Reform delay causes dental decay. It’s time for a national deal to fund dental care

A Senate Committee investigated the reasons why so many Australians do not receive dental care and came up with 35 reform recommendations.

The most comprehensive call is for universal coverage of essential dental care. The committee proposed several measures to provide dental care for groups that are currently underserved, such as those living in rural areas.

Three months are given to the government to respond. The government should develop a plan for expanding coverage gradually and put in place safeguards to ensure that care is effective, efficient, and equitable.

If Australians can’t pay, they miss out.

The Senate Committee report is a follow-up to over a dozen inquiries and information on dental care that have been conducted since 1998. Many of these findings are similar.

Due to concerns and opposition by dentists, dental care was excluded from Medicare.

Australia continues to fund oral health in a very different way than we do for other parts of the body. Patients are still paying the majority of the costs.

Many people are unable to afford dental care. In 2022-23, 2.3 million Australians delayed or skipped necessary dental care due to cost. This is up from 16.4% in the previous year.

The poorer people were more likely to be left out. The poorest people are three times more likely than those in wealthier areas to delay dental care for over two years. One out of four people report delaying treatment.

You might not even be able to get an appointment with a dentist if you have the money. In the inner city of most capitals, our analysis of census statistics shows that there is a dentist for every 400-500 people. In Blacktown North, an outer Sydney suburb, only one dentist is available for every 5,100 residents.

Regional areas are even worse off. In Ballarat, Victoria, there is only one dentist for every 10,300 people. Some remote areas have no dentists.

Grattan Institute

Dental care is important for the entire body.

Missing dental care can have serious consequences. A dental condition can be prevented in 80% of hospital visits.

Oral health issues are related to a variety of chronic diseases that affect the entire body and can cause brain damage.

The cost of people being unable to work or go to school is also a factor, resulting in an additional half billion dollars per year.

These numbers are only a hint of the suffering that each individual is experiencing. Dental disease is often associated with pain, shame, and embarrassment.

One 30-year-old with a low income told the Senate inquiry that he had been unable to afford dental care. The couple skipped meals to save money for the dentist and were diagnosed with advanced periodontal disease. Now, they expect to lose their teeth for the rest of life.

Dental spending is down, but dental problems are on the rise

Comparatively, compared to five years earlier, we have more untreated dental decay. We are also more concerned with the appearance of our smiles, avoid eating due to dental issues, and suffer from toothaches.

Despite this, government expenditure on dental health is declining. The federal government’s share in dental services, excluding rebates, fell from 12% down to 5% by 2020-21. The state’s share also fell from 10% down to 9%.

The federal government increased its spending on dental rebates under private health insurance, but this doesn’t solve the funding problem and doesn’t help those who are most vulnerable.

The rebates offered by private health insurance companies don’t assist those who cannot afford dental care. skynesher/Getty Image

Time for universal dental care

The majority of submissions to the Senate inquiry endorsed major reforms to expand dental coverage, as reviews previous Royal Commissions and a Grattan Institute 2019 report had recommended.

It will cost you a lot to get there.

The May budget kicked the can down the road by extending the current inadequate funding for public dental services for another year. That funding will now stop in mid-2025, the same time that federal and state governments need to agree on a new National Health Reform Agreement – the biggest financial health deal in Australia.

In less than two years, with the uncertainty surrounding national health funding, it is possible to develop a plan for expanding dental coverage.

The key to a fair and efficient system is phasing.

Australia hasn’t built a universal health care system in decades. More than just increasing funding is needed. Governments should instead seize this historic opportunity to avoid problems that have been encountered in other universal coverage schemes.

First, the coverage for dental care should be increased gradually. The Senate committee suggested that a universal plan be phased in, as well as establishing a Seniors Dental Benefit Scheme and expanding the Child Dental Benefits Schedule over time to cover all children.

As Australia develops a universal program, these initial steps will allow the workforce, providers, and government funding to grow to provide care to more people.

Second, policies must ensure that care is provided where it’s most needed. It is important to have more dentists available in rural and disadvantaged areas.

Some remote areas do not have dentists. 

Some sites, even with increased funding and wider coverage, will still struggle to attract dental professionals, especially where few people can afford the fees and where clinics must be built from scratch.

The committee recommended incentives for rural providers, new dental programs in regional universities, and expanding rural medical student scholarships to dentistry and oral health. It also suggested better pay for dentists at public dental clinics.

The care provided must be effective and efficient, especially given the high costs that are involved. The committee provided some suggestions on how to maximize value for money. The committee said that the universal scheme would fund only essential dental care. This would exclude cosmetic dentistry, for example. It wants to change funding and regulations so that oral health therapists are able to do more.

Governments and the public should also be able to see where the billions of dollars of new investment are going and the difference it is making.

Public and private clinics that participate should keep track of the treatments provided, patient satisfaction, waiting times, and results. Clinics should also commit to using data and evidence-based guidelines to improve their care continuously.

The demand for dental care has increased, but successive governments have cut back on the cost. These savings, however, are false economies that cause unnecessary disease and entrench inequality. The proposal today for health reform should be the final one – now is the time to close this gap.

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