Dental healthcare is treated very differently to general healthcare by the Medicare system. Is it time for governments to put their money where their mouths are? Frank Leggett investigates
If you look on the website of the Australian Government’s Private Health Insurance Ombudsman, you’ll find a list of items and services that are not covered by Medicare. Among them are podiatry, chiropractic services, acupuncture and ‘most dental examinations and treatment’. The decision to not include oral health in the Medicare system has had far-reaching effects and raises the question—is it a false economy to exclude dental care from Australia’s universal health scheme? Clinical Associate Professor Matthew Hopcraft has had a long-term involvement with public health and is CEO of the Australian Dental Association (ADA) Victoria Branch. Knowing how big the problem of poor dental health is in the community, and the impacts this has on overall health and general wellbeing, he is passionate about ensuring we are getting the best possible outcomes for as many people as possible.
“We could always be doing better,” says Professor Hopcraft. “At the same time we have a large dental workforce doing the best they can possibly do within the constraints of the system that currently operates. We know that about 85 per cent of dentists and about 85 per cent of dental services are provided through the private sector. We also know that in Victoria about 30-40 per cent of the population would be eligible for public dental services.
“The mismatch occurs in the more disadvantaged part of the population who tend to have more dental disease and who suffer from those impacts very acutely. The ADA advocates improving access to dental care for people who have the most difficulties accessing that care.”
Interestingly, there’s a number of publicly funded dental schemes available that are very much under-utilised. A prime example is the Child Benefits Dental Scheme that was put in place a number of years ago. It covers a wide range of dental services for children aged two to 17. Recently the federal government tried to close the scheme down, citing a lack of uptake as a major reason.
“The view of the ADA is that a universal scheme is probably not the best option in terms of cost-effectiveness for the government. However, a scheme that targets particularly disadvantaged groups and populations would be very effective.”—Professor Matthew Hopcraft, CEO, ADA Victoria Branch
The ADA successfully lobbied against the closure, pointing out that it is an effective scheme that is helping the people who do access it. The reason it is under-utilised is because the government isn’t actively promoting it or other schemes like it.
Ian McAuley, a fellow of the Centre for Policy Development, has seen this type of thing before.
“There’s no incentive for governments to go out and say, ‘This is available to you’,” says McAuley. “The information is out there but you need the ability and the knowledge to find it. It is particularly difficult for disadvantaged people or people from non-English-speaking backgrounds to access this kind of information. And, of course, it makes the bottom line look better by keeping programs quiet and under-utilised.”
The main impact in not having dental care included as part of the Medicare system is undoubtedly on low-income earners and the unemployed. If they can’t afford it, then they simply don’t go to the dentist and their condition gets worse.
A recent UNSW report written by Peter Saunders and Megan Bedford highlighted the dire situation for some people. While participants considered access to dental care as very important, cost and long public waiting lists saw most people going without—or finding their own alternatives. One man with two cracked teeth pulled them out himself because he could not afford a dentist or wait to reach the top of the waiting list. Another visited his GP for a broken molar because the doctor would bulk-bill. The study also found that home remedies, such as using alcohol or vinegar to ‘cure’ toothache, were very common.
It is clear that oral health has a serious impact on general health. Allowing dental problems to get worse until they reach a critical point is a big financial hit on the public health system—as well as a misery for the sufferer. What could have been solved with a simple filling or extraction two years ago is now an abscess requiring major surgery and rehabilitation. Money isn’t saved by excluding people from public-funded dental care; it is simply delayed and the cost increased.
“I think it would be an excellent idea to include dental care as part of Medicare. And I think it could be sold politically by having a small increase to the Medicare levy.”—Ian McAuley, fellow, Centre for Policy Development
Furthermore, poor oral health can stop people from joining the workforce. “We know that people who have problems with their teeth and appearance have difficulties finding employment,” says Professor Hopcraft. “This then exacerbates their lack of self-confidence and can spiral down to long-term unemployment.”
Ian McAuley agrees. “Experiments have repeatedly shown that when pictures are added to resumés for job applications, these pictures have a very big impact on who is employed. One thing that really stands out, particularly in an interview, is the state of your dental health. It is illegal to discriminate against people based on their skin colour but there is unintentional discrimination against people due to the appearance of their teeth.”
If people’s oral health is improved then there are significant savings down the track in terms of medical costs. The flow-on effect is an improvement in people’s wellbeing, employability and productivity with much less time off work. So is there a benefit for the government in being the funder of those services?
“I think it would be an excellent idea to include dental care as part of Medicare,” says McAuley. “And I think it could be sold politically by having a small increase to the Medicare levy. The research on taxation shows that if you ask people if they want more taxation they will answer in the negative. However, if you ask people if they are willing to pay more tax to support education and health, the answer is strongly positive.”
“The view of the ADA is that a universal scheme is probably not the best option in terms of cost-effectiveness for the government,” says Professor Hopcraft. “However, a scheme that targets particularly disadvantaged groups and populations would be very effective. Governments need to recognise that dental care is an important part of overall health care. At present, we don’t see that recognition at either the state or the federal level.”
For more information: The Australian Dental Health Plan, which can be found on the ADA ≠≠website (www.ada.org.au) spells out in detail the ADA’s vision for Commonwealth Government involvement in the delivery and funding of dental care in Australia.