ALEXANDER HOLDEN and HEIKO SPALLEK. We Must Fill the Hole in our Public Health Services: Why Doesn’t Medicare Cover the Mouth?

In Australia, the cost of visiting a GP can be completely covered by Medicare, with anyone being able to see a medical professional free of charge, regardless of their ability to pay privately.

This might be slightly more complicated when visiting a specialist or when needing extended care from a mental health professional. Despite the certain exceptions to the rule, fundamentally, when a person has need of medical attention or advice: they can access care.

However, what if you have a problem with your mouth? If it’s teeth and gums that need attention, or perhaps a denture that stops feeling so comfortable, anyone will notice the government’s lack of support for oral health as acutely as any toothache.

State and territory governments provide some access to public dental services, but these are means-tested and in many cases those who are eligible are left on multi-year long waiting lists to fend for themselves. In NSW, some public patients are issued with vouchers to fund care in private practice as a way of reducing waiting times. For the working poor; those who don’t meet the means-test of eligibility for public treatment, but who cannot afford the costs of private care, dentistry is even harder to access. But even 19% of patients with Private Health Insurance report that paying for dental care was a large financial burden.

The Grattan Institute report, Filling the dental gap: A universal dental scheme for Australia, sets out how the current and future dental workforce might be structured to provide care for all Australians. 2019 saw the Greens commit support for a universal dental scheme similar to Medicare, with Labour releasing a Federal election pledge to establish a dental scheme focused on pensioners’ oral health. The current Liberal government continue to promise nothing towards easing issues of access for dentistry; the absence of oral health in Australia’s health policy and priorities is shameful.

Looking at this situation, anyone could be forgiven for thinking that the mouth wasn’t an important part of health; an unspoilt smile being a luxury item or symbol of wealth. Narratives around oral health often show how oral health is presented in the media as a simple issue of personal responsibility – brush your teeth twice daily and you won’t have issues with your teeth.

Oral health is anything but simple; dental disease is a hugely complex socio-cultural issue, and therefore the wicked problems of dental decay, gum disease and oral cancer – the three big conditions dentistry is concerned with – need a political solution. Brushing one’s teeth twice daily does nothing to address the lack of affordable care, the tactics of commercial interests that seek to make sugar-sweetened products increasingly accessible, or the fact that the mouth is still excluded from general health.

Advocating for population-level actions that promote oral health, such as a tax on sugar-sweetened beverages, is important, but these preventative measures do not address the burden of disease already afflicting the Australian public. Fewer than 1 in 10 adults in Australia have no dental decay experience at all, although this data is not contemporary which might also be an expression of how little the system cares about even collecting oral health data as they are accumulated during routine care (all we count are fillings, crowns and dentures but not diagnosis). Good dental care should focus on a foundation of prevention, with restorative treatment being available where necessary. How can this be made available to all Australians? Dental care needs to be included within Medicare, with this being funded in part, by redirecting the rebate paid towards private health insurance.

In our previous post for this blog, we noted that $701 million is spent by the Commonwealth government on private health insurance rebates towards dental care. Whilst the cost of putting the mouth into health is estimated to be much higher than this, it should be noted that the Grattan Institute’s roadmap recommends a gradual spend on oral health services. The report recommends an initial takeover and investment by the federal government of state and territory-provided services to the tune of an extra $1.1 billion per year. Dentistry and oral health need public funding and investment. Redirecting the funding that currently makes up the private health insurance rebates would help to redirect support for oral health towards better oral health for all.

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.

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Professor Heiko Spallek serves as Head of School and Dean of The University of Sydney School of Dentistry. Professor Spallek’s research has as its focus the development of computerized clinical decision support tools.

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