First published: Tuesday, July 3, 2012
Recently a patient came to me for treatment of her rheumatoid arthritis. She’s 42, a single mum with 2 kids, surviving on a pension which she is about to lose as her youngest is 8 years old and budget changes mean she has to work or go on Newstart. Her teeth are terrible. For the last 3 years she has required antibiotics for tooth infections about every 6 months. I can treat her arthritis and there’s a good chance I can get her well enough to go to work, but only a modest chance I can return her to a pain free existence (and that will be with prescription drugs for years). She is one of the 400,000 people on waiting lists for public dental care. Because of her serious dental disease her risk of heart disease may be up to twice normal. There’s even weak evidence suggesting dental disease may play a role in causing her rheumatoid arthritis. Now that she has a chronic disease she can get $4000 of dental work done under the Chronic Disease Dental Scheme (CDDS). Better late than never. Even without that she may be one of those set to benefit from the recent Federal budget announcement of a $350 million package over 3 years to address the appalling waiting list for public dental care.
Sadly, that’s almost all there was in the budget to address the parlous dental state of our nation. At least one third of Australians don’t see or delay seeing a dentist because of cost. Dental problems are one of the commonest preventable causes of admission to public hospitals. But there is no vision yet from this Federal Government about how we address this problem. The best offered so far is like ‘cake from the rich man’s table’. The previously mentioned CDDS is a $1 billion a year program introduced by the Howard Government and has been a godsend for some desperate patients but is poorly targeted and structured in such a way that it is easily rorted. The Federal Government wants to stop it but can’t do so without the support of the Greens who are resisting because they want whatever replaces it to be a substantial improvement.
The problem of affordable access to dental care for all is not new. It was well documented by the Government’s own National Health and Hospitals Reform Commission which in 2009 recommended a scheme which would have cost an extra $4 billion per year to implement. This was ignored in the great health reform plan of 2011. Instead yet another committee, the National Advisory Council on Dental Health, was formed last year to suggest options. Basically it said that a capped Medicare style system to cover low income adults and all children would cost $8 billion per year and a capped public system provision for the same groups would cost $2.5 billion per year. Either proposal would be a large safety net aimed at addressing the needs of the most vulnerable. From these figures it would appear that funding dental through a Medicare style rebate system is vastly more expensive than funding through a major expansion of the public system. The public option suggested would essentially fund the states which could use a mixture of private and public dentists. One might expect Treasury to favour the cheaper option.
Unfortunately the current negotiations between the government and the Greens are not about a universal access scheme for dental care. It’s much less than that. Essentially, it is about the size of the safety net. The government did not request the Advisory Council to look at a universal access scheme and nor has the government expressed any vision for such a scheme. Whilst we can expect the Greens to demand a large safety net, this is an opportunity to begin to implement a universal access dental scheme based on need. We know from our experience with Medicare that a rebate style, fee for service system fails to deliver universal access either because patients can’t afford copayments or can’t find a doctor. If we are to have dental care for those who need it, now is the time to set in train a process to deliver such a scheme. The cheaper public option could form the basis for a universal access scheme. The more expensive Medicare style option will not.
This is an opportunity for the Federal Government to demonstrate a vision of a dental system which encompasses the principles of equity and efficiency. It could borrow from the Gonski review of education which recommended a needs based funding model for school education to ensure that access to funds would not be a barrier to equity in education. A needs based funding model could be introduced for dental care. Such funding could be distributed to regions, based in the new regional structures the government has introduced known as Medicare Locals. These are currently in development and thus incapable of immediately taking on the task of organising the regional use of such funds but the potential exists if the government would only return to its previously stated vision of ‘central funding and local control’. As an interim measure the government could adopt the public funding model recommended by its own Advisory Council.
Will the Federal Government waste another opportunity to demonstrate it has a vision for equity and a strategy to achieve such a vision?
Tim Woodruff
Vice president
Doctors Reform Society