19 March 2019

Moment of tooth for dental policy

Patients Political TheHill

The nation’s teeth are emerging as a political issue ahead of the federal election, with three competing proposals for increasing access to dental care.

The Greens have pledged to invest $5.8 billion over four years in accessible dental care for young and financially disadvantaged people.

The Grattan Institute has recommended a Medicare-style universal insurance scheme at a cost of $5.6 billion a year.

And private health insurers want to be able to tender as public service providers for low-income earners, declaring a universal scheme unaffordable.

Currently more than half of the annual $10.2 billion cost of dental care is borne by the individual, with health funds paying $2.6 billion a year and the federal government $2.4 billion, according to health funds peak body Private Healthcare Australia.

Under the Greens’ policy announced this month by Senator Richard di Natale, eligible groups will have up to $1000 worth of essential dental care over two years covered by Medicare.

Low-income earners have more than twice the rate of untreated tooth decay as high-income earners, the policy says. More than a third of remote residents and almost 60% of indigenous people have untreated tooth decay.

State-run public dental hospitals account for only 20% of the dental workforce, and most have long waiting lists.

The Greens’ plan would be staged, starting with people under 18 from July, adding aged pensioners in July 2020, full benefit recipients in 2021 and other concession card holders in 2022.

A Grattan Institute report released on March 17, “Filling the gap: A universal dental care scheme for Australia”, says the commonwealth government should assume full responsibility for primary dental care as it does other primary medical care, as there is “no compelling medical, economic, legal or logical reason to treat the mouth so differently from the rest of the body”.

The expensive change would have to be implemented gradually, the report says, beginning with people eligible for existing public dental schemes, then expand to children, welfare recipients and finally the whole population. It says private-sector providers should be able to deliver publicly funded care.

But PHA says the only way to make coverage universal would be to raise taxes, charge co-payments and/or limit the scope of services.

The group says private funders of dental care should be able to compete to provide existing commonwealth programs for low-income earners. “Increasingly, health funds are contracting with dentists and vertically integrating with dental practices, thereby consolidating and creating economies of scale,” CEO Dr Rachel David said.

Besides the immediate problems it causes, gum disease is implicated in a range of other conditions including diabetes, heart disease and, in recent experimental findings, Alzheimer’s.