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Put your money where your mouth is on dental health reform PDF Print

While many people say they fear going to the dentist it is more often the cost rather than the drill that causes the most pain. More than one-third of Australians say they put off going to the dentist because they cannot afford it.

Australia ranks among the bottom third of OECD countries for adult dental decay and people on low incomes and those living in poverty and social disadvantage experience a disproportionate burden of disease. Research shows they experience higher rates of tooth loss and decay and the most difficulty accessing and affording dental services.

The expert report of the National Advisory Council on Dental Health, released last week, seeks to address the current inequities in dental health by proposing a new national oral health system to provide equitable, affordable access to dental care for all Australians.

The report prioritises children and lower income adults as the first step to creating a more universal system. It outlines four options that would build on existing frameworks for an individual capped benefit scheme or expand state public dental services. Funding would cover basic dental services including diagnostic, preventive and routine care, with the provision for more expensive services in exceptional circumstances.

The National Health and Hospital Reform Commission identified the need for dental reform as a priority nearly three years ago. It recommended universal access through a "Denticare" scheme, which was rejected by the Government due to the $3billion price tag.

Last week's Report recommends a minimum $56 million on child dental services and $0.3 billion on adult services in 2012. Importantly, the Report recommended foundational measures to develop a national scheme over time, recognising that even a blank cheque won't address current deficiencies such as numbers in the dental workforce and their disparate distribution across the country.

Opponents of a universal access scheme argue that our oral health workforce and infrastructure are inadequate to service the tsunami of people who would scramble to get into the dentist chair. Critics also argue that the cost of the scheme would be too great in the current economic climate.

While a comprehensive dental system may be seen as financially costly, the cost of doing nothing is just as high and continues to mount. Poor access to dental care has significant costs to society. In 2009-10 the direct cost of dental services was $7.7bn, and indirect costs to the economy have been estimated of up to $2bn.

Much of these costs could be avoided through timely, preventive dental care, not to mention the costs to social and economic participation as stigma and self-doubt from poor teeth undermine individual efforts to obtain and maintain employment and meaningful social relationships.

In recognition of the current funding climate the Dental Council has proposed options that can be scaled up or phased in over time. They provide stepping-stones on the path to a universal access system. The most conservative model targeting those people already on public waiting lists would cost $343m in 2012-13. This is around two-thirds less than current Commonwealth expenditure on dental programs.

While targeted measures for those children and adults most in need are essential, they must not be the end point. The Medicare principles underpinning our health system mean that all Australian's are entitled to the same good quality care based on individual need rather than ability to pay.

This year's Federal Budget is the opportunity to commence a comprehensive plan to bring dentistry into Australia's universal health system. It is simply not fair that so many Australians are missing out on essential dental care, most noticeably for those on low incomes.

The Council report provides options that are fiscally responsible and pragmatic. They would improve dental care for those children and adults in greatest need, while laying the foundations for a more universal access system for all Australians.

Building on the Government's commitment to significant dental reform in this year's budget, the new Health Minister Tanya Plibersek has made welcome comments that revamping the dental system would be one of her priorities in the health portfolio. This Federal Budget lets see the Government put its money where its mouth is.

Dr Cassandra Goldie, ACOSS  - published in On Line Opinion on 12 March 2012