.

The reason, of course, why the mouth and its contents have to date been excluded from Medicare is largely that it limits the Commonwealth‟s exposure to costs that are already uncapped enough for the likes of Treasury and Finance. It‟s hard to prove, but in all probability there would actually be savings – cold, hard cash savings in the costs incurred by hospitals and through chronic disease like CVD and diabetes – never mind the savings in pain, delayed dental care and personal misery – if we did have a universal oral care system, including promotion of good oral hygiene and dental care for children. But the Treasury will want to see the whites of the eyes of the evidence.
And the up-front investment required to generate such savings (and greater equity) will be substantial. The cost of oral care to the nation was more than $6.1 billion in 2008/09, and when Tony Abbott was Health Minister he informed a delegation from the National Oral Health Alliance that it would cost about $11 billion to put dental care into Medicare.

Dental caries and periodontal diseases are largely preventable – but we‟ve done a very poor job in Australia on proving the case. So much so, that the National Advisory Council on Oral Health, a committee of the Australian Health Minsters‟ Conference and the body responsible for the National Oral Health Plan 2004-13, reported a few years ago that the oral health status of Australian adults ranked second worst in the OECD.

The problems get worse across the social gradient in Australia: the poorer and more socially isolated a family is, the poorer their access to care and the worse their tooth loss. People in rural and remote areas are among the unlucky ones, with the rural dental workforce per 100,000 population being about half that of urban centres.
This maldistribution goes some way to explaining the overall rural underspend on primary care of over $2 billion a year – every year.

All this is despite the existence of the National Oral Health Plan endorsed by Australian Health Ministers in July 2004. It has had some successes, such as fluoridation of water supplies and in providing a focus for oral health workforce shortages. But in 2009 the National Health and Hospitals Reform Commission (NHHRC) acknowledged the high costs of private dental care and the gross inadequacy of State and Territory public dental services, describing the situation as “inexcusable in a relatively wealthy country”. As a result, the NHHRC proposed a „Denticare package‟ to ensure universal access to effective, basic dental health services.

One of the four elements of this package, a one-year internship scheme prior to full registration for new dental and oral health graduates, was initiated (on a modest scale) in the Federal Budget in May 2011. The other three elements of the proposed package have no doubt been considered by the National Advisory Council on Dental Health established by the Gillard Government to work up proposals for the 2012-13 Budget.

Those other elements in the NHHRC‟s package were „Denticare Australia‟, the expansion of the pre-school and school dental programs, and additional funding for oral health promotion. The scheme proposed would provide people with a choice between public and private dental care. Anyone who chose to do so would be able to go publicly, at no personal cost but with a longer waiting period than for private dentistry. The scheme would be covered by a 0.75% increase in the Medicare levy and would pay private dentists 85% of the schedule fee, with the patient paying the gap. The scheme would not cover orthodontics, crowns or implants.

The Australian Dental Association does not support the establishment of a universal dental scheme such as Denticare or the inclusion of dental care in Medicare. Over 80 per cent of dentists choose to practise privately and the 45 per cent of Australians they see regularly (who include the better connected and informed) may have little incentive to support the establishment of a national public dental service.

It will take many years for Australia to establish the systems and the workforce distribution to radically improve the situation with oral health, particularly for those who are socio-economically and geographically disadvantaged. It will be critical that the additional investments announced in the May Budget are not swallowed up by those who already receive the bulk of good oral and dental care in Australia.

We should nevertheless welcome very strongly the start likely to be made in the May Budget – and the fact that both sides of politics agree that we can do much better as a nation where the health of our mouths is concerned. There is now no doubt that the Federal Government is responsible for ensuring the nation has a fair and workable oral health care system.

This will surely spell an end to the situation in which less than 50 per cent of the population visit a dentist regularly for checkups and care – and for people in rural and remote areas it‟s almost certainly less.


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