Affordability of dental care
How affordable is a trip to the dentist these days? And is it getting more expensive?
Around half of all Australian adults visited a dental professional in the previous 12 months, a figure that has remained relatively constant over the past decade. Dental visiting patterns, like dental disease, have a strong social gradient; people living in areas of least socioeconomic disadvantage or in major cities were more likely to have visited a dental professional in the previous 12 months. Conversely, people living in areas of greatest socioeconomic disadvantage, with long-term health conditions or in remote areas were more likely to delay or not access dental care when needed.
Cost has long been identified as one of the major barriers to accessing dental care, with over half of Australian adults reporting having a little or a lot of difficulties paying a $200 dental bill, and 44% avoiding or delaying dental treatment because of cost. Around 1 in 4 adults report difficulties paying for a basic preventive dental visit, and this is higher for people in lower income groups. Of significant concern is that the proportion of dentate adults who avoided or delayed dental care due to cost has been increasing, from 31% in 2004/06 to 39% in 2017/18. Delay or avoidance invariably means that dental disease progresses to a stage where the consequences are more significant.
So is dental care becoming more unaffordable? In the context of discussions about access to care and the need to increase government investment in dental programs, it’s an interesting question to ask and look at from a couple of different angles.
Firstly, lets look at dental fees over time, using Australian Dental Association fee surveys [noting that these survey reflect an average fee across Australia, self-reported by a subset of dentists who were members of the Australian Dental Association, with a wide variation across states and within states across metropolitan and rural areas].
In 1991, it would cost (on average) $102 to have an examination (including 2 x-rays) and a scale and clean, with costs for other dental treatments including a tooth extraction ($52.64), a large amalgam restoration (filling) on a molar ($70.91), a large composite resin restoration on a molar ($86.66), root canal treatment on a molar ($424.22) and a crown ($715.58). By 2022, these fees had increased to $280 for an exam (with x-rays and clean), extraction ($205), amalgam restoration ($229), composite resin restoration ($256), root canal treatment ($1207) and a crown ($1678). Looking at fees over time, there has been a steady increase for some of the lower cost items, but a much steeper increase in fees for other items such as root canal treatment and a crown.
Affordability is not just a function of the fees charged, but the ability for people to pay. The next chart shows the median (or 50th percentile) full-time weekly earnings. In 1991 the average (median) worker was earning $484 per week, increasing to $1,208 by 2014 and $1,516 by 2022.
But we know that there is significant income disparity in Australia, so it’s worth also looking at what the lowest 10% and 25% of Australians earn, compared with the median and the highest 10% and 25%. Unfortunately, this data only goes back to 2014, but the trend is pretty clear. There is a much bigger gap between the median ($1,516) and the top 25% (who earn $680 or 43% more) and the bottom 25% (who earn $411 or 26% less). And the gap is even bigger at the top 10% (earning $1,550 or 97%more) and the bottom 10% ($696 or 44% less).
To dig into the issue of affordability of care, I decided to look at the percentage of the median weekly full-time income that would be required to pay for various dental treatments. This chart shows that in 2014 a dental examination (including 2 x-rays and a clean) would have cost 22% of the median weekly income. By 2022, this had decreased to 18.5% - a result of wages increasing at a greater pace than dental fees. This would suggest that a dental examination is slightly more affordable now than it was in 2014.
But if we go back to 1991 and look across a range of procedures, we see a slightly different picture – some treatment items such as tooth extractions and large amalgam restorations are now more expensive relative to median weekly income now than they were in 1991, whilst others such as root canal treatment and crowns have become more affordable. Focusing on just the past 9 years, all of these dental treatment costs as a proportion of weekly earnings are slightly lower now than they were in 2014.
It's when we look at affordability at different income levels, that a slightly different picture emerges that helps to explain the affordability issue for many people. Although a dental check-up and clean costs 18.5% of the median weekly income in 2022, it represents nearly one third of the weekly income for 10% of the population on the lowest incomes, and one quarter of the weekly income for 1 in 4 lower income earners. Conversely, it represents less than 10% of the weekly income for the highest income earners.
This pattern is consistent across a range of dental procedures – for people in the lowest income decile, a large filling costs nearly 30% of weekly earners, root canal treatment 1.4 times their weekly earnings and a crown nearly twice their weekly earnings. So affordability means different things to different parts of the community. And it is perhaps easy to see why there is consistently a large part of the population who report that cost is a significant barrier to accessing dental care, even if in relative terms dental care appears to be more affordable now than in 2014.
There are a couple of important caveats with this analysis. Firstly, it uses average weekly earnings, so it is a subset of total household income. However, for the purposes of understanding affordability, it is a reasonable measure. Secondly, it doesn’t factor in other things that might impact on discretionary spending power – for example as housing costs have increased, do people now have less of their weekly income available to spend on things like dental care now than they did 20 years ago? And that might be an important factor contributing to issues of affordability and access to care for people who earn below the median income.
Technical notes:
This analysis is based on ADA fee surveys with data from 1991, 1993, 2014-20 and 2022. Although there is a significant gap in data from 1993 to 2014, the trends appear to be reasonably consistent.
ADA item numbers:
Examination, x-rays and scale and clean: 011, 022 x 2, 114
Extraction: 311
Large amalgam restoration on a molar: 513
Large composite resin restoration on a molar: 533
Root canal treatment on a mola: 415, 416 x 2, 417, 418 x 2
Crown: 615
Australian Bureau of Statistics weekly earning data.
In case you missed it ..
Last we I launched the first episode of the Dental As Anything podcast. You can find the episode here, or listen on Spotify or Apple Podcasts.