A wrap on the dental health reform package – an overview, analysis & some reaction
This post provides:
• A summary of the Federal Government’s dental reform package
• Analysis of the package and some of the questions yet to be answered about it – from Amanda Biggs of the Commonwealth Parliamentary Library’s FlagPost blog
• Some initial reaction to the announcement.
What does the package cover?
The Federal Health Minister Tanya Plibersek has announced a six-year, $4 billion dental reform package that is targeted at low and middle income people and includes:
• $2.7 billion for around 3.4 million Australian children who will be eligible for subsidised dental care. Children from the aged two to 17 in Family Tax Benefit Part A-eligible families will be entitled to subsidised basic dental treatment, capped at $1,000 per child over a two-year period. Legislation will be introduced this sitting session.
• $1.3 billion for around 1.4 million additional services for adults on low incomes, including pensioners and concession card holders, and those with special needs; who will have better access to dental care in the public system. This money will go to states and territories under a National Partnership Agreement to expand public dental services for low income adults. This funding will depend on the states and territories at least maintaining their current level of dental care services.
• $225 million for dental capital and workforce will be provided to support expanded services for people living in outer metropolitan, regional, rural and remote areas.
The Dental Health Reform package will replace the Medicare Teen Dental Plan and the Chronic Disease Dental Scheme (CDDS), which the Government says “was poorly targeted, saw significant waste and over-servicing and failed to address the capacity constraints in existing public dental services”.
Analysis: The announcement will be welcomed, but also raises some longer-term questions
In the article below, Amanda Biggs from the Commonwealth Parliamentary Library’s FlagPost blog outlines some of the questions surrounding the package and notes that it “continues a trend of moving away from the universal principle that underpins Medicare”.
Amanda Biggs writes:
Today the Health Minister, Tanya Plibersek, announced a new dental package worth $4 billion over six years. The government will provide Medicare funded dental services to children and an expanded public dental service for low-income adults and those in rural and regional areas, as well as an additional investment in dental infrastructure and workforce.
From January 2014, children aged 2 to 17 will be entitled to up to $1000 for ‘basic’ dental work over a 2 year period from a dentist of their choice on presentation of their Medicare card. Services funded will reportedly include a dental check-up, scale and clean, fissure sealants, and basic restorative work including fillings, but not more complex work such as orthodontics or crowns. The government estimates some 3.4 million children will be eligible.
The new child entitlement, costing $2.7 billion, will replace the Teen Dental Scheme (which subsidises an annual check-up for teenagers) and will be similarly targeted to families eligible for Family Tax Benefit A and other welfare entitlements.
From July 2014, an additional $1.3 billion will be directed towards state-run public dental programs to deliver services to those on low incomes and in outer metropolitan, rural and regional areas. States will be required to maintain their existing level of dental funding. Some $225 million will also be invested in infrastructure and dental workforce. This is in addition to the $515 million in extra funding announced in the last budget.
In order to fund the program, savings will be drawn from other areas of government expenditure. The controversial Chronic Disease Dental Scheme (CDDS)—targeted to those with chronic conditions and having cost more than $2.3 billion—will cease from 30 November 2012.
There will be a lag time between the closure of the CDDS and the commencement of the children’s entitlement and the expanded funding for public dental care.
Closure of CDDS will not require legislation but will require an administrative order which can be disallowed by the Parliament.
The Health Minister indicated at her press conference that savings from the closure of the CDDS would not count towards funding the new scheme, as its closure has been factored already into the forward estimates.
The Greens, who have previously opposed the closure of the CDDS, broadly support the new dental package including the closure of the CDDS. This means the government has secured the Parliamentary support it needs to close the CDDS, which it has long sought to close, following cost overruns, allegations of over-servicing and rorting, and administrative problems (as detailed in this previous Flagpost).
The Health Minister described the scheme today as a ‘bedrock’ scheme, which can be built on and expanded in the future. Full funding details will be released in the Mid-Year Economic and FiscaOutlook.
Legislation to establish the new entitlement scheme will be introduced in the next sitting period.
A number of issues were not fully addressed in today’s announcement.
These include what happens to those patients with chronic conditions with the closure of the CDDS, who may not be eligible for the expanded public dental services. Agreement with the states and territories over who and what will be funded through their public dental services must also be reached.
Under the new child entitlement scheme families may also face some out of pocket costs where the dentist charges a higher fee than is rebatable through Medicare. Whether private health insurance will be able to help fund this gap remains unclear. Another key issue will be ensuring the cooperation of dentists to keep their fees reasonable, given many were dissatisfied with how the government dealt with the administrative problems they encountered when providing services through the CDDS (and which were detailed to this Senate committee).
The capacity of the existing dental workforce to meet demand once the programs commence is also unclear. Although some funding has been provided to address workforce issues, and recent budgets have also increased funding for the dental workforce, there remain problems with the distribution of dentists. The majority continue to practice in urban areas, meaning that families in rural, regional and outer metropolitan areas may find it more difficult to redeem the entitlement or face higher out of pocket costs, compared to families in metropolitan areas, where dentists are more plentiful.
The Health Minister was also unable to detail where the money to fund the new scheme would be drawn from. Given the government remains committed to a small budget surplus it is likely to have to rely on savings from other government programs, unless there is an improvement in government revenues.
Finally, while many will applaud the additional investment in a long-overlooked area of Australian health, others may be concerned this new package continues a trend of moving away from the universal principle that underpins Medicare.
Public support for Medicare which remains funded through general taxation and a Medicare levy relies at least in part on its universal eligibility entitlement. Eroding this entitlement significantly over time could risk ongoing support.
• This article is cross-posted from the FlagPost blog.
Some of the reaction
For too long teeth have been left out of the health system, with over 650,000 Australians spending far too long on public dental waiting lists and access to dental care dependent on income levels.
“Today’s announcement is a game changer,” according to Carol Bennett, CEO of the Consumers Health Forum of Australia (CHF), the peak national body representing consumers in health care.
Ms Bennett was responding to today’s joint announcement by Health Minister Tanya Plibersek and Greens Senator Richard Di Natale of a record $4.1 billion in new dental care initiatives from the Federal Government.
Ms Bennett congratulated Minister Plibersek and Senator Di Natale for taking a strong stand for preventative and maintenance oral care in the community, and making a once in a decade commitment to dental care.
“Cost is the big barrier preventing a large section of the community from accessing preventative dental services, which in turn contributes to development of chronic conditions that place major demands on our health resources,” Ms Bennett said.
“By driving change through prevention in younger generations, there is increased likelihood that a whole generation will not need emergency treatment or hospital admission for chronic and preventable disease.
“By addressing the dental needs of seniors and pensioners before they develop other chronic conditions, it frees health resources for other areas of high need.
“This is a big win for the whole community. If you improve the health of those who can’t afford a decent standard of dental care, you raise the general health of the entire community.
The package of measures includes:
- Replacing the Chronic Disease Dental Scheme with entitlement based scheme for kids aged 2 – 17 including a full range of treatments from checkups to extractions
- Age and disability pensioners gaining an additional funding for public dental services
- Flexible grants to improve public and private dental facilities and services.
“CHF calls on the State and Territory governments to fully support this unique opportunity to improve health outcomes for vulnerable members of the community; and to partner with the Federal Government in the best interests of consumers.
“Today we have an opportunity to change not only the future of some of our most vulnerable people, but the habits of an entire generation for the better.
“CHF looks forward to working with the government on delivering this massive opportunity.”
ACOSS is all smiles, and hoping the states and territories are up to the task
ACOSS has applauded today’s dental announcement by the Federal Government and welcomed its dual focus on children and on those adults most disadvantaged in access to appropriate dental care.
“Today’s announcement secures adequate dental care for two-thirds of the children in Australia, many of whom would go without regular dental care otherwise. We are delighted the Government has recognised how crucial it is to establish and maintain good oral health from childhood by establishing an entitlement to access adequate and timely care,” said ACOSS CEO, Dr Cassandra Goldie.
ACOSS also welcomes the commitment to meet the oral health needs of adults experiencing poverty and inequality who have gone without dental care for too long. “By ensuring affordable appropriate and timely dental care for people on the aged or disability pension and all those with a health care card, this reform establishes the policies and funding mechanisms to reduce a major area of health inequality in Australia,” Dr Goldie said.
“Many people on low incomes have been forced to rely on an over-stretched and under-resourced public dental system and have suffered terrible pain and deteriorating oral health as a result. This agreement will ensure that not only are public dental waiting lists addressed, but people on low incomes are able to access the routine and preventive treatment that everyone needs to ensure healthy mouths and lives.”
Deputy CEO Dr Tessa Boyd-Caine, who was a member of the National Advisory Council on Dental Health stated, “ACOSS has long-championed the importance of a national approach to dental care that recognises how critical good oral health is, not just for general health but for social and economic participation.
“We hear often from people too embarrassed to go to job interviews or engage with their communities because of their teeth. That’s why we have been calling for many years for access to a basic course of treatment every two years as a minimum standard of oral health for everyone in Australia. This reform will be foundational in improving the oral health of the population through a significant entitlement to children, without leaving behind those adults who for too long have missed out on adequate dental care.
“We cannot improve our nation’s oral health without addressing the distribution of the oral health and allied workforce, including dentists, dental therapists and dental hygienists and health therapists. Equally important is national leadership of sustained investments in oral health promotion. Today’s announcement establishes a policy framework and sustained funding to address both.
“We will also see that the excellent work already being done in some states and territories through child and public dental systems will be sustained across Australia. The recognition of an entitlement to good dental care is a major breakthrough for those millions of Australians, some 40%, who have been going without adequate, appropriate and timely dental care.
“But no amount of federal funding can address Australia’s gaping oral health gaps without state and territory governments maintaining, and in some cases improving their investment in oral. We call on all governments to work together to ensure Australia at last can build a national oral health system,” Dr Boyd-Caine concluded.
A tick from the Public Health Association of Australia
The Public Health Association of Australia (PHAA) has welcomed the Australian Government’s decision to invest $4 billion over 6 years on dental health care for children, disadvantaged adults and those in rural, regional and remote areas.
“PHAA welcomes this initiative, particularly its emphasis on improving the oral health of children, adults on low incomes and the focus on service delivery in rural, regional and remote areas. It’s represents a $4 billion investment in the future health of kids and redressing existing inequities in service delivery across the country,” said Melanie Walker, Acting Chief Executive Officer of the PHAA.
“Children aged 2-17 in families who are eligible for Family Tax Benefit Part A will be able to access $1,000 worth of subsidised dental treatment each over a two-year period. This will have significant flow-on effects in terms of future savings for the health system, by helping to prevent dental and related health problems. The additional expenditure on public health services for disadvantaged adults will mean that services will now be accessible to a million people who have been unable to access basic dental services. Expenditure on capital and workforce measures in rural, regional and remote areas will also go a long way to redressing the inequities in service provision for people living in the bush.
“Scrapping the Chronic Diseases Dental Scheme, which wasn’t means-tested and enabled access to non-core services, will help to pay for this new initiative that is more targetted and better positioned to redress the considerable inequality in oral health in Australia.
“It will be important to ensure that implementation of the initiative allows for family-based care. A complementary emphasis on preventive care for adults is also important – while addressing access to dental services is fundamental for oral health, the other part of the equation is to prevent oral diseases from occurring in the first place. Prevention opportunities include the extension of water fluoridation, good oral health policy in key settings such as schools and nursing homes, and action to allow the healthy eating choices to be the easier choices.
“PHAA looks forward to participating in the development of the Australian Oral Health Promotion plan that was foreshadowed in the May Federal Budget,” said Ms Walker.
On Twitter, you can see some reaction at #dental4kids (although I wonder how much of this is being generated via Government channels given the specific hashtag that was quickly launched).
In this clip below (as much a plug for the Greens as for the package), Senator Richard di Natale describes the announcement as the most important health reform since Medicare.
Meanwhile, ACT Labor is reportedly promising extra cash for schools that phase out sugary drinks if it is re-elected to government in October.
• See previous posts at Croakey on to dental reform