Can you imagine an Australia where visiting a dentist was as simple as visiting a GP? The Grattan Institute has released a report: Filling the dental gap: A universal dental scheme for Australia, that does just this. The report begins by highlighting the disparity between a routine health check with a GP and visiting the dentist; those visiting the dentist might expect it to hurt more, but usually in the pocket more than anywhere else.
So what is the reason for this? As the report states, “There’s no compelling medical, economic, or legal reason to treat the mouth so differently from the rest of the body.” The solution? The Institute advocates for a gradual move towards a universal primary dental care scheme, funded by the Commonwealth Government.
So, the big question is, how much would this cost the Australian public purse? To establish the scheme as the report envisions, it would cost an extra $5.6 billion a year once fully established; the report is incisive in noting that the establishment of a universal scheme is not practicable overnight.
First steps to allow all Australians to access dental care are suggested; the Commonwealth would take over responsibility for funding existing public dental schemes and moreover, fund them appropriately; private dental providers should be able to provide publicly funded care; and the establishment of free treatment for those on Centrelink payments and for children, with the report stating that universal care should be established within ten years of the scheme’s commencement.
The report makes ten recommendations that centre around two key aspirations; establishing a commitment to the universal scheme and; how such a scheme would be established and developed to the point of universality making it an integral part of Australians’ universal access to health care.
Dr Stephen Duckett, Grattan’s Health Program Director, avoids grandiose ideas about how such a scheme might be quickly implemented, following the faith of the many previous governmental attempts of fixing the problem in an unsustainable way. The report clearly acknowledges that the roadmap to progressing this concept is paved with challenges; for example, offering a universal scheme would require the development and expansion of the oral health workforce as well as having significant consequences for private health insurers who responded to the introduction Medibank in 1974 under the Whitlam Government by offering dental cover to protect their revenue streams.
However, just because this plan might be challenging, doesn’t detract from its worth, or the value of investing in the future oral, and by extension general, health of Australians.
What’s the danger of doing nothing? Patients seeking public dental services currently play a postcode lottery of waiting times and what services are available to them due to the patch work of on-off programs and eligibility criteria. Most people who suffer from a toothache in Australia make a full recovery, but is that really the point? Decimated smiles impact quality of life, socially, culturally and psychologically. We know well that it is not the rich who endure the stigma of poor oral health. It is our obligation to reduce human suffering—for all Australians, not just those who benefit from the Commonwealth’s $701 million Private Health Insurance rebate for dental care. Readers should be shocked, and politicians be embarrassed by this truth “The Commonwealth provides nearly as much financial support for dental care through the Private Health Insurance rebate – which goes disproportionately to higher-income households – as it does to low-income people through the CDBS and the National Partnership Agreement.”
Furthermore, what happens if this level of funding is reduced? The report states; “If the current National Partnership Agreement funding which expires in 2019-20 is not renewed, the Commonwealth will spend more supporting dental care for privately insured people than for people who rely on public dental care.” There is no way of justifying this.
The report supports the integration of oral health into the wider environment of health provision; dentists are highly skilled leaders of the oral health workforce, it is neither practicable nor appropriate to assume that these practitioners are the most suitable members of the dental team to provide care in all situations. Where practicable and efficacious, other members of the oral health workforce and non-dental practitioner health providers should be considered as the providers of services.
Similarly, last year the Productivity Commission criticised the lack of preventative focus of the current public dental services, finding that the perpetuation of the traditional ‘drill and fill’ methodology to treat dental disease, with no focus on prevention, was in need of reform. The proposed scheme by the Grattan Institute is founded on the principles of prevention.
The universal nature of the proposed scheme will help to rectify the current void that exists between dentistry provided by the grossly underfunded public dental services, and the expensive private dental care funded by private health insurance. Caught in this gap are the working poor; those who earn just enough to be ineligible for means-tested dental care in the public system, but who cannot afford the costs of private health insurance.
The inequity of oral health services in Australia should be an embarrassment to all political parties. It is time to make dentistry an election issue. In the run up to this year’s Federal election, so far only one party has made a statement about their intentions for oral healthcare with the Greens announcing a $5.8 billion commitment to integrating dentistry in Medicare. Labor’s Catherine King mentions the word “dental” exactly one time in her announcement which spans over 3,500 words. Whilst we should accept that she couldn’t have mentioned everything, the mouth is an integral aspect to health and wellbeing; it is about time the health system recognised this.
Grattan’s report gives us hope by creating a vision that will bring dentistry in Australia forward into the 21st Century and in line with other first-world countries. For too long, the most vulnerable in our society have suffered—it’s time to a fundamental change in the way Australians get dental care; business as usual just isn’t an option. The proposed plan is both laudable and practicable. Will we find brave politicians who will adopt it?
Professor Heiko Spallek is Head of School and Dean; Dr Alexander Holden is Senior Lecturer in Dental Ethics, Law and Professionalism and Head of Subject Area – Professional Practice; both at The University of Sydney School of Dentistry.