Is the dentist too expensive?


Photo by "Nursing Schools Near me"

Dentist Chair (CC BY 2.0)

The Australian dental care system has been under some assessment recently, as the current policies fail to provide affordable and accessible dental care to Australians. This failure affects Australia’s working class the most. When you get injured or get sick, you are covered through Medicare, however, when it comes to your oral health it is an entirely different ball game. People find themselves on a long wait list under certain government schemes or they are hit with massive out of pocket expenses.

New reports call for dental care to be funded by Medicare. Statistically, over two million Australians avoid or delay going to the dentist each year because of the costs involved. The Greens recently announced a $5.6 billion dental policy to invest in providing Medicare-funded dental care.

This announcement is strongly supported by The Australian Dentist’s Association (ADA) and the Grattan Institute among other groups and organisations throughout Australia. ADA Federal President Dr Carmelo Bonanno said in a statement, “We welcome greater attention to oral health by political parties, and today’s announcement is a step in the right direction.”

A report from the Grattan Institute has called Australia’s current approach to dental health an “inequitable, ramshackle scheme.” The ADA has welcomed greater attention to oral health, particularly for young Australians, students and the underprivileged for whom going to the dentist is often not even an option because of the incredibly high price. If the costs were lowered and covered by Medicare it would mean affordable oral health care for those who are currently struggling in the existing system.

Dr Jilen Patel is a specialist paediatric dentist, senior lecturer in clinical dentistry at the University of Western Australia (UWA) Dental School and a consultant at Perth Children’s Hospital. Among many other things, he has volunteered in a team that provided dental services to remote communities across the Kimberley region, and more recently he has been formulating an integrated, multidisciplinary oral health education and prevention program for refugee children.

Dr Patel told NewsVineWA, “The cost of dental treatment is a significant barrier for many, however, the reasons behind the burden of dental disease in the community are extensive and multifactorial ranging from issues such as food policy through to affordability and access to timely dental care. As such, public expenditure and government subsidies on dental care may impact on the affordability and thereby influence the accessibility of dental care.”

Affordability is not the only factor influencing people’s oral health. There are a number of other factors involved in respect to dental care. Dr Patel pointed out, “It is equally important to appreciate that this may not necessarily reduce the influence of upstream determinants on dental disease such as education and health literacy which play a critical role in the rationale behind whether someone chooses to see a dentist in the first instance or whether care is sought symptomatically as opposed to prophylactically.”

The Grattan Institute reported that around two million Australians who needed dental care either did not get it or delayed getting it because of the cost. According to the report, “the poor and disadvantaged are most likely to miss out on care. About 60% of low-income people did not see a dentist at all in the past year.” Affordability also has a disproportionate influence on other groups of people such as women, Indigenous people and those aged between 25 and 44. According to the Commonwealth Fund’s International Health Policy Survey, “32% of Indigenous Australians skipped dental care due to the cost, compared to 21% of non-Indigenous people.”

In an interview with NewsVineWA, Grattan Institute’s Health Program Director, Dr Stephen Duckett said, “we have proposed that Australia moved towards a fully universal dental scheme. Only this will address the access issues. However, we acknowledge that this should be a long-term goal, and is not achievable in the short term both because of the cost and also because of the workforce implications. We have proposed the phasing in an arrangement starting with pensioners and healthcare cardholders. Our first phase will cost around $1 billion.”

Dr Duckett is an economist and a Fellow of the Academy of the Social Sciences in Australia and of the Australian Academy of Health and Medical Science. He has held top operational and policy leadership positions in health care in Australia and Canada, including as Secretary of the Commonwealth Department of Health.

Asked about the Greens’ recent $5.6 billion dental policy announcement, Dr Duckett added, “There are of course alternative ways in arrangements. The Greens have proposed starting with kids which has merit, as it hopefully will set people up for good oral health approaches for life. Tinkering with smaller sums than our $1 billion figure will not make a significant dent in existing public dental waiting lists. It is also important to stress that our scheme principally focuses on access, we must also ensure that prevention is not forgotten, including fluoridation of water supplies.”

NewVineWA asked The Department of Health if they believed this was a good policy announcement. The Department of Health responded that it was not appropriate for them to comment on any election commitments, however, did mention that some of the current policies and programs include private dentists arranging their own fees for services and payment for dental services, which vary in cost from practice to practice. State and territory governments are the providers of public dental services in Australia with additional schemes and programs supported by the Federal Government.

The Federal Government claims that they are aware of the restrictions on obtaining affordable dental services and provide a range of programs. Some of which include dental care through the Child Dental Benefits Schedule (CDBS) and National Partnership Agreement (NPA) on Public Dental Services for Adults with the states and territories, by supporting improved access to dental services for eligible people who rely on public dental services.

The Greens told NewVineWA, “For those who can’t afford to see a private dentist, the state governments provide care through public dental hospitals. They struggle to meet demand, and many parts of regional and remote Australia have no access to these public dental hospitals. There are hundreds of thousands of people stuck on state waiting lists, with wait times reaching up to years depending on the treatment required. Since 80% of the dental workforce works in the private sector, it’s clear public dental hospitals are only part of the solution.”

According to the Mid-Year Economic and Fiscal Outlook, “the Government announced an additional $108 million for an extension to the NPA.  The NPA commenced on 1 January 2017 and will now end on 30 June 2020 providing $350.5 million and supporting services to around 580,000 public dental patients.”Based on the many reports by experts such as the ADA, this approach seems like it only scratches the surface of the problem, it does not actually resolve the root cause of the dilemma when it comes to the current failures of the dental care system in Australia affecting thousands of people.

NewsVineWA asked Senator Di Natale’s office if the Greens believed that the government budget and announcements only scratches the surface of the problem.He said: “Yes. Dental should be available on Medicare. The Greens believe this because cost is a huge barrier to accessing a dentist in Australia. The lower your income, the more likely you are to have chronic dental problems: low income earners have more than twice the rate of untreated dental decay as high income earners.”

For people in rural and regional Australia, First Nations people, and the aged, the numbers are even worse.

“More than a third of remote area residents and an appalling 57% of First Nations Australians live with untreated tooth decay. The largest part of this burden falls on children. Four out of ten young children and three out of ten older children have experienced tooth decay. This is even more pronounced in children from low income families. Specifically, children from low socio-economic areas are more 70% more likely to have poor oral health than children in higher socio-economic areas.”

According to The Australian Labor Party (APL), “Over 300,000 disadvantaged Australians will miss out on critical dental care every year because of Scott Morrison’s latest funding cut.” The ALP has said they will reverse the cuts, according to their website, “Six state and territory governments have said that the cut will mean fewer people being seen and longer wait times.”

NewsVineWA asked the Greens if Labor’s plan to reverse cuts by the Government was good enough? They said, “The campaign to simply reverse the cuts is not good enough. The Greens have long fought for a greater expansion of dental coverage on Medicare. While we support Labor’s policy, Senator Di Natale will continue to work to expand the scheme. ”

According to the Greens website, millions of Australians have hesitated to visit the dentist because of high out of pocket expenses, “which is why the Greens have long been champions of Medicare-funded dental care.” Senator Richard Di Natale said, “The Coalition has never supported Medicare but if the Labor Party really support affordable universal healthcare, Bill Shorten should commit to working with the Greens to bring dental into Medicare.”

When asked, what do the Greens think will happen next with dental care policies, they said “We are hopeful that the ALP will consider a policy to expand dental under Medicare in the lead up to the election. Should they not, we will continue to work with the new government to expand dental on Medicare. What happens next depends on the results of the next federal election in May.”