Suffer the children

Dental health funding is droppingIf the Child Dental Benefit Scheme was so universally liked, why would the government replace it with a less targeted, less funded, less valuable scheme? By Sue Nelson.

In the week before the 2016 Budget was delivered, Federal Health Minister Sussan Ley announced the Government’s intention to overhaul dental health funding. Among the changes was the replacement of the existing Child Dental Benefits Schedule (CDBS) with what is being called the child and adult Public Dental Scheme (caPDS).

It’s a scheme that will use State and Territory public dental systems to treat, according to the Health Minister, five million children and five million adults on healthcare cards each year.

The minister has characterised this announcement as a doubling of Commonwealth funds into the public dental health system administered by the states—but how does the accounting stack up? And does the new arrangement threaten to spark a new dental health funding blame game between the states and the Commonwealth?

The scheme will spend $1.7 billion in total, offering $425 million per year over four years for more than five million children and five million adults. By comparison, the previous scheme, conceived by the ALP and implemented by the first iteration of the current Coalition Government, delivered $2.8 billion over six years, with $615 million in dental health funding available for each year of the scheme, though only a little more than half that budget was spent.

Wasn’t broken

The Australian Dental Association (ADA) has been campaigning to save the CDBS since the announcement was made. It argues that the previous scheme was well targeted and effective, and that it was allocated an appropriate level of dental health funding for its purpose.

“The existing CDBS scheme had bipartisan support,” says ADA President Dr Rick Olive. “One thing we particularly liked about it was that it complied with the ADA’s policy on publicly funded dental schemes. It was means tested and targeted to a cohort of patients that the government could define.

“The CDBS was the first stage of a multiple-stage targeting of groups that had been identified under the National Oral Health Plan and we believe that children are the obvious starting point for any public funding of healthcare. That is a principle that appears to be applied throughout the world.”

In addition to being well costed and targeted, the CDBS was reasonably administered—two separate reports into it, one by the National Auditor General and the other by the Department of Health, produced findings to this effect.

The new scheme

So how does the funding for the new scheme stack up? The involvement of the states and territories, now required under legislation to stump up 60 per cent to meet the Commonwealth’s 40 per cent contribution, may cloud the issue.

This 60–40 formula, which the government intends to enshrine in legislation, ensures that the states and territories will continue to spend on public dentistry. “There’s an opportunity for the state and territory governments, within that formula and given what they’re currently spending, to do some cost-shifting to the Commonwealth and to make themselves something of a saving,” says Dr Olive.

But it can’t be assumed that money provided to the states and territories will be spent on treatment alone: “The states, if they have guaranteed funding, have indicated to us that they would rather plan to build infrastructure and capacity for dentistry,” says Dr Olive. “The level of outsourcing to private practice is not going to be equivalent to what has occurred in the past.”

This has obvious implications for the wait times, which in recent years had been reduced from two years to one under the National Partnership Agreement.  The apparent sidelining of private dentists in the government’s package has other flow on effects. “Much of Australia is serviced by private dentists. If you cut a private dentist out of the picture then you’re removing 85 per cent of the dental care in Australia—and if you do that you can throw money at the public dental services but you’re not going to significantly increase or encourage access to these services. You may get a small reduction in wait times, but you’re not going to build these services up with only a small level of funding.”

“Much of Australia is serviced by private dentists. If you cut a private dentist out of the picture then you’re removing 85 per cent of the dental care in Australia.” – Dr Rick Olive, President, ADA

Which brings us to the dental health funding itself. The total spend under the Turnbull Government’s scheme—after the Commonwealth and state contributions are combined—is less than the aggregate amount spent by the Commonwealth and state and territory governments two years ago and last year.

“And the amount actually being spent on targeted groups is smaller than it was previously,” says Dr Olive. “It’s almost 200 million dollars less than was spent
in 2013–14.”

What’s needed

The average spend on dentistry in Australia is approximately $360 per person per year, according to the most recent data we have on funding of dentistry from the Australian Institute of Health and Welfare—a total spend of $8.9 billion in 2013–14. By contrast, the funding for this scheme, which is promising to provide publicly funded dentistry to 10 million people, works out at an average of $42 per capita.

“Now, $360 isn’t a huge amount of money, but by comparison, $42 is a very small amount of money,” Dr Olive says. “It seems to me that if the government had maintained last year’s budget for dental care it could have paid for the new caPDS and preserved and extended the CDBS to include targeted groups within the community that have been identified by the National Oral Health Plan as deserving of support under such a scheme.”

The problem of a dental health funding shortfall aside, the ADA welcomes changes, such as the enshrinement in legislation of the Commonwealth–state funding formula, to provide certainty through future changes of government. “We welcome that,” says Dr Olive. “The predictability and the continuity of funding are important and we recognise and applaud the move to legislate to protect them.” The ADA also applauds the use of activity-based funding in the new scheme, which increases the accountability of the state and territory public dental services.

Still, issues with the universality of the new scheme are pronounced. Dr Olive says: “If you’re serious about funding for 10 million people you don’t fund them to the tune of $42 per person and you don’t tie your hands behind your back by saying we’re only going to use 15 per cent of the dental practitioners in the country—those who work in the public system—to treat them, which is the effect of this deal.”

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