Dentistry - the forgotten part of health policy.
With an upcoming budget and election, there is an opportunity to reform the provision of dental services in Australia and ensure more equitable access to care.
A new paper published this week in the Australian Dental Journal highlights the inequities in public funding for dental services leading to poorer health outcomes for many Australians, and the need for urgent reform. The Albanese government is now overdue in releasing their response to the Senate Select Committee Report on the Provision of and Access to Dental Services. This is perhaps a sign that there are no plans to implement any new reforms. However, with an upcoming federal budget in May, and an election looming next year, it is important that pressure is maintained to keep oral health in the policy and funding mix.
The Senate Committee found significant barriers for many people accessing dental care, including high costs and long waiting times, with significant impacts including pain and suffering, shame and low self-esteem, poor nutrition and general health, and decreased productivity and employability.
Most experts agree that the Albanese government should commit to a means tested dental scheme providing care to all health care card holders, pension card holders and those on government income support payments as a matter of priority.
Inequities in dental funding
This new paper highlights some of the inequities in public funding for dental services in Australia that are contributing to poor health outcomes:
Australia spent $11.1 billion on dental care in 2021-22 and ranks 6th of 31 OECD countries in terms of per capita expenditure on dental care, but the majority is individual out-of-pocket spending
Oral diseases contribute 2.3% of the total burden of disease and 4.8% of total health expenditure, however governments allocate only 1.3% of their total health spending to dental care.
Governments fund 80% of hospital expenditure, 79% of medical services and 88% of benefit paid pharmaceuticals, but only 21% of dental expenditure
Since 2011/12, total Federal recurrent health expenditure (excluding private health premium rebates and Department of Veterans Affairs) has increased 88%, from $51.3 billion to $96.6 billion
+96% for public hospitals and +416% for private hospitals
+76% for referred and +61% for unreferred medical services
+41% for benefit paid pharmaceuticals
-53% for public dental care
Australia ranks 23rd of 31 OECD in terms of the relative contribution of government spending on dental services, and this has gone backwards over the past 15 years
Ongoing policy failures
More than 8 years after the release of the National Oral Health Plan 2015–2024, it is evident that nothing of substance has changed to improve access to dental services, and the considerable personal, financial and organisational barriers that it identified have not been addressed. The plan has 26 core indicators to measure progress, but many have either remained unchanged or have recorded unfavourable outcomes.
There have been numerous reports on oral health over the past 20 years with a series of recommendations which remain mostly unenacted including the National Hospitals and Health Reform Commission in 2009 (recommending the establishment of a Denticare scheme funded by a 0.75% increase in the Medicare levy); National Advisory Council on Dental Health in 2012 (recommending a means-tested individual capped benefit entitlement to increase access to basic dental services for all concession card holder adults); the Productivity Commission in 2017 (recommending introducing a new blended payment model for the Child Dental Benefits Schedule); and the Royal Commission into Aged Care Safety and Quality in 2021 (recommending the establishment of a Senior Dental Benefits Scheme).
Many of the key recommendations made in three reviews of the Child Dental Benefits Schedule have also not been implemented.
Urgent need for reform
The Senate inquiry provides a range of options to reform the dental sector and improve oral health outcomes. In the context of overall health budgets, the costs are modest, and the benefits to patients are profound.
There should be a strong focus on health promotion and the integration of oral health into primary health care, with a need to expand the oral health workforce into areas of need, particularly in regional and remotes areas, Aboriginal health, supporting disabled people and those living in residential aged care. Funding for service provision needs to follow the workforce into these areas, in a planned and phased manner, to allow for the workforce to grow and adapt to a new system.
This will ensure that care will be provided where it is needed most—targeted to those population groups that experience the greatest disadvantage.
Hopcraft MS. Commentary on the Senate Select Committee into the Provision of and Access to Dental Services in Australia: an opportunity for reform. Aust Dent J 2024. (published here).