STEPHEN DUCKETT. The tooth hurts but Victoria’s public dental system is broken (Grattan Institute).

Nov 23, 2018

Our dental care system is not working for a lot of Victorians. More than half a million Victorians say that the cost of dental care stopped them from getting care when they needed it in the past 12 months.

Victorians are more likely to report cost as a barrier to dental care than people in every other state and territory except Queensland and Tasmania.

The poorest Victorians suffer most. Public dental care for adults is restricted to those people who are least likely to be able to afford it themselves – people with health care or pensioner concession cards, as well as refugees and asylum seekers.

If people actually want to use the public dental system in Victoria, they had better plan ahead. The good news is that Victoria’s public dental system is meeting its stated objective, with average wait times below the statewide target. The bad news is that the target is a wait of 23 months for dental care, and the actual wait is more than 20 months.

Think about that: low-income Victorians are waiting on average nearly two years for dental care – and the wait list has been growing, not shrinking.

As Matt Hopcraft of the Australian Dental Association Victorian branch pointed out in The Age on November 6, Victoria’s public dental scheme is not funded to anywhere near the levels needed to provide care to all the eligible people who need it. More funding is needed, and quickly.

It would be money well spent, because more spending on oral health can prevent much more costly (and painful) problems from developing down the track.

Dental conditions are one of the main causes of preventable hospital admissions in Australia. Underfunded public dental care is bad for the people who rely on the services and ultimately bad for taxpayers as well.

But, although more funding is clearly needed, we need to do more than merely pouring more money into the existing public dental scheme. We need a big reform: the Commonwealth Government should take over responsibility for funding public dental care.

A Commonwealth takeover of public dental funding would produce big benefits. First, only the Commonwealth can ensure equity among Australians in different states. We already do this with Medicare – there’s no reason why the service people receive from public dental systems should vary as much as it does across the country.

Second, the federal government would be able to properly measure and monitor the efficiency and effectiveness of dental spending. Back in 2012, the states and territories agreed to monitor and report on public dental waiting times in a consistent way. Despite this agreement, the waiting times data remain so inconsistent across states that we can’t be sure whether Victorians are waiting longer for dental care than people in other states. A Commonwealth takeover could end this inconsistency. Beyond measuring waiting lists, a federal scheme would also be better placed to start measuring oral health outcomes, which ultimately matters more than the amount of time people spend on waiting lists.

Another reason for a federal scheme: that’s where the money is. Victoria is currently swimming in cash, but other states are struggling. The states’ budgets are generally tighter, and their ability to raise revenue more restricted, than the Commonwealth. So the federal government has greater capacity to fund public dental to the level that’s actually needed.

Finally, the Commonwealth taking control of public dental funding would lay a foundation on which to build a better public dental care system. If we want to move towards Australia having a universal primary dental scheme, as many experts and institutions have recommended over the years, it makes sense for that scheme to be operated at the federal level, as Medicare is.

The Commonwealth is already involved in funding public dental services. It funds the Child Dental Benefits Scheme, and provides some limited, soon-to-expire funding to the states to support their adult schemes. But the existing system of overlapping responsibilities, inadequate data collection and monitoring, and wavering Commonwealth enthusiasm is not a sustainable or efficient mix.

Dr Stephen Duckett has held top operational and policy leadership positions in health care in Australia and Canada, including as Secretary of what is now the Commonwealth Department of Health. He has a reputation for creativity, evidence-based innovation and reform in areas ranging from the introduction of activity-based funding for hospitals to new systems of accountability for the safety of hospital care. An economist, he is a Fellow of the Academy of the Social Sciences in Australia and of the Australian Academy of Health and Medical Science.

This article was published by Grattan Institute

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