Dental practitioners support giving Medicare teeth
New research highlights strong support amongst Australian dental practitioners to expand Medicare to include more dental services.
Challenging the status quo of the dominant model of private dental practice will inevitably result in resistance in some quarters. The status quo provides a veneer of comfort which allows people to believe that the current system is the best simply because is has withstood the test of time. Yet it is clear that our current dental system is no longer serving the needs of the whole community, with an increasing number of people experiencing challenges in accessing essential dental care. It is therefore important to challenge the dogma that underpins this model and question whether it is still fit for purpose in modern society.
More than 85% of dental care in Australia is provided through fee-for-service private practices, despite nearly 40% of Australians being eligible to access publicly funded dental care. The market failure is obvious. Public clinics struggle to recruit and retain experienced dental practitioners and waiting times to access basic dental care stretch past 2 years in many places. There is a strong social gradient to oral health, and we can tell someone’s bank balance from their smile. For many of those who are not eligible for public dental care, the cost of private dentistry is increasingly becoming more unaffordable, and many people delay care or make compromises to their oral health. But it doesn’t have to be this way.
It seems to be an article of faith that the overwhelming majority of dentists oppose any move to include dentistry in Medicare, so we set out to challenge some of those myths and misconceptions. Against the backdrop of more than a decade talking about the need to reform public dental funding in Australia, and brought sharply into focus with the recent Senate Select Committee into the Provision of and Access to Dental Services, we decided to find out what dental practitioners really thought about expanding Medicare to include more dental services.
What did we find?
Support for expanding Medicare to include more dental services
64.7% of practitioners supported expanding Medicare to include more dental services
There was still strong support even for those who worked exclusively in private practice (59.2%) or were dental practice owners (61.3%)
There was stronger support for those working in regional and remote areas (71.2%) and practitioners with more years of experience
Perceptions of affordability
35.9% of respondents said their patients experienced difficulties affording preventive care, with higher levels for general restorative and periodontal care (41.6%) and more complex endodontic and prosthodontic care (58%)
Nearly half reported that their patients had either delayed dental treatment due to cost or had chosen less than ideal treatment due to cost
More than 40% reported that these affordability challenges had increased over the past 12 months
Respondents who supported expanding Medicare to include more dental services were more likely to report their patients were experiencing these affordability challenges
Types of schemes supported
Practitioners were provided details of the various recommendations made by the Senate report and asked their thoughts:
The strongest support was for a means-tested and capped scheme (37.1%), followed by a capped universal scheme (30.4%), a capped seniors scheme (30.2%) and a preventive scheme (29%)
The services that had the strongest support for being included were examination/diagnostic (84.3%), preventive (82.6%), restorative (63.5%), periodontal (58.6%), oral surgery (53.9%), dentures (50.8%) and endodontics (40.7%)
There was little support for including cosmetic treatment (2.7%), veneers (4.7%), orthodontics (15.4%) or crowns/bridges (21.3%)
With access to dental care likely to play an important role in the post-election negotiations, understanding dental practitioner perceptions and attitudes to expanding Medicare is important. What this research shows is that many practitioners support that concept in principle, with some reservations expressed about how any scheme might operate. Many commented on the impact it might have on their income, whilst 20% mentioned the risk of over-servicing. Budgetary concerns – particularly if any scheme was uncapped like Medicare – were mentioned by many. At the same time there were comments about the benefits to patients in terms of reducing the burden of disease and the broader health impacts.
Obviously this study is only a snapshot from a small group of dental practitioners, and there is a risk of responder bias – although that could swing in either direction, with those opposed to adding dentistry to Medicare just as likely to want their views heard as those who support the idea. No doubt detractors will latch onto the sample size, so it’s worth noting that the final sample exceeded the number required to show a difference between support (40%) and opposition (60%) with a 95% confidence interval and power of 90%. Big sample sizes are not a prerequisite to gaining insight into a larger population group.
As we note in the paper, a range of factors over the past few decades has exacerbated socioeconomic disparities in accessing dental care, and this study provides important evidence of support for expanding Medicare that transcends the ‘vested interest’ cohorts in the dental profession.
Importantly any proposed new scheme must be organised and administered properly if it is to maintain the support and participation of the profession and also deliver high quality dental care to those most at need.
You can read the full paper here:
There is more information on universal health coverage and what some of these schemes might look like here.
Give Medicare Teeth Campaign
The Give Medicare Teeth campaign was launched on World Oral Health Day on 20 March. To date it has had good reach across a range of social media platforms, great engagement and support from the public and thousands of visits to the campaign website. Nearly 100 people have let us know that they have emailed their candidates in the upcoming election, and a number of those candidates have let us know that they are committed to supporting action to improve access to dental care if they are elected to the next parliament.
Monique Ryan (Kooyong) supports including dental care in Medicare.
Ben Ryan (Flinders) wants to expand Medicare to include basic dental care starting with seniors.
Helen Huang (Melbourne) says that Medicare should also cover essential dental and mental health check-ups.
Caz Heise (Cowper) supports the recommendations of the 2023 Senate Committee and will advocate for their implementation, starting with expanding Medicare to cover essential oral healthcare and properly funding the public system to end long wait times.
If you believe that there is a need to improve access to dental care in Australia, regardless of which particular model that you support, I encourage you to visit the Give Medicare Teeth website, find your electorate and email your candidates and ask them to commit to action. You can download social media tiles to share the message across your network.
It’s always interesting when long held public perceptions are found to not truly represent several individuals who are ignored. Thanks for sharing, Matt!