Final Report of The NACDH - 26 February 2012 (PUBLICATION)

Report
ofthe

NationalAdvisoryCouncil
onDentalHealth

23February2012

TheHonTanyaPlibersekMP
MinisterforHealth
DearMinister
Itismypleasure,onbehalfoftheCouncil,toprovidetoyoutheReport.
SincetheestablishmentoftheCouncilon5September2011,myfellowCouncil
membersandIhaveundertakenextensivework,inlinewithourTermsof
Reference,todevelopouradvicetotheAustralianGovernment.
TheCouncilsworkincludedconsultationwithdentalpeakbodies,consumergroups
andIndigenousorganisations.Iwouldliketoacknowledgeallthosewho
contributedtheirtimeandefforttoourwork.
TheCouncilhasgivencarefulconsiderationtotheissuesfacingAustraliansin
accessingappropriateandtimelydentalcareandhasdevelopedoptionstoimprove
dentalhealth.SinceprovidingtheInterimReport,theCouncilhasfurtherdeveloped
theoptionsandindicativecostings.
Asagoodoralhealthfoundationinchildhoodisthekeydeterminantoforalhealth
throughoutlife,theCouncilcommendstheimportanceofauniversaloptionfor
children.However,giventheexistingfiscalenvironment,theCouncilhasincluded
scaleddownoptionsforchildren,andadultoptionsthatarefocusedmainlyonthe
mosteconomicallydisadvantaged.
TheCouncilagreesthatthelongtermgoalfordentalhealthinAustraliashouldbea
systemthatallowsuniversalaccesstodentalcare.However,anyofthefouroptions
inthereportwillentailpreparatoryworkinvolvinglegislationand,mostlikely,COAG
consideration.Therefore,theCouncilhasprovided,asafirststep,forerunner
measuresthatcouldbeimplementedwhilepreparatoryworkisbeingadvanced.
Foundationalactivities,suchasinvestmentsinoralhealthpromotion,infrastructure,
andworkforce,areintegraltoalloptions,andwithoutadvancementonallofthese
activitiesthepolicyobjectivesoftheservicedeliveryoptionscannotbemet.
TheCounciltruststhattheReportwillassisttheAustralianGovernments
considerationofdentalhealthofAustralians.
Yourssincerely

MaryMurnanePSM
Chair,NationalAdvisoryCouncilonDentalHealth
23February2012
NationalAdvisoryCouncilonDentalHealth i

Membershipofthe
NationalAdvisoryCouncilonDentalHealth

MsMaryMurnane Chair
ProfessorJohnSpencer DeputyChair,EmeritusProfessor,Universityof
Adelaide
MsJulieBarker President,AustralianDentalandOralHealth
Therapists'Association
DrTessaBoydCaine DeputyChiefExecutiveOfficer,AustralianCouncilof
SocialService
ProfessorJohanndeVries Dean,SchoolofDentistry,UniversityofAdelaide
DrMartinDooland ExecutiveDirector,StatewideServices,SouthAustralia
DrShaneFryer President,AustralianDentalAssociation
MrAdamLongshaw HeadofBusinessRiskandWellnessServices,BUPA
Australia
DrJennyMay ImmediatePastChair,NationalRuralHealthAlliance
MrTonyMcBride ChairoftheAustralianHealthCareReformAlliance
MsPruePower ExecutiveDirector,AustralianHealthcareandHospitals
Association
ProfessorHalSwerissen ExecutiveDean,HealthSciences,LaTrobeUniversity
NationalAdvisoryCouncilonDentalHealth ii
Acknowledgements

TheNationalAdvisoryCouncilonDentalHealthwishestoacknowledgethe
assistanceoftheDepartmentofHealthandAgeingandthefollowingpeopleand
organisationsfortheircontributiontothedevelopmentofthisreport:
MsLorettaBettiens AustralianCapitalTerritoryDentalServices
DrChristineBennett Dean,SchoolofMedicine,Sydney
Prof.WernerBischof TheRoyalAustralasianCollegeofDentalSurgeons
MsEmmaBridge Manager,BusinessandServiceDevelopment,
OralHealthServicesTasmania
DrRobertBroadbent ChiefExecutiveOfficer,AustralianDentalCouncil
Prof.ChrisBrook ExecutiveDirector,VictorianDepartmentofHealth
Assoc.Prof.AngusCameron TheNewSouthWalesMinisterialTaskforceon
DentalHealth
DrKerryChant ChiefHealthOfficerforNewSouthWalesandDeputy
DirectorGeneral,PopulationHealth,NSWHealth
MsHellenChecker President,NationalPresident,DentalHygienists
AssociationofAustralia
DrDeborahCole ChiefExecutiveOfficer,DentalHealthServicesVictoria
DrBillCowie PrincipalAnalyst(Workforce),CentreforOralHealth
Strategy
MsRoslynElms WesternAustraliaDepartmentofHealth
DrMatthewFisher TheNewSouthWalesMinisterialTaskforceon
DentalHealth
MsSolangeFrost TheNewSouthWalesMinisterialTaskforceon
DentalHealth
DrMartinGlick Director,DentalHealthServices,WesternAustralia
DepartmentofHealth
MrJohnGrapsas WesternAustraliaDentalServices
MrDavidGriffiths DentalHealthProgram,AustralianCapitalTerritory
Health
Assoc.Prof.DianaO'Halloran NonExecutiveDirectorandChairoftheBoardof
Wentwest,MedicareLocal,WesternSydney,NewSouth
Wales
DrChrisHandbury NorthernTerritoryDentalServices
DrGlenHughes Dentist,CasinoAboriginalMedicalService,NewSouth
Wales
MsCatherineJames VictorianDentalService
DrLisaJamieson AustralianResearchCentreforPopulationOralHealth
MsSueKearney NationalOralHealthPromotionSteeringGroup,
DentalHealthServicesVictoria
DrJosephineKenny ActingNetworkDirector,OralHealthNetwork
DrGrahamKey AustralianDentalProsthetistsandDentalTechnicians
EducationalAdvisoryCouncil
MrGarryLaw ProjectOfficer,CentreforOralHealthStrategy
NationalAdvisoryCouncilonDentalHealth iii
DrJohnLockwood Chair,DentalBoardofAustralia
MrAndrewMcAuliffe ProgramDirector,OralHealth,NorthernTerritory
DepartmentofHealthandFamilies
DrSandraMeihubers DentistandIndependentDentalHealthConsultant
MsChristineMorris NationalOralHealthPromotionSteeringGroup,
SouthAustralianDentalService
MrStephenMurby Chair,ConsumersHealthForumofAustralia
MrJamieNewman TheNewSouthWalesMinisterialTaskforceon
DentalHealth
MsAnnePakPoy GeneralManager,AdelaideDentalHospital
Prof.ChrisPeck TheNewSouthWalesMinisterialTaskforceon
DentalHealth
Prof.KayeRobertsThomson DirectorofAustralianResearchCentreforPopulation
OralHealth,DirectoroftheDentalPracticeEducation
ResearchUnit
DrJohnRogan NationalPresident,AustralianDentalProsthetists
Association
DrKatherineO'Donoghue President,IndigenousDentistsAssociationofAustralia
Scarce andRepresentativefortheNationalCongressof
AustraliasFirstPeoples
Assoc.Prof.MarkSchifter
DrRhysThomas ChiefDentalOfficer,QueenslandDentalServices
MsTanyaVogt ExecutiveOfficer,DentalBoardofAustralia
MsOliviaWood ChiefExecutiveOfficer,Wentwest,MedicareLocal,
WesternSydney,NewSouthWales
DrCliveWright ChiefDentalOfficer,CentreforOralHealthStrategy
NewSouthWales,NSWHealth
Assoc.Prof.HansZoellner HeadofOralPathologyattheUniversityofSydney
TheNationalAboriginalCommunityControlledHealthOrganisation
TheNewSouthWalesMinisterialTaskforceonDentalHealth
StaffatMarionGPPlusClinic
StaffatSydneyDentalHospital
StaffatWentwest,MedicareLocal,WesternSydney
StaffinAcuteCareDivision,DepartmentofHealthandAgeing
StaffinAgeingandAgedCareDivision,DepartmentofHealthandAgeing
StaffinOfficeofAboriginalandTorresStraitIslanderHealth,DepartmentofHealth
andAgeing
StaffinPrivateHealthInsuranceBranch,MedicalBenefitsDivision,Departmentof
HealthandAgeing
StaffinHealthWorkforceDivision,DepartmentofHealthandAgeing
NationalAdvisoryCouncilonDentalHealth iv
TableofContents
ExecutiveSummary
StructureoftheReport .................................................................................................1
TheFindingsoftheCouncil...........................................................................................2
Summaryoftheoptionsfordentalservicesforchildren..............................................3
Option1Anindividualcappedbenefitentitlement.............................................3
Option2Enhancedaccesstopublicdentalservices...........................................4
Summaryoftheoptionsfordentalservicesforadults .................................................4
Option3Ameanstestedcappedbenefitentitlement .......................................4
Option4Enhancedaccesstopublicdentalservices ...........................................4
Anintegratedmodelforcardholderadultsandallchildren ........................................5
Foundationalactivities...................................................................................................5
Dentalworkforceandinfrastructure .....................................................................5
Dataandresearch..................................................................................................6
Oralhealthpromotion ...........................................................................................6
Groupswithspecialoralhealthneeds ...................................................................6
ChapterOneScopingtheProblem
Introduction...................................................................................................................7
WhatisOralHealth? .....................................................................................................7
OralHealthandVisitingPatternsofAustralianAdults ...............................................7
Adultoralhealthindicators ...........................................................................................7
Toothloss ...............................................................................................................8
Inadequatedentition .............................................................................................8
Periodontitis ...........................................................................................................8
Dentalcaries ..........................................................................................................8
Adultvisitingpatterns....................................................................................................9
OralHealthandVisitingPatternsofAustralianChildren ..........................................12
Childoralhealthindicators..........................................................................................12
Toothloss .............................................................................................................12
Deciduous(baby)toothdecay ...........................................................................13
Permanenttoothdecay .......................................................................................13
Childvisitingpatterns ..................................................................................................13
OutcomesandImpactofOralDisease .......................................................................14
ImpactsonIndividuals ................................................................................................14
Healthandwellbeing ...................................................................................................15
Financial .......................................................................................................................15
Children........................................................................................................................16
Waitinglists..................................................................................................................16
BroaderImpactsontheHealthSystem......................................................................16
Hospitalisations............................................................................................................16
Outpatientclinics .........................................................................................................17
Medicalservices...........................................................................................................18
CosttoGovernmentandSociety ................................................................................18
Hospitals.......................................................................................................................19
Outpatientclinics .........................................................................................................19
NationalAdvisoryCouncilonDentalHealth v
MedicalpractitionersMedicareandPharmaceuticalBenefitsSchemesubsidies ...19
Productivity ..................................................................................................................20
Conclusion ...................................................................................................................20
ChapterTwoTheDentalSystem
Introduction.................................................................................................................21
TheDentalSystem.......................................................................................................21
Publicservices ..............................................................................................................21
Privateservices ............................................................................................................21
Expenditureondentalservices....................................................................................22
OverlapofCommonwealthandStateandTerritoryGovernmentResponsibilities
andServices.................................................................................................................23
Governmentauthorityfordentalhealthprovision .....................................................23
Whocurrentlytakesresponsibilityfordentalserviceprovision? ...............................24
StateandTerritoryGovernments ........................................................................24
CommonwealthGovernment...............................................................................24
Individualsandprivatehealthinsurance .............................................................25
OverlapandduplicationCommonwealthandstates ...............................................26
Lackofharmonisationacrossthestates......................................................................27
Children ................................................................................................................27
Adults ...................................................................................................................28
Dentalworkforcecharacteristics .................................................................................28
Gender..................................................................................................................29
Age .......................................................................................................................29
Internationallyborndentists................................................................................30
Hoursworked .......................................................................................................30
Indigenousdentalworkforce ...............................................................................30
Workforcedistribution ................................................................................................30
Privateandpublicemployment ...........................................................................30
Geographiclocation .............................................................................................31
Regulationofthedentalprofession ............................................................................32
Registrationprocess.............................................................................................33
Demandandsupply .....................................................................................................35
Domesticsupplyofdentists .................................................................................36
Internationalsupplyofdentists ...........................................................................36
Projectedworkforceto2020................................................................................37
Factorsaffectingworkforcesupply..............................................................................38
Educationandtraining.........................................................................................38
Dentalacademicsinuniversitiesandcomplementaryworkforces......................39
Workforcedemographics.....................................................................................39
Registrationandaccreditationcontrols...............................................................39
Infrastructureandcapital ....................................................................................40
Publicsectorissues...............................................................................................40
Governmentmeasurestoaffectworkforcesupply..............................................40
Conclusion ...................................................................................................................41
NationalAdvisoryCouncilonDentalHealth vi
ChapterThreeWhoMissesOut?
Introduction.................................................................................................................43
Adults...........................................................................................................................43
Concessioncardholders ..............................................................................................43
Ruralandregionalresidents ........................................................................................44
IndigenousAustralians.................................................................................................44
Frailandolderpeopleinthecommunityandinresidentialcare................................44
Lowincomeworkers ....................................................................................................44
Homelessness...............................................................................................................45
Children........................................................................................................................45
Concessioncardholders ..............................................................................................45
Ruralandregionalresidents ........................................................................................45
Indigenouschildren......................................................................................................46
Childrenoflowincomeearners...................................................................................46
Conclusion ...................................................................................................................47
ChapterFourCausesofPoorOralHealth
Introduction.................................................................................................................49
Access...........................................................................................................................49
Affordabilityofprivatecareadults............................................................................49
Accessinthepublicsectorlackoffundingandwaitingtimesforadults.................50
Lowincomeearners.....................................................................................................50
Access(AvailabilityofServices)..................................................................................51
Behaviour .....................................................................................................................51
Dietandbehaviour ......................................................................................................52
Fearofthedentist........................................................................................................52
Children........................................................................................................................52
Access...........................................................................................................................52
Parentaleducationandawarenessfearofdentistandlackoforalhealtheducation
......................................................................................................................................53
Conclusion ...................................................................................................................53
ChapterFiveLongTermAspirations
Goal..............................................................................................................................55
CouncilDiscussionsonUniversalDentalCare ...........................................................55
AspirationOne.............................................................................................................56
AspirationTwo ............................................................................................................57
AspirationThree..........................................................................................................58
AspirationFour............................................................................................................59
AspirationFive.............................................................................................................59
AspirationSix...............................................................................................................61
AspirationSeven .........................................................................................................62
AspirationEight ...........................................................................................................63
ChapterSixOptionsforReform...............................................................................65
NationalAdvisoryCouncilonDentalHealth vii
ChapterSixOptionsforRefrom
Introduction.................................................................................................................65
BasicPreventiveandTreatmentServices...................................................................66
OptionsforChildren....................................................................................................66
Option1Anindividualcappedbenefitentitlement .................................................67
Operation .............................................................................................................67
Timingofimplementation....................................................................................68
Scalability .............................................................................................................68
Comments ............................................................................................................69
Option2Enhancedpublicsectorchilddentalservices.............................................69
Operation .............................................................................................................69
Scalability .............................................................................................................70
Comments ............................................................................................................70
OptionsforLowIncomeAdults ..................................................................................70
Option3Accesstoameanstestedindividualcappedbenefitentitlement.............71
Operation .............................................................................................................71
Scalability .............................................................................................................72
Comments ............................................................................................................72
Option4Enhancedaccesstopublicdentalservices ................................................73
Operation .............................................................................................................73
Scalability .............................................................................................................74
Comments ............................................................................................................74
IntegratedAdultandChildOptions............................................................................75
FutureofGovernmentDentalPrograms....................................................................76
MedicareTeenDentalPlan..........................................................................................76
MedicareChronicDiseaseDentalScheme ..................................................................77
Privatehealthinsurancerebate...................................................................................78
OtherCommonwealthandStatedentalprograms .....................................................78
FoundationalActivities ...............................................................................................78
Possiblemechanismfordeliveringfoundationalactivities .........................................79
Dentalworkforceandinfrastructure ...........................................................................80
Workforceutilisation,supplyandmaldistribution ..............................................80
Coordinationandplanningaroundthedentalworkforce..................................81
Academicandclinicaltrainingandinfrastructure...............................................81
Dataandresearch ........................................................................................................81
Targetinggroupswithspecialoralhealthcareneeds .................................................83
Indigenouspeople ................................................................................................84
Peopleresidinginruralandremoteareas...........................................................84
Frailolderpeopleinthecommunityandresidentialcare ...................................84
Homelesspeople ..................................................................................................85
Peoplewithdisabilities.........................................................................................86
Prisoners...............................................................................................................86
NationalAdvisoryCouncilonDentalHealth viii
Appendicies
AppendixATermsofReference ..............................................................................87
AppendixBPrinciples...............................................................................................89
AppendixCServiceDeliveryOptions ......................................................................91
AppendixDAdultDentalServicesProvidedbytheStatesandTerritories ...........94
AppendixEChildDentalServicesProvidedbytheStatesandTerritories.............97
AppendixFCurrentCommonwealthGovernmentDentalPrograms...................101
AppendixGAListofCentrelinksupportedPensionsandtheirEligibilityfor
ConcessionCards.......................................................................................................103
AppendixHNationalAdvisoryCouncilonDentalHealthConsultationProcess .107
AppendixILetterfromtheMinisterfromHealthandAgeingregardingthe
InterimReport..115
AppendixJProBonoServicesProvidedbyDentalPractitioners.........................116
AppendixKScheduleofDentalServices ...............................................................118
AbbreviationsandAcronyms....................................................................................123
NationalAdvisoryCouncilonDentalHealth ix
ExecutiveSummary
On5September2011,thethenMinisterforHealthandAgeing,theHonNicolaRoxonMP,
andSenatorRichardDiNataleannouncedtheestablishmentoftheNationalAdvisory
CouncilonDentalHealth(theCouncil).SeeAppendixAfortheCouncilsTermsof
Reference.
TheCouncilsdeliberationshavebeeninformedbydiscussionswithkeydentalhealth
bodies,consumergrouprepresentatives,Indigenousorganisationsandotherkey
stakeholders(seeAppendixH).TheCouncilprovidedaninterimreporttotheMinisterfor
HealthandAgeingon30November2011.Thisreportcontainsoptionsandprioritiesfor
considerationinthe201213Budget.
StructureoftheReport
ChapterOnediscussesoralhealthinAustralia,includingthesignificantimprovementsto
oralhealthoverthepastfewdecades.Despitetheseimprovements,toomanyAustralians
havedifficultyaccessingservices.Manyofthesepeoplehavepoororalhealth,sufferfrom
painandsocialexclusionandhavepoorergeneralhealth.Thisextendsbeyondthe
individualtothewidereconomythroughlostproductivityandcoststothehealthsystem.
ChapterTwoprovidesanoverviewofthedentalsysteminAustralia,includingtherolesof
theStateandTerritoryandCommonwealthGovernments.Italsodiscussesthedental
workforce.
ChaptersThreeandFourdescribetheindicatorsofandreasonsforpoororalhealthacross
thepopulation.Theburdenofpoororalhealthisgreatestinlowerincomegroupsandfor
ruralandremoteresidents.Thereasonsforpoororalhealtharecomplex,butstructural
factorsplayamajorrole.Inadentalsystemwhichislargelyprivate,affordabilityremainsa
keybarrier.Otherfactorswhichinfluenceaccessaretheinadequatecapacityandfunding
ofthepublicsectoraswellasworkforcemaldistribution,whichlimitsthesupplyofdental
practitionersinruralandremotelocations.Socialandbehaviouralfactorsalsoinfluence
access.
ChapterFivepresentseightaspirationsfororalhealth(basedonthePrinciplesatAppendix
B),whichtheCouncilbelievesarenecessaryforachievinglongtermimprovementsinoral
health.TheaspirationsformthepathwaytoachievingoptimaloralhealthforAustralians.
Theyrequirecollaborationandacommitmentfromallstakeholderstolongtermreform
andinvestment.Theseaspirationsarealsopartoftheframeworkthatunderpinsshorter
termoptions,ensuringtheyformasolidfoundationforfuturereform.
ChapterSixprovidestheCouncilsadviceonoptionsthattakeintoaccountexisting
Commonwealthandstateandterritoryprograms,aswellashowresponsestooralhealth
couldbephased,orscaled,overtimeandstillremainintegratedwiththelongertermgoal.
However,inthemediumandlongerterm,financingoptionsmayberequired.
NationalAdvisoryCouncilonDentalHealth 1

ExecutiveSummary
TheFindingsoftheCouncil
AllmembersoftheCouncilbelievethatthelongtermgoalshouldbeuniversaland
equitableaccesstodentalcareforallAustralians.Onememberbelievesthatequitable
accesstocareshouldoccurthroughtheprovisionoftargetedschemesaimedatdeliveryof
comprehensivecaretodisadvantagedadultsonpublicwaitinglistsandauniversalscheme
forchildren.
TheCouncilunderstandsthatacomprehensiveresponseforthosefacingaccessbarriersis
potentiallyverycostly.Achievingbetteraccessacrossthepopulationwouldrequirealevel
offundingmanytimesabovecurrentgovernmentexpenditureonoralhealth.
Asafirststepinaddressingthenationsoralhealthneeds,theCouncilhasfocusedon
improvingaccessforchildrenandlowerincomeadults.Childrenareaprioritybecause
improvementstochildoralhealthandpreventionwillreducetheoverallburdenofdisease
andimprovelongtermoralhealthacrossthepopulation.Lowincomeadultsareapriority
becausetheyaremorevulnerabletodentaldiseasetreatingtheirexistingandcomplex
oralhealthproblemswilllayafoundationformoreeffectivelongtermpreventive
measures.Theseprioritygroupscouldbeseparatelytargeted.However,theCouncil
recommendsthattheGovernmentconsidersactiontoaddresstheneedsofboth.
TheCouncilbelievesthatincaseswherefundingislimited,itiscrucialthatmeasuresto
increaseaccesstoservices,wherepossible,useexistingservicemechanismssothatfunds
areusedefficiently.Engagementacrossgovernmentstoclearlydefineresponsibilities
wouldhelppolicyplanningandensurefundingcanbeappropriatelyappliedwithin
respectivefundingframeworksandservicedeliverymodels.Inregardtoprioritygroups,
stateandterritoryexpertiseshouldbeusedasmuchaspossibletomaximisedesired
outcomes.Torecognisethis,alloptionsinteractwiththestateandterritorypublicdental
system.
Tofurtherensurethatservicesaredeliveredefficiently,thefoundationalactivitiesare
proposedtoencouragecoordinationofexistingassetsaswellassupportforsynergies
betweenlocal,stateandnationalorganisations.
TheCouncilhasstructuredoptionssothattheycouldbearticulatedwithinafuture
universalaccesssystem.Furthermore,optionscanbescaledovertime.
TheCouncilagreesthatoralhealthshouldbeseeninthecontextofgeneralhealthandthat
oralhealthreformshouldalsobelinkedtocurrenthealthreforms,suchasthe
establishmentofMedicareLocalsandLocalHospitalNetworks.Incorporatingoralhealth
withinthesereformswillhelptoidentifyservicegaps,improveaccesstoservicesand
integrateoralhealthserviceswithotherprimaryhealthcareservices.
ItistheCouncilsviewthattheessentialdentalservicesshouldincludediagnostic,
preventiveandroutineservices.Thisapproachallowsforafocusonpreventionandearly
intervention.However,somepatientsmayrequiremorecomplexhighendoralcarethatis
ExecutiveSummary
notcategorisedasdiagnostic,preventiveorroutine.Inthesecases,theCouncil
recommendsthatthereshouldbeamechanismwherebypatientscouldaccesscomplex
careitemsinexceptionalcircumstances.Thiscouldbethesubjectoffurtheranalysisinthe
contextofimplementingoptions.
TheCouncilrecognisestheroleprivatehealthinsuranceplaysintheassisting11.9million
Australianswithfinancingofhealthcare,includingdentistry.TheCouncilwasnotableto
considerprivatehealthinsuranceinanydepth.Furtherconsiderationneedstobegivento
theinteractionsbetweentheoptionspursuedandprivatehealthinsurance.Thisincludes
considerationofthepotentialforoverlapinpublicsubsidiesfordentalservicesandprivate
healthinsurance.TheCouncilagreedthatsuchconsiderationcouldextendtofuture
reformsandincentivesforprivatehealthinsuranceaswellasothermethodsoffinancing
dentalservices.
AsummaryoftheCouncilsproposedservicedeliveryoptionsarepresentedbelow,with
furtherdetailsprovidedinChapterSixandatAppendixC.Estimatesofcostshavebeen
developedbytheSecretariatinconsultationwithDrMartinDooland.
ProfessorSpencerexpressedsupportfortheimplementationofoptionstobeadvancedinto
the201213year.Thiswouldallowtheintegrationofthefirststepsforchildrenandshort
termactivitiesforadultsintotherespectiveselectedoption.Itwouldalsohave
consequencesforthecostsfor201213andtheforwardestimates.
Summaryoftheoptionsfordentalservicesforchildren
TheCouncilhasputforwardtwobroadmodelsforauniversalchildrensschemebasedon
currentdentalservicedeliverysystems.Thefirstwouldutiliseanindividualcappedbenefit
entitlementandprovideabasicsuiteofpreventiveandtreatmentservices.Thesecond
wouldexpandservicesandimproveconsistencyacrossstateandterritorypublicdental
services.
TheCouncilbelievesthattheoptionsforchildrenhavebothshortandlongtermbenefits.
Intheshortterm,theywillstrengthentheexistingsystemandmaintainvisitingpatternsfor
themajorityofchildren.Atthesametime,additionalarrangementswillfocusonreaching
childrenwhoarereceivinginadequateservices.Effortsinthisareawillhelpreducemore
seriousdecayandinfection,therebyreducingadmissionstohospitalforremovalofteeth
underanaesthetic.Overthelongterm,theimprovementsintheoralhealthofallchildren
willbuildanexcellentfoundationforimprovementsacrossthepopulation.
Thechildoptionscouldbescaled.Thiscouldstartbytargetingchildrenofconcessioncard
holdersandthenmovingtoothergroupssuchaslowincomenonconcessioncardholders
andthosereceivingothergovernmentpayments.
Option1Anindividualcappedbenefitentitlement
Thisoptionisaimedatincreasingaccesstobasicdentalservicesforallchildrenuptothe
ageof18.Thiscouldbedonebyexpandingexistingservicearrangementsandeligibility
throughtheMedicareTeenDentalProgram(MTDP).Theannualbenefitentitlementcap
wouldbeincreasedtoreflectthecostofaccessingbasicpreventivecareandtreatment.
ExecutiveSummary
Thebenefitcouldbeusedinthepublicorprivatesector(estimatedcostovertheforward
estimatesfrom201213$3.0billion).
Option2Enhancedaccesstopublicdentalservices
Thisoptionisaimedatincreasingaccessforallchildrenuptotheageof18tobasicdental
servicesbyenhancingexistingpublicsectorservices.Servicesforchildrenwouldbe
improvedthroughconsistenteligibilitycriteriaandservicelevelsacrossthestatesand
territories.Programrequirementsandthefundingmodelwouldneedtobedeveloped
throughformaldiscussionsattheintergovernmentallevel(estimatedcostovertheforward
estimatesfrom201213$2.5billion).
Summaryoftheoptionsfordentalservicesforadults
Asafirststeptowardsuniversalaccess,themajorityoftheCouncilbelievesthatthisshould
startwithservicingthoseingreatestneed,namelylowincomeadults.DrShaneFryer
supportedanoptionaimedatdisadvantagedadultsonpublicdentalwaitinglistsand
believedthiswouldbethemosteffectiveindeliveringequitableandcomprehensivedental
care.
TheCouncilconsidersthattherearetwobroadmodelsavailablefortargetingservicesto
lowerincomeadults.Thefirstwouldutiliseanindividualcappedbenefitentitlement,which
couldbuildonexistinglegislativeframeworks,suchastheMedicareChronicDiseaseDental
Scheme(CDDS).Thesecondadultoptionwouldexpandcapacityandimproveconsistency
acrossexistingstateandterritoryservices.Theseoptionsaredesignedasasteppingstone
onapathtoauniversalaccessprogram.
Theseoptionscouldincludeashorttermmeasuretofasttrackservicesforpeopleonpublic
dentalwaitinglists.Thismayrequireadditionalfundingtothestatesandterritorieswhile
anyotheradultoptionsarebeingimplemented.Thiswouldbeaninterimmeasureand
shouldnotimpedetheimplementationofotheradultoptions.
Adultoptionscouldbescaledupovertimetoincludeothereligiblegroups,forexample
chronicdiseasesufferersandlowincomenonconcessioncardholderadults.
Option3Ameanstestedindividualcappedbenefitentitlement
Thisoptionisaimedatincreasingaccesstobasicdentalservicesforallconcessioncard
holderadultswithfundingprovidedthroughacappedbenefitentitlementschemethrough
ascheduleofservices.TheCDDScouldprovidetheservicedeliveryplatform.Amechanism
foraccesstohighendservicesorcapscouldalsobemadeavailableinexceptional
circumstances(estimatedcostovertheforwardestimatesfrom201213$7.1billion).
Thisoptionisaimedatincreasingaccessforconcessioncardholderadultstobasicdental
servicesbyenhancingthepublicsector.Servicesforadultsacrossthepublicdentalsystem
wouldbeimprovedthroughcapacitybuildingandconsistentservicelevels. Program
requirementsandthefundingmodelwouldneedtobedevelopedthroughformal
discussionsattheintergovernmentallevel(estimatedcostovertheforwardestimatesfrom
201213$3.0billion).
ExecutiveSummary
Anintegratedmodelforcardholderadultsandallchildren
TheCouncilalsoconsidersthatimplementingtheadultandchildoptionsatthesametime
wouldimproveservicesacrossallagecohorts.Thepossiblecombinationofoptionsfor
childrenandadultscouldalsodifferentiateCommonwealthandstateresponsibilitiesfor
dentalhealth.Additionally,theywouldhelpensurethateachlevelofgovernment
continuestomaintainitseffortinprovidingorfundingdentalservices.
TheCouncilexaminedeachpossiblecombinationofchildandadultoptions.
Oneexampleofanintegratedapproachdemonstratesapossibledivisionofresponsibilities
betweentheCommonwealthandthestates,andusesexistingsystemsintheshortterm,
expandingitsreachovertime:
Thestatesandterritorieshavealongstandinginvolvementinschooldentalservicesand
coulddevelopthecapacitytocareforallchildren,particularlyfocusedonthosemostin
need.Inthiscombinationofoptions,stateswouldberesponsiblefordeliveringservices
tochildren.Stateswouldalsoundertakeadditionalactivitiestoreachthosechildren
whocurrentlydonothaveaccesstoadequatecare.
TheCommonwealthwouldtakeresponsibilityforconcessioncardholderadultsfor
preventiveandtreatmentservices.ThiscouldbebuiltaroundanalteredCDDS
framework.Eligibleadultswouldaccessservicesinthepublicorprivatesector.Phasing
ofthisoptioncouldprovideshorttermassistancetothe400,000adultsonpublicdental
waitinglists.
Thetotalestimatedcostforthisoptionwouldbeintheorderof$10.1billionoverthe
forwardestimatesfrom201213.Othercombinationsofoptionsandlinesofresponsibility
arepossible.Partofthedentalreformprocesscouldincludediscussionsbetweenstates
andtheCommonwealth(formaldiscussionsattheintergovernmentallevel)on
responsibilityforchildrenandadultsorotheroptions,includingsharedresponsibilityfor
particulargroups.
Foundationalactivities
Allservicedeliveryoptionsrequirefoundationalactivitiesaroundworkforce,capital
infrastructure,oralhealthpromotionandspecialaccessprograms(forpopulationgroups
thatfacebarriers),whicharespecificallydesignedtosupportsuccessfulandsustainable
improvementsinoralhealthforprioritygroupsand,eventually,universalaccess.
Therangeofactivitieswouldrequireanappropriatedeliveryframework.AppendixH
highlightstheworkofaMedicareLocalinSydney,providinganexamplewhichcouldbethe
foundationofafuturedeliveryframework.
Dentalworkforceandinfrastructure
Theterrainofthedentalworkforcehaschangedsignificantlyinrecentyears,withthe
growthinthecombinednumberoforalhealththerapists,dentalhygienistsanddental
therapists(notingthattherearevariationswithintheindividualprofessions).Thishas
providedthecontexttoreexaminepathwaysforcoordinatedanalysisandplanningofthe
futuredentalworkforce.
ExecutiveSummary
TheCouncilrecognisestheimportantworkofalldentalpractitionersworkingtogether
dentists,oralhealththerapists,dentalhygienists,dentaltherapists,dentalprosthetistsand
dentalspecialists.However,workforcefoundationalactivitieswouldalsorequireactionon
workforceutilisation,supplyandinfrastructure,andacademicandclinicaltrainingand
infrastructure.
Dataandresearch
TheCouncilsupportsimprovingtheevidencebaseforworkforceplanningthroughongoing
research.Therecentpublicationofnewdataonpractitionerregistrationshighlightsthe
needforongoingmonitoringofthedentalworkforceandtheperiodicrevisionofdental
workforcesupplyprojections.
Policymaking,programdesignandevaluationneedstobesupportedbysufficientongoing
fundingfordataandresearch.Existingsupportforpopulationlevelmonitoringand
surveillanceoforalhealth,useofdentalservicesandpracticeactivitycouldbemaintained.
TheCouncilbelievesitwouldalsoappropriatefortheGovernmenttofundperiodicresearch
andanalysis.
Oralhealthpromotion
Australiahasaworldclassrecordinhealthpromotion,includingtacklingroadaccidentsand
drinkdriving,smoking,andHIV/AIDS.However,expenditureonoralhealthpromotionand
nonclinicalpreventionactivitiesisverylowestimatedtobearoundonepercentof
expenditure,comparedtoeventhehighlymodesttwopercentofexpenditureacrossthe
wholehealthsystem.Thiscouldbesignificantlyincreasedtoreducetheincidenceofdental
cariesandperiodontaldiseases.ThiswouldbothimprovethequalityoflifeofAustralians
andreducethedemandforfuturedentalcare.
Groupswithspecialoralhealthneeds
TheCouncilsuggestsarangeofactivitiestargetingIndigenouspeople,peopleresidingin
ruralandremoteareas,peopleinresidentialcare,homelesspeopleandpeoplewith
disabilities.MedicareLocalscouldbeparticularlyusefulincoordinatingservicesforthese
groups.
Byundertakingthesefoundationalactivities,workforcemaldistributionbetweenruraland
urbanareas,aswellasthepublicandprivatesectors,couldbereduced.Appropriate
infrastructuremayhelptobotheducatedentalpractitionersfromunderrepresented
groupsandprovideimprovedservicelevelstothepopulation.Improvedresearchcanallow
forgroupswithspecialoralhealthneedstoreceiveappropriatedentalcareandtargeted
oralhealthpromotion.Thesefoundationalactivitiesarecomplementarytoeachotherand
wouldhelptotargetservicesappropriately.
Introduction
Oralhealthisanimportantpartofgeneralhealth,withimplicationsnotonlyforthe
individualbutalsoforthebroaderhealthsystemandeconomy.Oralhealthacrossthe
populationvariesconsiderablybetweensocioeconomicgroupsandbetweenadultsand
children.Accesstoservicesisimportant,withpreventionandearlyinterventionplayinga
keyroleinimprovingoralhealthstatus.Inpartsofthepopulationwhereaccessispoor,the
riskofpoororalhealthoutcomesincreases.Thecosttoindividuals,thehealthsystemand
theeconomycanbesignificant.
WhatisOralHealth?
Informulatingourproposals,weconsideredthecurrentstateoforalhealthinthe
Australianpopulation.Goodoralhealthcanbecharacterisedbyadequatedentitionandthe
absenceofuntreatedtoothdecayorperiodontaldiseaseandanumberofotherless
prevalentoraldiseasesanddisorders.Theimpactofpoororalhealthisvaried, 1 butas
outlinedinAustraliasNationalOralHealthPlan20042013,oralhealthisfundamentalto
overallhealth,wellbeingandqualityoflife.Ahealthymouthenablespeopletoeat,speak
andsocialisewithoutpain,discomfortorembarrassment. 2 Itisforthesereasonsthat
strengtheningoralhealthpromotionandimprovingaccesstodentalcareinAustraliaisso
important.
OralHealthandVisitingPatternsofAustralianAdults
InformationanddataontheoralhealthofAustraliansislargelyavailablethrough
populationhealthsurveydatafromtheAustralianResearchCentreforPopulationOral
Health(ARCPOH)anditsconstituentunit,theAustralianInstituteofHealthandWelfares
DentalStatisticsResearchUnit(AIHWDSRU).Thisreportdiscussestheoralhealthof
Australiansbylookingatadultsandchildrenseparately.Thiswillhelpfocusthe
developmentoflongtermpolicyandshortertermprogramsmoreappropriately,reflecting
thedifferentreasonsforpoororalhealthineachgroupandtheneedtodevelopdifferent
approachestoimproveoutcomes.
Adultoralhealthindicators
Thereareseveralmeasuresofadultoralhealth,includingcompletetoothloss(edentulism),
inadequatedentition,untreateddecayandperiodontaldisease.Thesemeasuresoforal
healthvaryacrossthepopulationdependingonconcessioncardholderstatus(i.e.whether
ornotapersonisaholderofaHealthCareCard(HCC)orPensionerConcessionCard(PCC)
issuedbytheCommonwealthGovernment),Indigenousstatus,educationandage
1
Sanders,A.E.,Slade,G.D.,Lim,S.andReisine,S.T.(2009),ImpactoforaldiseaseonqualityoflifeintheUS
andAustralianpopulations,CommunityDentistryandOralEpidemiology,Vol.37,pp.171181.
2
HealthyMouths,HealthyLives:AustraliasNationalOralHealthPlan200413(2004),Preparedbythe
NationalAdvisoryCommitteeonOralHealth.

(particularlyintermsofthegenerationwithinwhichpeoplewereborn).In2008,only
11percentofadultsratedtheiroralhealthasexcellent. 3
Toothloss
The200406NationalSurveyofAdultOralHealthshowedthat6.4percentoftheAustralian
populationhadlostalloftheirteeth.Forallagescombined,theprevalenceofcomplete
toothlosswas17.1percentforpeopleeligibleforpublicdentalcarecomparedto
2.7percentofthosewhowereineligible.However,therewaslittledifferenceincomplete
toothlossbetweenIndigenousandnonIndigenousAustralians.Improvementsandchanges
indentalpracticehaveseendecliningratesofedentulisminyoungergenerations. 4
Inadequatedentition
Inadequatedentitionisdefinedashavingfewerthan21teeth,becauseoftheimpactthis
hasonfunctionandappearance.FordentateAustralians(havinganynumberofteeth),
11.4percenthadfewerthan21teeth.ThosewithoutformaleducationbeyondYearNine
hadthehighestproportionofinadequatedentition,at34percent.Thenumberofmissing
teethincreaseswithage.Further,peopleeligibleforpublicdentalcarehad1.7timesmore
thenumberofmissingteethcomparedtothosewhowereineligibletoaccesspublicdental
care. 5
Periodontitis
Moderateorsevereperiodontitis(gumdisease)ispresentin22.9percentoftheAustralian
population.Periodontitisisstronglylinkedtoage,witholdergenerationshavingamuch
higherprevalenceofperiodontitisthanyoungerpeople. 6
Dentalcaries
TheprevalenceofuntreateddentaldecayisalsostronglylinkedtoIndigenousstatusand
increasingage. 7 Thereisarelationshipbetweenincomeanddentalcariesprevalence,
althoughtherelationshipisnotstrong(refertoFigure1.1below).Forexample,themean
decayed,missingandfilledteeth(DMFT)ofpeopleinhouseholdswithincomesoflessthan
$20,000perannumwas14.97comparedto13.34inhighincomehouseholdsof$80,000per
annum.However,whatissignificantisthat39.8percentoflowincomehouseholdshad
untreateddecaycomparedto17.3percentofhighincomehouseholds. 8 Thissuggeststhat
differencesinincomemakeadifferencetothetreatmentpathway,ratherthantheinitial
experienceofdecay(refertoFigure1.1below).
3
AustralianInstituteofHealthandWelfare(AIHW)(2010),Selfratedoralhealthofadults,ResearchReport
SeriesNo.51.
4
RobertsThomson,K.andDo,L.,Chapter5OralHealthStatus.InSlade,G.D.,Spencer,A.J.,
RobertsThomson,K.F.(editors)(2007),AustraliasDentalGenerations:TheNationalSurveyofAdultOral
Health200406,AIHWDentalStatisticsandResearchSeriesNo.34,Canberra,pp.8284.
5
ibid,pp.8593.
6
ibid,p.119.
7
ibid,p.105.
8
Spencer,A.J.,OralHealthandDentalServicesinAustralia,PresentationtotheNationalAdvisoryCouncilon
DentalHealth,5October2011.
Figure1.1:IncomelevelsandDMFTanduntreateddecayamongAustralianadults18+
Ageandsexadjusted.
Source:ProfessorJohnSpencer,presentationtoNationalAdvisoryCouncilonDentalHealth,5October2011.
Ithasalsobeenfoundthatpeopleattendingpublicdentalclinicstendedtohavehigher
levelsofdecayaswellasfewerfilledteethcomparedtothoseattendingprivatedentists. 9
Adultvisitingpatterns
Visitingpatternsareagoodindicatoroforalhealthbecausethefrequencyandreasonfor
dentalvisitsindicatesthelikelypathwayfortreatmentorservice.Visitingpatternsalso
provideanindicationoftheriskofpoororalhealth.Visitingpatternscanbedefinedas
favourable,unfavourableorintermediate.Peoplewithfavourablevisitingpatterns
generallyhavegoodoralhealth,visitthesamedentistonceayearandvisitforacheckup
ratherthanaproblem.Peoplewithunfavourablevisitingpatternsdonotusuallyvisitthe
samedentist,donotvisityearly,areoftenseekingtreatmentforaproblemratherthan
visitingforacheckupandtendtohavepooreroralhealth(seeTables1.1to1.3below).
Incomparisontoadultswithfavourablevisitingpatterns,adultswithunfavourablevisiting
patternsarehalfaslikelytoreceivepreventivetreatmentandfourtimesmorelikelyto
receiveextractions. 10 Australianadultsvisitingpatternsshowthat:
39percentofadultshavefavourablevisitingpatterns;
29percentofadultshaveunfavourablevisitingpatterns;and
32percentofadultshaveamixedorintermediatevisitingpattern. 11
9
AustralianResearchCentreforPopulationOralHealth(2009),Cariesexperienceofprivateandpublic
dentalpatients,AustralianDentalJournal,Vol.54,pp.6669.
10
Ellershaw,A.C.andSpencerA.J.(2011),Dentalattendancepatternsandoralhealthstatus,AIHWDental
StatisticsandResearchSeriesNo.57,p.23.
11
Spencer,A.J.andHarfordJ.(2008),ImprovingOralHealthandDentalCareforAustralians.Preparedforthe
NationalHealthandHospitalsReformCommission(NHHRC),p.7.
Table1.1:Treatmentreceivedduringprevious12monthsbypatternofdentalattendance(percent(a))
Dentalattendancepattern
Treatmentreceived Favourable(%) Intermediate(%) Unfavourable(%)
Receivedanextraction 8.9 19.4 32.8
(b)
95%CI (7.8,10.0) (17.3,21.4) (29.0,36.6)
Receivedafilling 38.3 51.7 45.8
95%CI (36.4,40.1) (49.0,54.4) (41.7,49.9)
Receivedaprofessionalcleanandpolish 84.3 59.2 41.0
and/orscaling 95%CI (82.8,85.7) (65.5,61.9) (37.2,44.7)
(a) Ageandsexadjustedvialogitmodel.
(b) ConfidenceInterval.
Source:EllershawA.C.andSpencer,A.J.(2011)Dentalattendancepatternsoralhealthstatus,Australian
InstituteofHealthandWelfare,Canberra(DentalStatisticsResearchSeriesNo.57,p.23).
Whilepoororalhealthispresentacrossallvisitingpatterns,themostsignificantriskofpoor
oralhealthislikelytobeforlowerincomehouseholdswithpoorvisitingpatterns.Thisis
consistentwith200406surveydatawhichlinksvisitingpatternstoadultoralhealth.For
example,9.4percentofadultswithfavourablevisitingpatternshavefewerthan
21naturalteethcomparedto23.3percentofadultswithunfavourablevisitingpatterns
(seeTable1.2).Bothmoderatetosevereperiodontaldiseaseanduntreateddecayarealso
morelikelyinadultswithunfavourablepatternscomparedtoadultswithfavourable
patterns. 12
Table1.2:Oralhealthofdentateadultsbypatternofdentalvisiting
Patternofdental DMFT untreateddecay moderate/severe <21teethdentate
visiting (%) periodontaldisease(%) adults(%)

Unfavourable 13.9 38.4 31.1 23.3

Intermediate 14.4 26.9 29.7 14.5

Favourable 14.1 14.4 21.2 9.4

Ageandsexadjustedestimates.
Source:Spencer,A.J.andHarford,J.(2008)ImprovingOralHealthanddentalCareforAustralians;Prepared
fortheNationalHealthandHospitalsReformCommission,p.26.
Around56percentofhighincomehouseholdshaveafavourablevisitingpatterncompared
to22.1percentoflowerincomehouseholds.Thereisaninverserelationshipwith
unfavourablepatternswithonly16.2percentofhighincomehouseholdswithunfavourable
visitingpatterns,comparedto43.7percentoflowincomehouseholds. 13 However,the
datashowthatunfavourablepatternsarepresentacrossallincomegroups,withsignificant
numbersofpeopleineachoftheincomegroups. 14 Thisisanimportantcaveat,becauseit
12
Spencer,A.J.andHarford,J.(2008),ImprovingOralHealthandDentalCareforAustralians,Preparedforthe
NHHRC,p.26.
13
EllershawA.C.andSpencer,A.J.(2011),Dentalattendancepatternsoralhealthstatus,AIHWDental
StatisticsandResearchSeriesNo.57,p.12.
14
Spencer,A.J.(2011),ImprovingaccesstodentalservicesandoralhealthforAustraliansimplicationsfrom
surveillancedata.PresentationtotheAustraliaDepartmentofHealthandAgeing,29August2011,Canberra.
indicatesthatunfavourablevisitingpatternsandtheriskofpoororalhealthispresent
acrossthepopulationalthoughinunequalproportions(seeTable1.3).
Lowerincomegroupsaremorelikelytoincludeasignificantnumberofprioritygroups,
includingconcessioncardholders,IndigenousAustralians,lowerincomeworkersand
peoplewithmoreseverechronicdiseasesanddisabilities,especiallythosewhoseillnessor
disabilityincludesaccesstohealthconcessioncards.Theseprioritygroupsandtheiroral
healthstatusarediscussedinmoredetailinChapterThree.
Table1.3:Patternofdentalattendance,byannualhouseholdincome(percent(a))
Annualhousehold Patternofdentalattendance
income Favourable(%) Intermediate(%) Unfavourable(%)
Lessthan$20,000 22.1 34.2 43.7
(b)
95%CI (19.1,25.5) (30.3,38.3) (39.7,47.8)
$20,000<$40,000 28.9 34.6 36.5

95%CI (26.8,31.2) (32.2,37.1) (34.1,38.9)
$40,000<$60,000 38.7 33.0 28.2

95%CI (36.1,41.4) (30.6,35.6) (25.5,31.1)

$60,000<$80,000 43.5 31.5 25.0
95%CI (40.3,46.7) (28.5,34.6) (22.2,28.0)

$80,000<$100,000 51.8 27.6 20.6
95%CI (48.5,55.1) (24.6,30.8) (18.0,23.5)

$100,000andover 56.0 27.8 16.2
95%CI (53.0,59.0) (25.2,30.5) (13.9,18.9)
(a) Ageandsexstandardisedviadirectstandardisationmethod.
(b) ConfidenceInterval.
Source:EllershawA.C.andSpencer,A.J.(2011)Dentalattendancepatternsoralhealthstatus,Australian
InstituteofHealthandWelfare,Canberra(DentalStatisticsResearchSeriesNo.57p.12).
Peoplewithprivatehealthinsurancehavemorefavourablevisitingpatternsthanthose
withoutprivatehealthinsurance.Acrossallagegroups,peoplewithprivatehealth
insurancewere1.5timesmorelikelytohavevisitedadentistintheprevious12months.
Seventypercentofpeoplewithprivatehealthinsurancewerelikelytovisitforacheckup
comparedto43.2percentofuninsuredpeople.Somecautionneedstobeappliedin
concludingthatprivatehealthinsuranceisthesolereasonfortheincreasedvisitsbecause
ofcertaindemographicandsocioeconomicfactorsthatinfluenceprivatehealthinsurance
holders.Evenso,studieshaveshownthatinsuredpeoplewhoarealsoeligibleforpublic
dentalcarewillaccessdentalcareatsimilarlevelstoholdersofprivatehealthinsurance
whoarenoteligibleforpublicdentalcare. 15
15
Spencer,A.J.,Sendziuk,P.,Slade,G.andHarford,J.Chapter9InterpretationofFindings.InSlade,G.D.,
Spencer,A.J.,RobertsThomson,K.F.(editors)(2007),AustraliasDentalGenerations:TheNationalSurveyof
AdultOralHealth200406,AIHWDentalStatisticsandResearchSeriesNo.34,p.242.
OralHealthandVisitingPatternsofAustralianChildren
TheoralhealthofAustralianchildrenhasimprovedsignificantlysincethemidlate1970s,
withdentaldiseasereducingsubstantially.Thisismostlikelytheresultofimprovedaccess
tofluoridateddrinkingwater,theuseoffluoridatedtoothpastes,theprovisionofpreventive
oralhealthservicesandtheadoptionofgooddentalhygienepractices. 16
However,sincethelate1990s,theprevalenceofchildcariesandthemeannumberofteeth
affectedbydentaldiseaseinchildrenhasincreased. 17 Themajorityofchildcaries
experienceisconcentratedinaminorityofchildrenwhosufferagreaterburdenofdisease.
Forexample,approximately20percentoffouryearoldsand20percentof15yearolds
haveapproximately90percentofthetotaltoothdecayfortheiragegroup. 18 Recent
studieshavealsorevealedthatthereisaslightsocialgradientintheprevalenceofchild
caries,withthosechildrenintheleastadvantagedareasexperiencingapproximately1.5
timesthenumberofcariesthanchildreninthemostadvantagedareas. 19 However,the
Councildoesnotsupportanoptiontofocusonlyonlowincomechildren.Cariesand
untreatedcariesareevidentacrossallsocioeconomicgroups.Surprisingproportionsof
thosechildrenaffectedarefoundinmiddleanduppersocioeconomicgroups.Auniversal
programisthebestoptionforreachingallchildrenandestablishingafoundationforgood
oralhealththroughoutlife.
Recentchangesintheprevalenceofdentaldiseaseinchildrenmayreflectchangesinschool
dentalprogramsacrossthestatesandterritoriesaswellaschangesindietarybehaviours,
includingreducedconsumptionoffluoridatedwaterandincreasedsugarconsumption. 20
Childrenareeatinglessthantherecommendedamountoffruitandvegetablesandare
consumingmorethantheirrecommendedenergyfromsugars. 21 Poorchildhoodoralhealth
isastrongpredictorofpooradultoralhealth. 22
Childoralhealthindicators
Toothloss
TheAustralianChildDentalHealthSurvey(200304)showedthat,inchildrenofallages,the
averagenumberofmissingteethduetodentaldecaywaslow. 23 However,ingroupswhere
16
AustralianInstituteofHealthandWelfare(2009),APictureofAustraliasChildren2009,p.38.
17
Spencer,A.J.andHarford,J.(2008),ImprovingOralHealthandDentalCareforAustralians.Preparedforthe
NHHRC,p.36.
18
Rogers,J.G.(2011),Evidencebasedoralhealthpromotionresource,PreventionandPopulationHealth
Branch,GovernmentofVictoria,DepartmentofHealth,p.42.
19
Spencer,A.J.andHarford,J.(2008),ImprovingOralHealthanddentalcareforAustralians.Preparedforthe
NHHRC,p.35.
20
21
Rogers,J.G.(2011),Evidencebasedoralhealthpromotionresource,PreventionandPopulationHealth
Branch,GovernmentofVictoria,DepartmentofHealth,p.42.
22
Lucas,N.,Neumann,A.,Kilpatrick,N.andNicholson,J.M.(2011),Stateleveldifferencesintheoralhealthof
Australianpreschoolandearlyprimaryschoolagechildren,AustralianDentalJournal,Vol.56,pp.5662.
23
Armfield,J.M.,Spencer,A.J.andBrennan,D.S.(2009),DentalhealthofAustraliasteenagersandpreteen
children:TheChildDentalHealthSurvey,Australia200304,AIHWDentalStatisticsandResearchSeriesNo.52,
pp.1and16.
dentaldecayisanissue,dentalextractionsandrestorationsarethemostcommoncausefor
hospitalseparations.Thisoutcomeshouldbepreventable.
Deciduous(baby)toothdecay
Dentalcariesinchildrencauseabscessformation,cellulitisandthesystemicspreadof
disease. 24 Italsocausespain,problemswitheatingordrinking,lossofsleepwitheffectson
schoolattendanceandperformance.
TheAustralianChildDentalHealthSurvey(200304)showedthat48.7percentofchildren
aged56yearshaveexperienceddentalcariesintheirdeciduousteethandapproximately
41.3percenthaduntreateddecay. 25 Theprevalence,severityandlevelofuntreateddental
decayforthesechildrenwasfoundtobehigherinareasoflowersocioeconomicstatus.
Permanenttoothdecay
Atapproximatelyfiveyearsofage,childrenstarttolosetheirdeciduousteeth,whichare
thenreplacedbytheirpermanentteeth. 26 By12yearsofage,mostchildrenhaveallof
theirsuccessorpermanentteeth.DatafromtheAustralianChildDentalHealthSurvey
(200304)revealedthat45.1percentof12yearoldshaddecayintheirpermanentteeth
and
24.8percenthaduntreateddentaldecay. 27 Similartothe56yearoldcohort,the
prevalence,severityandlevelofuntreateddentaldecaywashigherinareasoflower
socioeconomicstatus.
Childvisitingpatterns
Aswithadults,visitingpatternsforchildrenareagoodindicatoroftheriskofpoororal
health.Childrenwithfavourablevisitingpatternsaremorelikelytoreceivepreventive
dentalservicesandbenefitfromearlydiagnosisandprompttreatment.Childrenthatfall
intothiscategoryarealsomorelikelytoreportlowlevelsofextractionsandpossiblylow
levelsoffillings, 28 whereaschildrenwithunfavourablevisitingpatterns(whodonotvisita
dentalpractitionerregularlyandvisittotreataproblem)areatahigherriskofexperiencing
oraldisease.
TheNationalDentalTelephoneInterviewSurvey(19942005)showsthatmostchildrenhave
goodvisitingpatterns,usuallyvisitingthedentalpractitioneratleastonceayear,with
prevalencerangingfrom86.8percentto90.4percentfor511yearoldsandaround
80percentfor1217yearolds. 29 Mostchildrenwerealsoreportedasvisitingadental
practitionerforacheckupratherthantotreataproblem.Childrenvisitingadental
24
25
Ha,D.(2011),DentaldecayamongAustralianchildren,AIHWDentalStatisticsandResearchReportSeries,
No.53,p.6.
26
Armfield,J.M.,Spencer,A.J.andBrennan,D.S.(2009),DentalhealthofAustraliasteenagersandpreteen
children:TheChildDentalHealthSurvey,Australia200304,AIHWDentalStatisticsandResearchSeries,No.52,
p.16.
27
Ha,D.(2011),DentaldecayamongAustralianchildren,AIHWDentalStatisticsandResearchReportSeries,
No.53,pp.7and10.
28
Ellershaw,A.C.andSpencer,A.J.(2009),TrendsinaccesstodentalcareamongAustralianchildren,AIHW
DentalStatisticsandResearchSeries,No.51,pp.12and36.
29
Ibid,pp.2730.
practitionerforacheckuprangedfrom84.3percentto91.3percentfor511yearoldsand
from76.0percentto82.9percentfor1217yearolds. 30
However,thedatasuggestthatapproximatelyonefifthofchildrenarenotusuallyvisitinga
dentalpractitioneronceayearandarevisitingadentalpractitionertotreataproblem
ratherthanreceivingregularpreventiveservices.ANationalChildOralHealthSurvey,
currentlyunderway,willprovidemoreuptodateinformationonthevisitingpatternsand
oralhealthofchildren.
Certainchildprioritygroupsareathigherriskofpoorvisitingpatterns,whichplacesthemat
ahigherriskofdevelopingoraldisease.Thesegroupsinclude:
childrenfromlowerincomehouseholds;
dependantsofparentconcessioncardholders;
childconcessioncardholders;
Indigenouschildren;and
homelesschildren.
TheseissuesarediscussedinmoredetailinChapterThree.
OutcomesandImpactofOralDisease
ThestartofthisChapterdefinedoralhealththissectionprovidesdetailsonwhygoodoral
healthisimportant.Oraldiseaseisverycommonanditsimpactonindividualsandsocietyis
significant.Webelievetheseimpactscanbeunderestimatedforboththeindividualandthe
healthsystem.Itisimportanttounderstandthatforthosewhofindaccessdifficult,the
delayindentaltreatmentcanoftenresultinseriousinfectionandpainwithpoororalhealth
outcomes.Beyondtheindividual,thebroadercosttothehealthsystemisalsoaconcern,
withcostsfocusedonthetreatmentofpainandinfection,ratherthanaccesstoadental
practitionerforthetreatmentoftheunderlyingcause.
ImpactsonIndividuals
TheNationalOralHealthPlan200413highlightstheimportanceoforalhealthandthe
impactoforaldisease:
Oralhealthisfundamentaltooverallhealth,wellbeingandqualityoflife.Ahealthy
mouthenablespeopletoeat,speakandsocialisewithoutpain,discomfortor
embarrassment.Theimpactoforaldiseaseonpeopleseverydaylivesissubtleand
pervasive,influencingeating,sleep,workandsocialroles.Theprevalenceand
recurrencesoftheseimpactsconstitutesasilentepidemic. 31
Oraldiseasesanddisorderscreateshorttermandprolongedphysicaldiscomfort.Pain,
infectionandtoothlossarethemostcommonconsequencesoforaldisease,causing
difficultieswithchewing,swallowing,speaking,andcandisruptsleepandproductivity.The
30
ibid,pp.32and34.
31
HealthyMouths,HealthyLives:AustraliasNationalOralHealthPlan200413(2004).Preparedbythe
NationalAdvisoryCommitteeonOralHealth.
NationalSurveyofAdultOralHealth200406indicatesthatoftheAustralianpopulation:
17.4percentavoidfoodsduetodentalproblems;15.1percentexperiencetoothache;and
22.6percentexperienceorofacial(jaw)pain. 32 Dentaldiseasecanalsoleadtodestruction
ofsofttissuesinthemouth,leadingtolastingdisabilityand,inrarecases,death.
Healthandwellbeing
Oralhealthisintegraltogeneralhealth.Toothlossisdirectlyassociatedwithdeteriorating
dietandcompromisednutrition, 33 whichcanimpairgeneralhealthandexacerbateexisting
healthconditions.Further,themouthisoftenanentrypointforinfections,whichmay
spreadtootherpartsofthebody. 34 Internationalresearchindicatesthereareassociations
betweenchronicoralinfectionsandheartandlungdiseases,stroke,lowbirthweightand
prematurebirths.Associationsbetweenperiodontaldiseaseanddiabeteshavealsobeen
notedininternationalliterature. 35
Dentaldiseasenegativelyimpactsgeneralqualityoflife,affectingnotonlyphysical
wellbeingbutalsopsychologicalandsocialwellbeing. 36 TheUSDepartmentofHealthand
HumanServicesnotestheseimpactsinclude:atendencytoavoidsocialcontactasaresult
ofconcernsoverfacialappearance...[and]persistentpainhassimilarisolatingand
depressingeffects.Further:giventheimportanceofthemouthandteethinverbaland
nonverbalcommunication,diseasesthatdisrupttheirfunctionsarelikelytodamageself
imageandaltertheabilitytosustainandbuildsocialrelationships. 37 Dentaldiseasecan
affectthewayapersonlooksandsounds,withasignificantimpactonwellbeingaperson
whoseappearanceandspeechareimpairedbydentaldiseasecanexperienceanxiety,
depression,poorselfesteemandsocialstigmawhichinturnmayinhibitopportunitiesfor
education,employmentandsocialrelationships.
Financial
Thefinancialimpactoforaldiseaseforindividualsincludestheoutofpocketcostsfor
privatecare,estimatedtobe$4.698billionperannumasat200910.Acutedental
32
Harford,J.andSpencerA.J.Chapter7OralHealthPerceptions,InSlade,G.D.,Spencer,A.J.,Roberts
Thomson,K.F.(editors)(2007),AustraliasDentalGenerations:TheNationalSurveyofAdultOralHealth
200406,AIHWDentalStatisticsandResearchSeriesNo.34,pp.173184.
33
Locker,D.(1992),Theburdenoforalhealthinapopulationofolderadults,CommunityDentalHealth,
June;9(2),pp.10924.
34
USDepartmentofHealthandHumanServices(2000),OralhealthinAmerica:Areportofthe
SurgeonGeneral,Rockville,MD:USDepartmentofHealthandHumanServices,NationalInstituteofDental
andCraniofacialResearch,NationalInstitutesofHealth,pp.104109.
35
ibid,pp.109123.
36
TheWorldHealthOrganizationdefinedhealthasthecompletestateofphysical,mental,andsocialwell
beingandnotmerelytheabsenceofinfirmity.Physicalwellbeingassumestheabilitytofunctionnormallyin
activitiessuchasbathing,dressing,eating,andmovingaround.Mentalwellbeingimpliesthatcognitive
facultiesareintactandthatthereisnoburdenoffear,anxiety,stress,depression,orothernegativeemotions.
Socialwellbeingrelatestoonesabilitytoparticipateinsociety,fulfillingrolesasfamilymember,friend,
worker,orcitizenorinotherwaysengagingininteractionswithothers.ibid,p.133
37
ibid,p.137.
conditionsalsocanrestricttheparticipationofadultsintheworkforce,includingrestricted
dutiesandlostworkdaysduetodentalrelatedillness. 38
Children
Childrenfacetheadditionalchallengeofpoororalhealthand/orpoororalhealthhabits
havingfarreachingeffectsintotheiradulthood.Dentalconditionsinchildhoodcanrestrict
childrensparticipationinschoolingandeducationthroughdayslosttoillness.Impaired
physicalappearanceduetodentaldiseasecanfurtherlimitchildrensabilitytosocialise
withconfidenceanddevelopsocialnormsandrelationships.
Waitinglists
ForsomeAustralians,theimpactsofdentaldiseasearemagnifiedandprolongedbecause
theyareunabletoaffordprivatetreatmentandopttogoonpublicsectorwaitinglistsfor
treatment.Thesepeoplemaywaitsignificantperiodsforcare,therebyworseningtheiroral
healthoutcomes.Problemswhichcouldhavebeenfixedrelativelyeasilybecomemore
complexandcostlytotheindividual.Thereareuptoapproximately400,000patientson
publicdentalwaitinglists;afigurewhichhasbeendecreasingsince2004. 39 However,the
waitingtimehasbeenincreasinginSouthAustralia,preschoolchildrenarewaitingan
averageofovertwoyearsforgeneralanaestheticfordentaltreatmentinpublichospitals.
BroaderImpactsontheHealthSystem
Individualswhohavedifficultyaccessingdentalcareseekrelieffrompainandinfection
throughotherservices.Theendresultofdelaysintreatmentcanbeadmissiontohospital
totreatseriousinfections.Thisputspressureonthebroaderhealthsystemthroughdental
treatmentsoughtfromhospitals(publicandprivate),nonadmittedclinics(outpatient
treatment)andgeneralpractitioners(GPs).
Hospitalisations
Althoughcomplicationsfromdentaldiseasearetheoreticallypreventablebyadequate
preventivecareandtreatment,individualsareoftenhospitalisedbecauseofthelackof
adequateandtimelydentalcare.In200910,therewere60,251potentiallypreventable
hospitalisations(PPH)fordentalconditionsalmost9percentofallPPHsandthefourth
mostcommoncauseofPPHbehinddiabetes(24percent),dehydrationandgastroenteritis
(10percent)andchronicobstructivepulmonarydisease(9percent).Table1.4below
refers.
38
USDepartmentofHealthandHumanServices(2000),OralhealthinAmerica:AreportoftheSurgeon
General,Rockville,MD:USDepartmentofHealthandHumanServices,NationalInstituteofDentaland
CraniofacialResearch,NationalInstitutesofHealth,pp.7and147.
39
Giveninconsistentdefinitionsandmeasuresofwaitinglistsnumbersacrossthestatesandterritories,the
estimateof400,000currentlyonpublicdentalwaitinglistsisbasedonthebestavailabledataasgatheredby
thestateandterritorypublicdentalservicesthroughtheNationalDentalDirectorsCommittee.
Table1.4:Separationsforselectedpotentiallypreventablehospitalisations(publicandprivate),bystateor
territoryofusualresidence,200910
NSW Vic Qld WA SA Tas ACT NT Total
Dentalconditions 15,757 16,583 12,592 7,919 5,002 1,105 610 663 60,251
TotalPPH 204,930 171,872 152,025 84,015 53,290 12,982 6,689 9,305 695,560
Source:AIHWAustralianHospitalStatistics200910,TableS7.10
Ofthetotalnumberofhospitalisationsduetodentaldisease,thenumberofadmissionsto
publichospitalshasremainedfairlystableoverthelastdecade,whilethenumberof
admissionstoprivatehospitalshasincreasedoverthepastthreeyears.
Datafrom200910indicatetherewere336,770proceduresperformedinpublicandprivate
hospitalsfordentalservices.Ofthese,morethanhalfwerefororalsurgery,specificallyfor
surgicalremovalofteeth.Figure1.2belowrefers.
Figure1.2:Percentageofdentalproceduresperformedinhospitals,200910
Prosthodontics Other services

Endontics 4%
1%
3%
Diagnostic dental 3%
Preventative dental 11%
Oral Surgery
52%
Resorative dental 26%

Source:AIHWNationalHospitalMorbidityDatabase(AustralianClassificationofHealthInterventions(ACHI)data)
Outpatientclinics
Thosewhoarenotadmittedtohospitalfordentaltreatmentcanbetreatedinpublic
outpatientclinicsinstead.Thenumberofoccasionsofdentalservicefornonadmitted
clinicsin200809was33,672morethandoublethe200607figureof15,698(referto
Figure1.3below).
Figure1.3:Numberofoccasionsofdentalservicesfornonadmitted(outpatient)clinics
No. No.
30,000 30,000
Occasions of service
20,000 20,000
10,000 10,000
0 0
2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09

Source:DoHA,NationalHospitalCostDataCollectionCostReport,Round13(200809)toRound7(200203)
Medicalservices
Whenindividualscannotaccessdentalcare,theymayseekmedicalassistancethrougha
rangeofservices,includinggeneralpractitioners.Estimatessuggesttherewere
approximatelyoverthreequartersofamillionencounterswithgeneralmedical
practitionerslastyearfordentalproblemsandcomplaints.
ThemainreasonsAustraliansvisitGPsfordentalproblemsistoalleviatepainandinfection
dueto:dentalorgumabscess;toothorguminfection;gingivitis;anddentalcariesand
dentalimpaction.ThemostcommontreatmentsprovidedbyGPsinclude:prescriptionsfor
painreliefmedicationandantibiotics;referralstodentists;andadviceondentalhygiene.
PatientsmustalsovisitGPsiftheywishtoobtainachronicdiseasemanagementplanin
ordertoaccesstheCommonwealthGovernmentsMedicareChronicDiseaseDentalScheme
(CDDS).
CosttoGovernmentandSociety
Thedirectcostsofdentaldiseasearethedirectexpenditurebyindividualsandgovernments
ondentalservices.In200910,totalexpenditureondentalservicesinAustraliawas
$7.690billion.ChapterTwodiscussesthesedirectcostsinmoredetail.
Whiletherehasbeensomeattempttoquantifytheindirectcoststogovernmentand
societyofdentaldiseaseonthehealthsystem,thereisalackofconsistentquantitative
analysisandinformation.Robustdataandeconomicanalysisisstillrequiredtoquantify
thesecostsandtheindirectfinancialpressuresthatdentaldiseaseplacesongovernment
andsociety.
Hospitals
Thecostofpublichospitaladmissionsduetodentaldiseasefor200809wasapproximately
$84million.Whileadmissionnumbersremainfairlystableovertime,theaveragecostper
admissionhasincreased,leadingtoanincreaseintotalcosts(refertoFigure1.4below).
Figure1.4:Publicsectorcostsofhospitaladmissionsfordentaldisease(nominal$millions)
$m $m
Total cost
$80 $80
$60 $60
Dental extractions and

resorations
$40 $40
Other oral and
dental disorders
$20 $20
$0 $0
1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09

Note:overtimethecostweightsareupdatedfromARDRGversion4.1to5.2,hencethecomparisons
betweenyearsareindicativeonlyandnotexact.
Source:DepartmentofHealthandAgeingNationalHospitalCostDataCollectionCostReport,PublicSector
EstimateRound4(19992000)toRound13(200809).
Outpatientclinics
Whiletherehasbeenanincreaseinthenumberofdentalservicesfornonadmitted
patients,theaveragecostperoccasionofserviceisquitelowinoutpatientclinics.Thetotal
costfortheseservicesisestimatedtobejustover$10millionin200809.
MedicalpractitionersMedicareandPharmaceuticalBenefitsSchemesubsidies
Asdiscussedabove,patientsoftenaccesstheservicesofmedicalpractitioners,including
prescriptionsforantibioticsandpainkillers,fortreatmentfordentaldisease.Thisimposesa
costtotheCommonwealthGovernmentthroughpaymentsofMedicaresubsidiesforGP
consultationsandPharmaceuticalBenefitsScheme(PBS)subsidiesforcertain
medicationsprescribedbyGPsanddentalpractitioners.
WhiletherehavebeensomeattemptstoquantifythecostofMedicaresubsidiestothe
Governmentestimatesrangewidelyfrom$10millionperannum 40 upto$300millionper
annum 41 therearenoestimatesforthecostofPBSsubsidies.
40
AustralianHealthMinistersAdvisoryCouncilSteeringCommitteeforNationalPlanning
forOralHealth(2001),OralhealthofAustralians:Nationalplanningfororalhealthimprovement:Final
Report,SouthAustralianDepartmentofHumanServices.
Productivity
Dentaldecayalsoimpactsonbroadersocietythroughreducingproductivityand
participationintheworkforce.Someclaimthatthecosttotheeconomycouldbeupto
$2billionperannum. 42 However,thereisnorobustdataoreconomicresearchtoquantify
themagnitudeofthesecostsandfurtheranalysiswouldberequiredtoproperlyassessthe
economicimpactofdentaldiseaseonlostworkdays,workforceparticipationand
productivity.
Conclusion
Overthelastdecades,clinicalpracticeinoralhealth,homecareandfluoridationhasleadto
significantimprovementsinoralhealth. 43 Thisisapositiveoutcomewhichreflectslong
termprogressindentalcareandprevention.Despitetheseimprovements,themajorityof
thepopulationvisitadentalpractitionerlessfrequentlythanmaybeclinicallyappropriate.
Themajorcausesofthisarethelackofaffordableaccesstoprivateservicesforpeopleon
belowaverageincomesandthelackoftimelycareforconcessioncardholdersinthepublic
sectorduetoinadequatefunding.Additionally,someareasofAustraliastilldonothave
fluoridatedwater,therebyincreasingtheriskofpoororalhealth.
Adultvisitingpatternshighlighttwodistinctgroupsinthecommunity.Thefirstisthe
39percentofpeoplewithfavourablevisitingpatternswhoaccessservicesfocusedon
preventionandtheearlytreatmentofproblems.Thisgrouppredominatelyusestheprivate
sectoranarrangementthatworkswell.However,forthemajorityofthepopulation
unabletoaccesstheprivatesector,orwithlongwaitingtimesinthepublicsector,current
arrangementsareinadequate.Forthisgroupvisitsarelessfrequentandfalloutside
acceptedclinicalrecommendations,leadingtogreaterriskofpoororalhealth.
Thisseparationisevidentacrossadultsandchildrenandcanleadtoverydifferentoral
healthoutcomes.Whilechildrensvisitingpatternsarehighacrossthepopulation,recent
increasesincariesinchildrenhighlightstheneedtorefocuseffortstoreducetheprevalence
ofdentaldecay,particularlyintheminorityofchildrenwhosufferthegreatestburdenof
disease.
Poororalhealthhasanimpactonindividualsintermsofoverallhealth,painandsocial
exclusion.Poororalhealthalsohasbroadereconomicimpactsintermsofeconomicloss
andtheimpactonCommonwealthandStateandTerritorygovernmentexpenditurewith
fundsallocatedtothetreatmentofcomplexproblemsinhospitalsandvisitstoGPsand
pharmacistsfortreatmentofpainandinfection.
41
Leeder,S.andRussell,L.(2007),DentalandOralHealthPolicyIssuePaper:PolicyIssuePaper,Menzies
CentreforHealthPolicy,21September2007.
42
ibid.
43
Peterson,P.E.andLennon,M.(2004),Effectiveuseoffluoridesforthepreventionofdentalcariesinthe
21stcentury:theWHOapproach,CommunityDentalOralEpidemiology,Vol32,pp.31921andMcDonagh,
M.S.,Whiting,P.F.,Wilson,P.M.,Sutton,A.J.,Chestnut,I.,Cooper,J.etal.(2000),Systematicreviewofwater
fluoridation.BridgeMedicalJournal,Vol321.pp.8559.
Introduction
ThischapterprovidesanoverviewofthedentalsysteminAustralia,thefunding
components,thelevelsofresponsibilityandtheworkforcethatdeliversdentalservices.
Theseissuesprovideimportantcontexttohelpunderstand,whichpartsofthesystemare
workingwell,whichpartsarenot,whetherfundingimbalancesarecontributingtoproblems
andwhatarrangementsareinplaceforthedentalworkforce,whichisakeycomponentin
deliveringexistingservicesandmeetingfuturedemand.
TheDentalSystem
Publicservices
Dentaltreatmentisprovidedbothinthepublicandtheprivatesector.Statesandterritories
arethecurrentprovidersofmostpublicdentalservices.Foradults,accessislargely
determinedbyeligibilityforconcessioncards(seeAppendixD).Eligibleadultscangenerally
accesspublicdentalservicesfromage18,withtheexceptionofQueenslandwhere
eligibilityisfromabovetheageofcompletionofYear10.Thetypeofconcessioncard
whichallowsaccesstopublicdentalservicesandtheamountof
copaymentvariesfromstatetostate.However,thetypeofservicesavailableisgenerally
similaracrossjurisdictionsandislimitedtoemergencydentalcareandgeneraldental
treatment.Waitingtimesaresignificant,withtheaverageexceedingtwoyearsinsome
statesanduptofiveyearsinsomelocations.
Forchildren,eligibilitycriteria,copaymentsandlevelofclinicalservicesavailablealsovary
acrossthestatesandterritories(seeAppendixE).Therearealsodifferencesinthemodels
ofservicedelivery.Forexample,WesternAustralia,QueenslandandSouthAustraliahave
dedicatedschooldentalprograms.TheNorthernTerritoryusesahybridmodelconsistingof
communitybasedservicesandschooldentalprograms.NewSouthWales,Victoria,
TasmaniaandtheAustralianCapitalTerritoryrelypredominantlyoncommunitybased
clinics.
Inthepublicsector,childrenareseenasamatterofpriorityforemergencyandgeneral
serviceswithnosignificantwaitingperiodsforcare.However,waitingtimesforservices
requiringhospitaladmissioncanbeuptotwoyearse.g.extractionsundergeneral
anaesthetic.
Privateservices
Theprivatesectoroffersservicestoadultsandchildrenandistheonlyplacethat
nonconcessioncardholderadultscanaccessdentalcare.Acomprehensiverangeof
servicesareprovidedintheprivatesector,includingemergencyandgeneraldentalaswell
asmorecomplexandcostlytreatmentssuchasorthodonticandendodonticservices.
Concessioncardholdersalsotendtoaccessprivatedentalcare,withapproximatelytwo
thirdsofcardholdersvisitingprivatedentists.
DatacollectedthroughtheNationalDentalTelephoneInterviewSurveys,whichare
conductedeverythreeyearsbyARCPOH,indicatethatoverhalfofAustralianchildrenare
receivingtheirdentalcareintheprivatesector.Thepercentageofchildrenwhoattendeda
privatedentalpracticefortheirlastdentalserviceincreasedfromapproximately33percent
in1994to53percentin2005for511yearoldsandfluctuatedbetween53percentand
59percentfor1217yearolds. 44
Expenditureondentalservices 45
PublicconsolidatedexpenditureondentalservicesissourcedfromtheAustralianInstitute
ofHealthandWelfare(AIHW).ThemostrecentpublicationinOctober2011relatesto
200910expenditure.In200910,totalexpenditureondentalservicesinAustraliawas
$7.690billion.Ofthis,$4.698billionwasfundedbyindividuals;$1.257billionbythe
CommonwealthGovernment;$1.076billionbyprivatehealthinsurancefunds(whichwould
befundedthroughthepremiumsofmembers);and$628millionbyStateandTerritory
Governments.Overall,individualsdirectlyfundasignificantproportion(61percent)of
totalexpenditure,reflectingthestructuralnatureofthedentalsysteminwhichthevast
majorityofpractisingdentistsandservicesareintheprivatesector.Intermsofpublic
sectorfinancing,theCommonwealthisthedominantfunder,althoughin200708thesplit
betweentheCommonwealthGovernmentandstatesandterritorieswasrelativelyeven
(seeAppendixFformoredetailonCommonwealthGovernmentfundedprograms).
PriortotheoperationoftheCommonwealthDentalHealthProgram(CDHP)in19941996,
statesandterritorieshadprovidedapproximately80percentofgovernmentfundingfor
dentalservices.TheyearsbetweenthecessationoftheCDHPandtheintroductionofthe
PrivateHealthInsuranceRebate(theRebate)on1January1999sawtheoveralllevelof
governmentfundingfordentalservicesmaintained,despitethewithdrawalof
Commonwealthfunds.
TheRebateincreasedtheCommonwealthsshareoffundingfordentalservicesfrom40to
48percent.ThisremainedsteadyuntiltheintroductionoftheCDDSin200708,whichhas
resultedintheCommonwealthsshareofgovernmentfundingofdentalservicesexceeding
thatofthestatesandterritories.In200809,theCommonwealthcontributed61percentof
governmentexpenditureondentalservices.Thisrepresentsareductioninstateand
territoryfundingfrom80percentinthelate1980stoearly1990stoaround40percentin
200809.ThisshiftisduetoasignificantincreaseinCommonwealthfundingstateand
territoryfundinghasconsistentlyincreasedsince200001.
Thechartbelowshowsthesignificantproportionofprivateexpendituredirectedtoward
dentalservicescomparedtogovernmentfunding.Theinclusionofprivatehealthinsurance
islargelyanindirectextensionofprivateexpenditureasitisfundedthroughpremiumspaid
byindividuals.Withthistakenintoaccount,aroundthreequartersofalldentalexpenditure
isfundedbyindividuals.
44
DentalStatisticsandResearchSeries,No.51,p.19.
45
ThemostrecentpublishedconsolidatedexpenditureondentalissourcedfromtheAIHW.Themostrecent
publicationinOctober2011relatesto200910expenditure.
Figure2.1:PercentageofExpenditureonDentalServices,bysource200910
Australian Government
16%
State and local governments

8%
Individuals
62% Health insurance funds
14%
OverlapofCommonwealthandStateandTerritoryGovernment
ResponsibilitiesandServices
Governmentauthorityfordentalhealthprovision
TheCommonwealthGovernmenthaspowerstolegislatefor:Theprovisionof
pharmaceutical,sicknessandhospitalbenefits,medicalanddentalservices(butnotsoasto
authoriseanyformofcivilconscription),underSection51xxiiiAoftheAustralian
Constitution.ThisprovidestheCommonwealthwiththepowertoprovideawiderangeof
healthservicesandbenefits,includingdentalhealth.46
However,theStateandTerritoryGovernmentshavetraditionallybeenresponsiblefor
dentalhealthservicespriortotheaboveamendmenttotheConstitutionin1946,states
andterritorieshadsoleresponsiblyforpublicdentalhealthandtheCommonwealthwas
onlyresponsibleforhealthservicesforwarserviceveterans(theirdependantsand
widows). 47
Thissituation,wherebybothlevelsofgovernmenthaveoverlappingauthority,invites
confusionastowhethertheCommonwealthorthestategovernments(orboth)have
ultimateresponsibilityforgovernmentprovisionofdentalhealthservices.
46
Biggs,A.(2008),OverviewofCommonwealthinvolvementinfundingdentalcare,ResearchPaperNo.12008
09,13August2008ParliamentaryLibrary,ParliamentofAustralia.
47
ibid
Whocurrentlytakesresponsibilityfordentalserviceprovision?
StateandTerritoryGovernments
Asoutlinedearlierinthischapter,StateandTerritoryGovernmentsareresponsiblefor
publicdentalservices.Theyprovideemergencydentalcareandgeneraldentaltreatmentto
eligibleadultsandschoolagedchildren.
Statesarealsoresponsibleforwaterfluoridationapreventivemeasurethataimsto
reducedentalcariesbythecontrolledadditionoffluorideintothepublicwatersupply. 48
CommonwealthGovernment
SincetheWhitlamGovernment,successiveCommonwealthGovernmentshavehaddiffering
viewsabouttheGovernmentsroleindentalhealth.Thisisreflectedintheirdifferent
policiesrangingfromdirectrolesinfundingtargeteddentalhealthprograms,toindirect
rolessuchasprovidingsomelimitedassistancethroughMedicareandofferingsubsidiesto
encouragethewideruseofprivatehealthinsurance. 49
Asatthebeginningof2012,theCommonwealthhastwoprogramstargetedtoparticular
populationgroups.In2004,thethenCommonwealthGovernmenttookresponsibilityfor
providingdentalservicesforthosewithchronicdiseasesallowingpatientswithEnhanced
PrimaryCareplansfromageneralpractitionertousetheAlliedHealthandDentalHealth
CareInitiativetoaccessMedicarebenefitsforthreedentaltreatmentsayear(witharebate
ofupto$220peryear). 50 In2007,theseprovisionswereexpandedtoincludebenefitsfor
enhanceddiagnosticandtreatmentservicesandsupplyofprostheses,includingdentures.
Thebenefitscapwasincreasedto$4250overtwocalendaryears.Thisresultedinthe
currentCDDSprogram.However,thecurrentGovernmenthasindicateditsintentionto
discontinuethisprograminordertoredirectfundingandtakeonagreaterroleinproviding
assistancetoconcessioncardholdersbycontractingthestatestoprovideadditional
publicdentalservicesthroughanewCDHP. 51
In2008,theCommonwealthexpandeditsresponsibilitiestoprovideupto$150(currently
$163.05)pereligibleteenager 52 towardsanannualpreventativedentalcheckthroughthe
MedicareTeenDentalPlan(MTDP).Atthetimeofwritingthisreport,thelegislationthat
administerstheMTDP,theDentalBenefitsAct2008,wasundergoingalegislativereview.
TheCouncilhasconsideredthefindingofthereviewinthisreport(asnotedbelow).
48
AustralianResearchCentreforPopulationOralHealth(2006),TheuseoffluoridesinAustralia:guidelines,
AustralianDentalJournal,Vol51,(2),pp.195199.
49
Biggs,A.(2008),OverviewofCommonwealthinvolvementinfundingdentalcare,ResearchPaperNo.1
200809,13August2008ParliamentaryLibrary,ParliamentofAustralia.
50
Ibid.
51
The199394BudgetprovidedfundingforaCDHPto199697.$278millionwasprovidedtothestatesand
territoriesoverfouryearstoadministeremergencycare(Emergency DentalScheme)andgeneraldentalcare
(GeneralDentalScheme)forhealthcarecardholders.WiththecessationoftheCDHPin1997,sole
governmentresponsibilityforpublicdentalservicesreturnedtothestates.ibid.
52
Eligibleteenagersare1217yearsofageinfamiliesreceivingFamilyTaxBenefitPartA,andteenagersinthe
sameagegroupreceivingcertaingovernmentpayments.
OtherCommonwealthsupportedmeasures 53 fordentalservicesinclude:
somesupportthroughMedicare,includingtheCleftLipandCleftPalateScheme;
subsidisedprescriptionsbydentalpractitionersunderthePharmaceuticalBenefits
Scheme(PBS);
providingmembersoftheAustralianDefenceForceandtheArmyReservewithafull
rangeofdentalservicesatnocost;
afullrangeofdentalservicestoeligibleveterans;
partlyfundinguniversityeducationofdentalpractitionersthroughCommonwealth
supportedplacesandtheHigherEducationLoanProgram(HELP);
expandingdentaltrainingandserviceprovision,inregionalsettingsundertheDental
TrainingExpandingRuralPlacements(DTERP)program;
fundingupto50voluntaryinternplacementsperyearforgraduatingdentistsfrom
2013;
a30percenttaxrebateonprivatehealthinsurance,whichcouldcoverdentalservices;
dentalservicesprovidedthroughCommunityControlledAboriginalMedicalServices;
dentalservicesintheChristmasandCocosIslandsandforasylumseekersincommunity
detention;and
accesstobroaderscholarshipschemesandlocumsupport.
OtherCommonwealthActsandregulationalsoapplytothepractiseofthedental
practitioners,suchaslegislationgoverningtheNationalRegistrationandAccreditation
Scheme(discussedlaterinthischapter).
Individualsandprivatehealthinsurance
Allotherindividuals(i.e.nonconcessioncardholdersandthoseineligiblefor
Commonwealthprograms)areresponsibleforfundingtheirowndentalcare.Thisgroup
includeslowincomepeopleonlowerthanaverageincomes.Theprivatesectoristheonly
placethatnoncardholderadultscanaccessdentalcare.
In2008,50percentofallAustralianadultsheldprivatehealthinsurance,including
26.8percentofcardholders. 54 In2011,theaveragebenefitpaidbyinsurersfordental
treatmentwas50.3percent. 55 Afurther35percentofthepopulationdonothaveprivate
healthinsurancebutusetheservicesofprivatedentalpractitioners. 56 Asignificantnumber
ofchildrenarecoveredbyprivatehealthinsurance.In2005,43.8percentofchildrenaged
511yearsand49.6percentof12yearoldswerecoveredbyprivatehealthinsurance. 57
Therearetwobroadlevelsofcover:generaldentalcoverage,whichtypicallycoversgeneral
dentalservicessuchascleaning,removalofplaque,xraysandsmallfillings;andmajor
53
ibid.
54
Harford,J.E.,Ellershaw,A.C.andSpencer,A.J.(2011),TrendsinaccesstodentalcareamongAustralian
adults19942008,AIHWDentalStatisticsandResearchSeries,No.55,pp.1011.
55
PrivateHealthInsuranceAdministrationCouncil(2011),AnnualReport,DataTables,December2011.
56
AHealthierFutureForAllAustraliansInterimReportoftheNHHRC,December2008,p.266.
57
DentalStatisticsandResearchSeries,No.51,pp.1011.
dentaltreatment,whichoftenincludesadditionaldentalitemssuchasorthodontics,
wisdomteethremoval,crowns,bridgesanddentures. 58
OverlapandduplicationCommonwealthandstates
TheareaofmostobviousoverlapofresponsibilitiesbetweentheCommonwealthandstates
isservicesforchildren;statesofferarangeofservicesformostchildrenuptotheageof18
andtheCommonwealthsMTDPoffersasubsidyforpreventativeservicesforeligible1218
yearolds.
TheservicessubsidisedundertheMTDPprogramalsooverlapwiththebasicpreventive
checkupandservicessubsidisedbythemajorityofprivatehealthinsuranceproviders(as
notedinthischapter,asignificantnumberofchildrenarecoveredbyprivatehealth
insurance43.8percentof511yearoldsand40.6percentof12yearolds).
TheSecondReviewoftheDentalBenefitsAct2008notedthattheuptakefortheMTDPhas
beendisappointinganddeclinedin201211toonly30percentofalleligibleteenagers.
Further,thereviewnotedthatalthoughtheMTDPvouchersystemworkedfora
mainstreamteenageraudience,itsappealcouldnotbeassumedtoextendtoatriskand
hardtoreachgroupssuchasAboriginalandTorresStraitIslanderteenagers,culturallyand
linguisticallydiverseteenagers,disabledteenagersandhomelessteenagers.Thereview
alsonotedthatevaluationoftheoperationsoftheprogramiswarrantedandrecommended
thatfurtherworktopromotetheMTDPtohardtoreachteensshouldbeundertaken.
Giventheoverlap,pooruptakeanddeficienciesinreachingalleligibleteenagers,itwould
beworthwhilereevaluatingtheefficiencyandeffectivenessoftheMTDPinachievingoral
healthoutcomesforteenagers.
Datapublishedin2011ontheMTDPvoucheruse(collectedaspartoftheNationalDental
TelephoneInterviewSurvey(2010))providedthefirstopportunitytoexaminetheprograms
impactonvisitingpatterns.WhilethereceiptoftheMTDPvouchersindicatedadegreeof
successintargetingteenagersaccordingtoincome,thedataindicatedagenerallylow
uptakeofthevouchersandloweruseamonglowincomehouseholds.Comparisonwith
visitingpatternsforteenagersinpreviousyearsdidnotsupportaconclusionthattheMTDP
hadamajorimpactonteenagevisiting. 59 Thissupportsevaluatingwhethertoextendthe
MTDPentitlementtoincluderoutinedentalservicesandfurtherconsideringpoliciesto
boostuseofdentalservicesbyteens.
Thereisalsosomedegreeofoverlapforservicesprovidedtoadults,withmanypatients
eligiblefortreatmentthroughthestatespublicsystemandtheCommonwealthsCDDS
programapproximately80percentofthoseaccessingtheCDDSalsohaveconcession
cardsandareeligibleforthedentalservicesfromthestatepublicsystem.Peoplereceiving
dentalcarethroughtheDepartmentofVeteransAffairs(DVA)mayalsobeentitledtoboth
oftheabovepayments.Additionaloverlapexistswithprivatehealthinsurancethroughthe
30percentrebateonpremiums.
58
ibid,p.9.
59
AustralianResearchCentreforPopulationOralHealth(2011),Teendentalplanvoucheruse,Australian
DentalJournal,Vol56,Issue4,pp.437440.
Onepotentialareaofoverlapamongjurisdictionsisdentalgraduateactivities.Somestates
havepreviouslyandcontinuetooffervariousnewgraduateopportunitiesinthepublic
dentalsector.Asaresultofdecisionstakeninits201112Budget,theCommonwealthwill
alsoofferdentalinternplacementsfornewgraduatesfrom2013,largelyfocusedonthe
publicsector,throughitsVoluntaryDentalInternProgram.Althoughtheprogramisyetto
commence,itwillaimtobuildonandcomplementexistingjurisdictionalprogramsrather
thanduplicateorreplaceexistingefforts.
Lackofharmonisationacrossthestates
Thereisgeneralinconsistencyinstateservicesprovidedforchildrenandadults,including
thetreatmentthatisavailableandeligibilityandcopaymentrequirements.Thereisalsoa
significantvariationbetweenthestatesandterritoriesinthelevelofinvestmentinpublic
dentalservices,onapercapitabasis.Thisvariationininvestmentwillaffectthespeedwith
whichoptionsforreformcanbeimplemented.
Children
In1973,thestatesandtheCommonwealthagreedtoestablishacommonAustralianSchool
DentalschemetoprovidecomprehensivedentaltreatmentforallAustralianschoolchildren
uptotheageof15years.Althoughthestateswereresponsiblefordeliveryofthedental
services,itwasmainlyfundedbytheCommonwealth. Intheearly1980s,fundingwas
graduallysubsumedintogeneralpurposegrantstothestates,whicheffectivelyended
directCommonwealthfundingandresponsibilityforthescheme. 60
Currently,onlyWesternAustralia,Queensland,SouthAustraliaandtheNorthernTerritory
operatesomeformofdedicatedschooldentalprogram.NewSouthWales,Victoria,
TasmaniaandtheAustralianCapitalTerritoryprovidepublicdentalservicestochildren
throughcommunitybasedclinics.Eligibilityforservicesandthelevelofcopaymentsalso
varyacrossstates(formoredetailrefertothetableatAppendixE:Childdentalservices
providedbytheStatesandTerritories).
Itisdifficulttogetaclearpictureoftheextenttowhichthedifferentstatebasedservice
arrangementsaffectchildhoodcariesexperienceasnotallstatesparticipateinthenational
datacollection.Furtherinformationonthestatusofchildren'soralhealthisprovidedin
ChapterThree.
NewSouthWalescommissionedaChildDentalHealthSurveyin2007toestablishtheoral
healthstatusofprimaryschoolchildrenaged512years.Keyfindingsfromthesurvey
include:meandmftfor56yearoldsof1.53andmeanDMFTfor1112yearoldsof0.74;
andthat61.2percentof56yearoldsand65.4percentof1112yearoldshavenever
experienceddecayintheirprimaryandpermanentteeth,respectively.TheNSWOral
HealthStrategicDirections20112020consultationdocumentstatesthatthesefigures
comparefavourablytonationalbenchmarkssetin2001. 61
60
SenateCommunityAffairsReferencesCommittee(1998),Reportonpublicdentalservices,Senate
CommunityAffairsReferencesCommittee,1998,p.48.
61
NSWOralHealthStrategicDirections20112020(2010).NewSouthWalesDepartmentofHealth,December
2010.
Adults
Likechildprograms,therearevariationsbetweenthestatesregardingtheservicesthey
offer,theeligibilitycriteriafortreatmentandthelevelsofcopaymentsrequiredforadults
(formoredetailrefertoAppendixDonadultdentalservicesprovidedbythestatesand
territories).
DentalWorkforce
Dentalworkforcecharacteristics 62
Thedentalworkforceiscomprisedofdentalpractitionerswhoarecategorisedby
registrationintodentists,dentalhygienists,dentaltherapists,oralhealththerapistsand
dentalprosthetists.Thereisalsoacategoryofspecialistregistrationfordentistsonly.
Table2.1belowoutlinestheroleofthevariousdentalpractitionersandthenumberof
practisingworkers(basedon2006data).
Table2.1:Dentalworkforcerolesandnumbersofpractisingprofessionals(2006)
Number
DentalPractitioners RoleDescription
Practising
Dentists Diagnoseandtreatdiseases,injuriesandabnormalitiesof
teeth,gumsandrelatedoralstructures;prescribeand
administerrestorativeandpreventiveprocedures;and
conductsurgeryoruseotherspecialisttechniques. 10,404

Dentistsareresponsibleforthesupervisionofhygienists,
therapistsandoralhealththerapists.
Dentaltherapists Provideoralhealthcare,includingexaminations,treatment
andpreventivecare,mainlytoschoolagedchildren.
1,171
Mustpracticewithinastructuredprofessionalrelationship
withadentist.
Dentalhygienists Usepreventive,educationalandtherapeuticmethodsto
helppreventandcontroloraldiseaseandmaintainoral
health.
674

withadentist.
Oralhealththerapists Maypracticeinbothclinicalcapacitiesormaybeworking
principallyasahygienistorasatherapist.
371
withadentist.
Dentalprosthetists(a) Independentpractitionerswhomake,fit,supplyandrepair
921
denturesandotherdentalappliances.
TOTAL 13,541
(a)NodatawereavailableforprosthetistspractisingintheNT.
Source:BalasubramanianM,TeusnerD2011.Dentists,specialistsandalliedpractitionersinAustralia:Dental
LabourForceCollection,2006.Dentalstatisticsandresearchseriesno.53.Cat.no.DEN202.Canberra:AIHW.
62
Alldatacitedinthissectionofthereportisfromthefollowingsource,unlessnotedotherwise:
BalasubramanianM,TeusnerD(2011),Dentists,specialistsandalliedpractitionersinAustralia:DentalLabour
ForceCollection,2006.AIHWDentalStatisticsandResearchSeries,No.53.
Thetotalnumberofthepractisingdentalworkforcewas13,541in2006.Inaddition,there
were15,381practisingdentalassistants,whosupportdentalprofessionalsbypreparing
patientsfordentalexaminationsandassistingdentalpractitionersinprovidingcareand
treatment,and2,558dentaltechnicians,whoconstructandrepairdentalappliancesunder
thedirectionofadentist.
Dentistsmakeup77percentofthedentalworkforce(excludingdentalassistantsand
technicians).Ofthese,84percentareingeneraldentalpracticeand12percentare
registereddentalspecialists.
MorerecentdatahavebecomeavailablefromtheDentalBoardofAustralia(DBA)basedon
the201011registrationsofdentalpractitionersthroughtheAustralianHealthPractitioner
RegistrationAgency(AHPRA).Thetotalnumberofregistrantswas18,319comprising;
13,830dentists;1,206dentaltherapists;1,148dentalhygienists;610dualqualifieddental
hygienistsanddentaltherapists;362oralhealththerapists;1,160dentalprosthetists;anda
verysmallnumberofpractitionersotherwisecategorised. 63 Thesenumbersarehigherthan
thosepresentedaboveforthedentalworkforcein2006becauseitcoversallregistrants,not
justthoseactivelypractisingdentistry.Activeparticipationratesvaryacrossdifferent
practitioners.Forinstancetheparticipationrateamongdentistsisapproximately
94percent.
Timeseriesdatasuggeststhatthenumbersofpractisingdentistshaveincreasedoverthe
pastdecadefrom8,338in1996to10,404in2006(a24.8percentincrease).However,
relativetothepopulation,thenumbersofpractisingdentistshaveonlyincreasedslightly
overthissameperiodfrom46.6to50.3dentistsper100,000population.
Inaddition,thedentalworkforcewasprojectedtogrowacrossthelaterpartofthe2000
decade.Forinstance,thenumberofpractisingdentistswasprojectedtogrowfrom10,067
in2005to11,551in2010.However,whenDBAandAHPRAdatahavebeenreconciled
againsttheexistingdataacrossthe2000decadetheyindicatedthatthedentalworkforce
mayhavegrownalittlemorerapidlythanprojected.
Gender
Malesmakeupthemajorityofthedentalworkforce71.0percentofdentists;
82.5percentofdentalspecialists;and90.0percentofdentalprosthestists.However,
womenmakeupthemajorityofdentalhygienists(96.7percent),dentaltherapists
(98.8percent)andoralhealththerapists(94.8percent).Thenumberoffemalesentering
dentalstudyisincreasing,witharound53percentofcommencingstudentsand
58percentofdentalgraduates.
Age
In2006,theaverageageofthedentalworkforcewasaroundthemid40s.Thedental
professionwiththeoldestworkersonaveragewasdentalprosthetists(50.1years),followed
bydentists(45.1yearswith37percentofdentistsovertheageof50years),dental
therapists(42.9years)anddentalhygienists(37.7years).
63
AustralianHealthPractitionerRegistrationAgencyandtheNationalBoards,AnnualReport201011,p.49.
Internationallyborndentists
FortysevenpercentofpractisingdentistsinAustraliawerebornoverseas.Someofthese
dentistscompletedtheirqualificationoverseaswhilstothersobtainedtheirinitialor
specialistqualificationinAustralia.
Hoursworked
Dentistshavebeenpractisingroughlythesamehoursperweekoverthelastdecade.
Femalespractisefewerhoursonaveragethanmen(34.1hoursperweekcomparedto40.2
hours).Thehoursworkeddecreasedonaveragefordentistsaged60yearsandolder.
Indigenousdentalworkforce
ThemostcurrentrecognisedsourceofdataforIndigenousdentalworkersindicatesthere
were18Indigenousdentists,15oraldentalworkersand171dentalassistantsin2006.It
shouldbenotedthatnotallIndigenoushealthprofessionalschoosetoidentifyas
IndigenousorpracticeinIndigenousregions. 64
Workforcedistribution
Privateandpublicemployment
Basedontheirmainareaofpractice,themajorityofthedentalworkforceisemployedin
theprivatesector:84.2percentofdentists;92.7percentofdentalhygienists;around
62percentoforalhealththerapists;and90.5percentofdentalprosthetists.
Dentistsemployedintheprivatesectortendtoworkinsoloandsolowithanassistant
practices,asshowninFigure2.2below.
64
AustralianBureauofStatistics,CensusofPopulationandHousing,2006.
Figure2.2:Practisingdentistsbypracticetypeatmainlocation
3.7%
Private - other
4.6%
Public - other
1.2%
Public - school dental
4.8%
Public - general dental
5.1%
Public - dental hospital
15.1%
Private - work as an assistant
Private - group practice 22.6%

(associateships and partnerships)
42.8%
Private - solo (and solo with an
assistant)
0 1000 2000 3000 4000 5000

Source:BalasubramanianM.andTeusner,D.(2011),Dentists,specialistsandalliedpractitionersinAustralia:
DentalLabourForceCollection,2006.AIHWDentalstatisticsandresearchseries,no.53.
Dentaltherapistshavethehighestproportionofemployeesinthepublicsector,with
81.9percentworkingpredominantlyinpublicschooldentalservices(60.4percent)andin
publiccommunitydentalclinics(16.2percent).
Anumberofdentalpractitionersalsoengageinvolunteerorphilanthropicwork,suchas
providingclinicalservicestovulnerableanddisparatepeopleinsocietyaswellasvolunteer
teaching.(RefertoAppendixJonprobonoservicesprovidedbydentalpractitioners).
Thestategovernmentsarethemainemployersofpublicsectordentists.The
CommonwealthGovernmentonlyemploys94dentistsfortheAustralianDefenceForce.
Further,whiletheCommonwealthmayfundtheservicesofgeneralmedicalpractitioners
throughpaymentsmadeundertheMedicareBenefitsSchedule(MBS),the
CommonwealthsfundingrolethroughtheMBSfordentistsisquitelimited(withthe
exceptionofpaymentsfortheCDDSprogram).
Geographiclocation
Thegeographicaldistributionofthedentalworkforceisconcentratedinurbanareas.The
majorityofthedentalworkforcepractiseinMajorCities:81.0percentofdentists;
87.4percentofdentalhygienists;62.2percentofdentaltherapists;74.7percentoforal
healththerapists;and67.5percentofdentalprosthetists.
Therearethreetimesasmanydentistspractisingper100,000populationinMajorCities
(59.5per100,000)thaninRemote/VeryRemoteareas(17.9per100,000).However,there
aremoredentaltherapistspractisingper100,000populationinOuterRegionalareas
(7.5per100,000)areasthaninInnerRegionalareas(6.7per100,000)andinMajorCities
(5.1per100,000).Table2.2belowshowsthedistributionofthedentalworkforceby
remotenessarea.
Table2.2:Dentalworkforceper100,000populationbyRemotenessArea,2006
Dental Remote/Very
Majorcities Innerregional Outerregional Australia
Professional remote
Dentists 59.5 33.1 27.5 17.9 50.3
Dentaltherapists 5.1 6.7 7.5 4.3 5.7
Dentalhygienists 4.1 1.5 1.2 3.3
Oralhealth
therapists 2.0 1.4 1.8 0.6 1.8
Dental
prosthetists(a) 4.4 5.9 2.8 0.9 4.4
(a)NodataisavailableforprosthetistspractisingintheNT.
Source:AIHW/DSRUDentalLabourForceSurvey2006.
Acomparisonwiththedistributionofmedicalpractitionersspecificallyprimarycare
clinicianshighlightstherelativemaldistributionofdentalpractitionersinRemote/Very
remoteareas.DatafromAIHWs2009MedicalLabourForceSurveyshowsthatthenumber
ofprimarycarecliniciansper100,000populationis118.4inmajorcitiesand125.8in
remoteandveryremoteareas.
Themaldistributionofthedentalworkforce,betweensectorsandgeographically,can
impedetimelyandaffordableaccesstoservicesforcertaingroups,includingruraland
remotecommunities,Indigenouspeoples,lowsocioeconomicgroupsandthosewith
specialneeds.
Regulationofthedentalprofession
Historically,theregulationofhealthprofessionalswasundertakenbystatesandterritories.
InJuly2006,theCouncilofAustralianGovernments(COAG)agreedtoimplementaNational
RegistrationandAccreditationScheme(NRAS)forhealthprofessionals.TheNRASwas
establishedon1July2010toalignthestateandterritoryregistrationschemesforcertain
healthpractitioners,includingdentalpractitioners.
TheschemeoperatesindependentlyoftheCommonwealthGovernmentundertheHealth
PractitionerRegulationNationalLawAct2009.OversightoftheNRASisprovidedjointlyby
state,territoryandCommonwealthHealthMinistersthroughtheAustralianHealth
WorkforceMinisterialCouncil.
UndertheNRAS,theDBAisresponsiblefor:registeringdentalprofessionalsandstudents;
developingstandards,codesandguidelinesforthedentalprofession;handlingnotifications,
complaints,investigationsanddisciplinaryhearings;approvingaccreditationstandardsand
accreditedcoursesofstudy;andassessingtheskillsandqualificationsofoverseastrained
dentalpractitionerswhowishtopracticeinAustralia.
TheDBAissupportedbyanindependentstatutoryagency,AHPRA,whichadministersthe
receiptandprocessingofapplicationsforregistrationandmaintainsapublicregisterof
registeredhealthpractitioners.TheDBAhasappointedtheAustralianDentalCouncil(ADC)
astheaccreditationagencyresponsibleforaccreditingeducationprovidersandprogramsof
studyforthedentalprofessionaswellasassessinginternationaldentalpractitioners.
Registrationprocess
StudentsofaccreditedAustraliandentalcoursesaregrantedstudentregistrationunderthe
NRAS.StudentsseekingtoworkasdentalpractitionersinAustraliafollowinggraduation
mustgaingeneralregistrationundertheNRASbeforepractisingintheworkforce(withthe
exceptionofdentaltechniciansanddentalassistants).Toregisterasadentalpractitioner,
individualsmustcompleteaDBAapprovedprogramofstudy(listofstudiesareinTable2.3)
andhavetheirapplicationassessedandregistrationconfirmedbyAHPRA.Newgraduates
areregisteredandeligibletostartworkingassoonastheirnameispublishedonthe
RegisterofPractitionersbyAHPRA.
Anotabledifferencebetweendentalpractitionersandgeneralmedicalpractitionersseeking
generalregistrationisthatdentalpractitionersarenotrequiredtocompleteamandatory
approvedinternshipinadditiontotheirapprovedcourseofstudyinordertopractisein
theirownright. 65
RegistrationstandardsdevelopedbytheDBAfurtherdefinetherequirementsthatdental
practitionersmustmeettopractiseintheirfieldandmaintainregistration.Theseinclude
scopeofpracticeregistrationstandards,continuingprofessionaldevelopmentandrecency
ofpracticestandards.
65
http://www.medicalboard.gov.au/Registration/Types/GeneralRegistration.aspx(asat18October2011).
Table2.3:Approvedprogramsofstudyqualificationswhichleadtogeneralregistrationasadentalpractitioner
Dentists Allieddentalpractitioners Dentalprosthetistsandtechnicians
Institution
Programsofstudy Programsofstudy ProgramsofStudy
GriffithUniversity BachelorofOralHealthinDentalScience OralhealththerapistsBachelorofOralHealth MastersofDentalTechnology(DentalProsthetics)
GraduateDiplomaofDentistry DentaltechnicianBachelorofOralHealth(Dental
Technology
UniversityofAdelaide BachelorofDentalSurgery OralhealththerapistsBachelorofOralHealth
CharlesSturtUniversity BachelorofDentalScience OralhealththerapistsBachelorofOralHealth

JamesCookUniversity BachelorofDentalSurgery
LaTrobeUniversity BachelorofHealthSciencesinDentistry OralhealththerapistsBachelorofOralHealth
MasterofDentistry
UniversityofMelbourne BachelorofDentalScience OralhealththerapistsBachelorofOralHealth
DoctorofDentalSurgery
UniversityofQueensland BachelorofDentalScience OralhealththerapistsBachelorofOralHealth
UniversityofSydney BachelorofDentistry OralhealththerapistsBachelorofOralHealth
DoctorofDentalMedicine,
UniversityofWesternAustralia BachelorofDentalScience
DoctorofDentalMedicine
CurtinUniversity OralhealththerapistsAssociateDegree
UniversityofNewcastle DentaltherapistsGraduateDiploma
DentalhygienistBachelorofOralHealth
TAFESouthAustralia DentalhygienistsAdvancedDiploma AdvancedDiplomaofDentalProsthetics
DentalTechnicianDiplomaofDentalTechnology
BaxterInstitute(VIC) DentalTechnicianDiplomaofDentalTechnology
CentralInstituteofTechnology(WA) AdvancedDiplomaofDentalProsthetics
CharlesInstituteofTechnology(NSW) DentalTechnicianDiplomaofDentalTechnology
DNAKingston(WA) DentalTechnicianDiplomaofDentalTechnology
Holmesglen(VIC) DentalTechnicianDiplomaofDentalTechnology
RMITUniversity(VIC) AdvancedDiplomaofDentalProsthetics
SouthbankInstituteofTechnology(QLD) AdvancedDiplomaofDentalProsthetics
SydneyInstitute,RandwickCollege,TAFE AdvancedDiplomaofDentalProsthetics
*thisprogramisinprocessofnewprogramaccreditationbytheADC

Themajorityofdentalprofessionsrequiretertiaryeducationqualifications,whichhave
varyingcoursedurations.Dentalandoralhealththerapystudentstypicallygaintheirclinical
experienceinthepublicsectoranduniversityfacilities
Table2.4:Dentalprofessionscoursedurations
DentalPractitioners StudyTime(fulltime)
Dentists 5yearsofuniversityeducation(or4yearsifcommencingdental
programwithanapplicableundergraduatedegree).
Specialisationanadditional35yearsatdentalschoolsaccredited
bytheAustralianDentalCouncilandtheDentalBoardofAustralia.
Dentaltherapists 1yearpostgraduateprogramaccreditedbytheAustralianDental
CouncilandtheDentalBoardofAustralia.
Previousdentaltherapisteducationwasa2yearcertificateor
diplomacoursedeliveredbysomestategovernmentsthesehave
beenacknowledgedbytheDBAasregistrablequalifications.
Dentalhygienists 2or3yearsofeducationaccreditedbytheAustralianDental
Oralhealththerapists Generally3yearsofeducationandaccreditedbytheAustralian
DentalCouncilandtheDentalBoardofAustralia.
Dentalprosthetists Generally2yearsoftrainingpriortoregistration,following2years
ofdentaltechniciantraining.AccreditedbytheAustralianDental
Dentalassistants Generallycompleteacertificatelevelqualificationorinservice
training.
Source:DentalBoardofAustralia,http://www.dentalboard.gov.au/Accreditation.aspx
Demandandsupply
Australiaenteredthe2000decadewithaprojectedshortfallinitsdentalworkforcerelative
totheexpecteddemandfordentalvisitsandservices.Asaresult,oneoftheactionareasin
theNationalOralHealthPlan200413wasthedevelopmentofthedentalworkforce.Inthe
decadesince,therehavebeensubstantialchangesintherecruitmenttoandlossofdental
providersfromtheworkforceandtotheexpecteddemandfordentalservicesfromthe
Australianpopulation.
Overthelastdecadetherehasbeenexcessdemandfortheservicesofdentistsinboththe
publicandprivatesector.
Inthepublicsector,approximately400,000peoplearecurrentlyestimatedtobeon
waitinglists.Thisindicatesthatthereismoredemandforservicesthanthepublic
sectorisabletosupply.
Privatesectorpatientsalsocanexperiencedifficultyaccessingtreatmentandgettingon
thebooksforprivateclinics.Thisisexacerbatedbythevariationbetweenareasinthe
rateofsupplyofdentists,forinstancethelowsupplyrateinruralandouter
metropolitanareasofcapitalcities.Inaddition,thesignificantpricedifferentialinthe
privatesectorsendsapricesignaltoconsumerstomoderatedemandalthough
patientsmayhaveahighwillingnesstopayforservices,theirrelativelylowerabilityto
paymaymeantheyhavetoconsumefewerdentalservicesthantheywouldprefer.
ThedemandforservicesacrossAustraliaislikelytoincreaseinthefutureinresponsetoa
range of factors including population growth, an increasing proportion of adults who are
dentate(i.e.havesomenaturalteeth),andrisingconsumerexpectations.
Further,newpolicyoptionsarelikelytoaddstimulateddemandfordentalvisitsand
servicesfromtargetgroupsthathaveformerlybeenlowusersofdentalservices.
Domesticsupplyofdentists
ThenumberofdentistgraduatesinAustraliahasincreased,from228in2006to469in
2009,adoublinginthreeyears.Thisreflectstheadditionofanewdentalschoolgraduating
dentistsinthisperiodaswellasincreasesintheintakeandgraduatenumbersfromthefive
longstandingdentalschools.Thenumberofinternationalstudentshasbeenincreasing
withintheintakesofdentiststudentsinAustralianuniversities.
In2007and2008around85percentofgraduatesweredomesticstudentsandin2009this
increasedto89percent.Thenumberofdentistgraduatesbetween20032009,including
domesticandinternationalstudentsisshownbelow.
Table2.5:Dentistgraduates,20032009(a)
2003 2004 2005 2006 2007 2008 2009
227 220 230 228 193 349 469
(a)2007to2009datasourcedfromDepartmentofEducation,EmploymentandWorkplaceRelations
administrativedata,2009;mayincludepostgraduatecoursecompletions.
Source:2003to2006,ARCPOH,basedondatasourcedfromthethenDepartmentofEducation,Scienceand
TechnologyongraduatesfromdentalschoolsofferingBachelorofDentalStudiesorBachelorofHealthScience
withMasterinDentistry.
Internationalsupplyofdentists
TheADCadministersassessmentstoallowoverseastraineddentistsgainregistrationin
Australia.TherearethreepathwaystogeneralregistrationinAustraliafordentistswith
overseasqualifications:
1. dentistswhoareregisteredtopracticeinNewZealandunderTransTasmanmutual
recognition;
2. dentistswitheligiblequalificationsfromtheUnitedKingdom,RepublicofIreland,New
ZealandandCanada;or
3. dentistswithotherqualifications(administeredbytheADC).
Dentistswhomeettherequirementsofpathwayoneortwoareeligibleforgeneral
registrationinAustraliaandcanapplydirectlytotheDBAforregistration.
Dentistswithqualificationsthatdonotmeettheautomaticregistrationrequirementsneed
toeithercompleteanAustralianqualificationorundertaketheexaminationprocedure
conductedbytheADC,whichinvolvesclinicalpracticeinthepublicsector. 66 In2006,
66
DentistsmayundertakethefollowinglimitedpracticeoptionswhiletheyworktowardsGeneral
Registrationunderpathway3:
- PublicSectorDentalWorkforcescheme:Theschemewasintroducedin2005tohelpalleviate
workforceshortagesinthepublicsector,withaparticularemphasisonruralandremoteareas.
GraduateswithcertaindegreesfromCanada,HongKong,Ireland,Malaysia,Singapore,SouthAfrica,
UnitedKingdomandtheUnitedStatesaregrantedanexemptionfromtheADCPreliminary
ExaminationandmustcompletetheFinalExaminationwithinthreeyearsoffirstbecomingregistered.
Participantsmustundertakesupervisedpracticeandbeemployedinapublicsectorfacility.
- LimitedRegistrationofDentistsforpostgraduatetrainingorsupervisedpracticeOtherinternational
graduates:AnalternativepathwayforgraduatesnoteligibleforthePSDWS.Thesedentistsmust
158overseastraineddentistssuccessfullycompletedtheADCfinalexamination.This
increasedto204in2009.TheADCcanalsoprovidesimilarservicesfortheassessmentof
dentaltherapists,dentalhygienistsandoralhealththerapists.
Projectedworkforceto2020
Thelatestpublisheddentistlabourforceprojectionsweremadein2008byAIHWDSRU.
Thebestestimateprojectionsindicatethatthenumberofpractisingdentistsisforecastto
increasebetween2005and2020by49.4percent,toover15,000by2020. 67 Thestudyalso
predictsthatthenumberofdentistsper100,000populationisexpectedtoincreaseby
27.9percent,to63.2dentistsper100,000,by2020.Capacitytosupplydentistvisitsis
projectedtoincreaseby28.6percentby2020fromapproximately31.5millionvisitsin
2010to36.6millionvisitsin2020.
Thenumbersoforalhealthpractitionersisalsoprojectedtogrow,butthisreflectsvarying
trendsamongthecomponentoccupations.Dualqualifieddentaltherapistsanddental
hygienistsareincreasingrapidlyfromaverylowbaseofsome591in2010toananticipated
2,117in2020.Thenumbersofdentalhygienistsarealsoprojectedtoincreasefrom1,065
in2010to1,458in2020.However,thenumbersofdentaltherapistsareexpectedto
decreasefrom1,023in2010to443in2020.Totalnumbersofdentalhygienists,dental
therapistsandoralhealththerapistsarealmostdoublingfrom2,404in2010to4,017in
2020.Dentalprosthetistnumbersareprojectedtobeslowlydecreasing.Thecapacityof
theseoralhealthpractitionerstoprovidevisitsandservicestotheAustralianpopulationis
increasing.
Thelatestpublishedprojectionsforeffectivedemandbetween2005and2020showthat
visitscouldincreaseto33.6millionvisitsin2020whenonlypopulationgrowthand
increasingproportionofadultsbeingdentatewereconsidered. 68 However,therehasbeen
alongtermhistoricaltrendofanincreasinguseofdentalservicesbytheadultpopulation
andanincreasingaveragenumberofdentalvisitsmadeinayear.Ifevenamodest
continuationofthistrendweretooccur,thentheexpecteddemandforvisitsat37.9million
visitswouldslightlyexceedtheprojectedcapacityofthedentalworkforcetoprovidevisits
andservices.
Whentheseprojectionsweremadein2008bytheAIHWDSRU,thecomparisonof
projectedsupplywithprojecteddemandfortotalaggregatedentalvisitsindicatedan
approximateshortfallof800to900dentalpractitionersby2020.
Therecentpublicationofworkforcerelateddatahavehighlightedtheneedforongoing
monitoringofthedentalworkforceandtheperiodicrevisionofdentalworkforcesupply
(e.g.projectionsoftheDBAandAHPRAdataondentalpractitionerregistrationsin201011;
completetheADCPreliminaryExaminationwithinoneyearofgaininglimitedregistrationinorderto
applyandthenmustalsoworkundersupervisedpracticeemploymentinapublicsectorfacility.
67
AIHWDentalStatisticsandResearchUnit(2008),Dentistlabourforceprojections,20052020,DSRU
ResearchReport,No.43,andAIHWDentalStatisticsandResearchUnit(2008),Projecteddemandfordental
careto2020.DSRUResearchReport,No.42.
68
Teusner,D.N.Chrisopoulos,S.andSpencer,A.J.(2008),Projecteddemandandsupplyfordentalvisitsin
Australia:analysisoftheimpactofchangesinkeyinputs,AIHWDentalStatisticsandResearchSeries,No.38.
thedataonintakesintheAustraliandentalschools;andthenumbersofcandidatessitting
andsuccessfullypassingtheADCexaminationsprocessin2011).Areconciliationofthis
newdataonregistrationsin201011withtheprojectednumberofpractisingdentistsfor
theyear2010hasindicatedafasterrateofgrowthofthenumberofpractisingdentiststhan
expectedbetween2005and2010.
AlthoughsomecautionisrequiredininterpretingtheAHPRAdata(i.e.itmayinclude
multipleregistrationsandmaynotaccuratelyreflectemploymentratesofregistered
professionals),somegeneralobservationscouldbemade,including:
thenumberofdomesticgraduateshasincreasedfasterthanexpected(through
increasesingraduatenumbersinthelongstandingdentalschools);
thefullextentofinternationalstudentsremaininginAustraliatopracticemaynotbe
capturedinthemigrationassumptionsinexistingmodels;and
thenumberofsuccessfulADCcandidatesislargerthanexpected(althoughthe
proportionwhotakeupactivepracticeofdentistryinAustraliaremainslittle
understood).
Therehasbeensomediscussionthattheexpectednumberofdentistgraduatesacrossthe
2010decadewillcontinuetoexceedthatassumedin2008andthenumberofdentists
recruitedfromoverseasactuallytakinguppractiseinAustraliawillalsobehigherthan
expected.Thismayresultindentistnumbersexceedingtheexistingprojectionsfor2020.
Actualemploymentrates,recruitmentofinternationallyqualifieddentists,retirementsand
workforceparticipationofdentalprofessionalsinthefuturearenotknownandmayimpact,
positivelyornegatively,onoveralldentistsupply.Theimpactwillnotbeknownwithout
furtherresearchintoandanalysisofdentistsupplyprojections. 69
Whilethenumberofdentistsisincreasingthereareconcernsoverthenumberofdentists
goingontoproceduralspecialtiesandwiththedistributionofthosespecialistsacrossthe
variousspecialityareas.Further,theincreaseincapacitytosupplydentalvisitsissomewhat
temperedbychangesinworkhoursandinthenumberofvisitssuppliedinthatworktime.
Factorsaffectingworkforcesupply
Educationandtraining
In2007,threenewdentalschoolswereestablishedandareexpectedtoincreasethesupply
ofdentalgraduatesCharlesSturtUniversity,JamesCookUniversity,Universityof
NewcastleandLaTrobeUniversity.Theseschoolsareexpectedtograduatetheirfirst
intakesby2013.GriffithUniversityalsostartedanewdentalprogramandgraduatedits
firstcohortoforalhealththerapistsin2006anddentistsin2008.Additionally,CharlesSturt
UniversityandLaTrobeUniversityeachgraduatedtheirfirstcohortsoforalhealth
69
Itneedstoberecognisedthatuncertaintyalsoexistsaroundeffectivedemandfordentalservices.For
instance,sincethe2008study,theAustralianBureauofStatisticshasrevisedthepopulationprojectionforthe
year2020,increasingtheforecasttotalnumberofvisitsbynearlytwomillion.Inaddition,policiestoimprove
accesstodentalserviceswouldalsostimulatedemand.Overallgrowthinsupplyisexpectedtooutpace
populationgrowththroughto2020allowingfornewdemand.Acrucialissueiswhetherthatnewdemandwill
comefromgroupsinthepopulationmarginalisedfromregulardentalservicesornot.
therapistsin2011.OtherAustralianuniversitiesareconsideringestablishingdentistand
oralhealthpractitionercourses.
Further,thebroadermovetowardsademanddrivenuniversitysystemfrom2012may
affectthesupplyofdomesticallyeducateddentists.TheGovernmentwillbefunding
CommonwealthSupportedPlacesforallundergraduatedomesticstudentsacceptedintoan
eligiblehighereducationcourse,includingfordentistry(butexcludingmedicine).Higher
educationproviderswilldecidehowmanyplacestheywilloffer,andinwhichdisciplines,in
responsetoemployerandstudentdemand.Whiletheimpactofthiswillnotbeknownfor
someyears,thenumbersofdentalgraduatesmayincreaseduetouncappeddemandor
decreaseifpotentialstudentsarelosttootherprofessions.
Thecontinuinggrowthinstudentuptakeishavinganimpactonclinicaltrainingcapacityand
willbeachallengeinthefutureifclinicaltrainingcapacitycannotbemaintained.Further,
increasingAustralianeducatedgraduatenumbersmayalsohaveflowonimpactstothe
numberofinternationaldentalgraduatesrecruitedintoAustralia.AustraliasNationalOral
HealthPlan200413emphasisedasustainableselfsufficiencyforthedentalworkforceand
supportedtherecruitmentofinternationaldentalgraduatesasashorttermmeasureto
boostsupply.
Dentalacademicsinuniversitiesandcomplementaryworkforces
Thesupplyofcomplementaryworkforcesaffectstheabilityofthedentalworkforceto
provideservicesi.e.theavailabilityandqualityofsupervisorsanddentalacademics
influencesthepotentialnumbersofnewdentalstudentsaswellasthequalityoftheir
educationatuniversityandoncetheycommencepractice.
Fortytwopercentofdentalacademicswereaged50yearsorolderin2006, 70 whichcould
potentiallyleadtohighretirementratesincomingyears.Thegapbetweenacademic
salariesandremunerationforprivatelypractisingdentalpractitionersmakesitdifficultfor
dentalschoolstoattractandretainteachingstaff.
Inaddition,anadequatesupplyofdentalassistantsanddentaltechniciansarerequiredto
supportpractisingdentalprofessionalstoefficientlyprovideservices.
Workforcedemographics
Thedentalworkforceisalsoageing,whichmayleadtomoredentalpractitionersretiringor
reducingthehourstheyworkincomingyears.Youngerdentalpractitionersmayalso
choosetoworkfewerhoursduetolifestylechoices.Femaledentistsaremorelikelyto
workparttimeandhavecareerbreaksthanmaledentalpractitioners,whichmayalso
impactfuturesupplyiftheproportionoffemalegraduatesincreases.
Registrationandaccreditationcontrols
Theregistrationandpractiseofdentalpractitionersiscontrolledbytheregistrationand
accreditationstandardssetbytheDBA.Anyfuturechangestothestandard,eitherrelaxing
ortightening,couldresultinanincreaseordecreaseinthesupplyofdentalpractitioners.
70
CouncilfortheHumanities,ArtsandSocialSciences(2008),OccasionalPaperNo.6,November2008.
Infrastructureandcapital
Thereareseveralissuesrelatedtoinfrastructurefordentalservicesthatcanaffectthe
supplyofdentalservicesandtheincentivesandabilityfordentalpractitionerstoprovide
theseservicesinvariouslocationsandpractices:
capitalinfrastructurebuildingsandclinics,dentalchairsandequipment,mobiledental
facilitiesforremotelocationsetc;and
socialinfrastructure(especiallyrelevantforremotelocations)studentaccommodation
inruralareasforclinicalplacements,socialsupportstructures,transport,professional
networksetc.
Theavailabilityofthesedifferenttypesofresourcesvariesconsiderablybetween
jurisdictions.Ruralareasfacepronouncedinfrastructureconstraintsimpactingtheabilityof
regionalcentrestoattractandretaindentalprofessionals.
Publicsectorissues
Thereisasignificantdifferenceinexpectedsalariesforthepublicandprivateworkforce
averagesalariesforalldentalprofessionsintheprivatesectorarealmostdoublethatof
thoseinthepublicsector.Thisdiscrepancymakesworkinginthepublicdentalsectorless
attractiveandisonefactorthatinhibitstheworkforcesupplyinthepublicsector.Other
factorsincludeaperceivedlackofadefinedcareerpathcomparedtotheprivatesector,
clinicalsupportandcontinuingprofessionaldevelopmentopportunitiesaswellasrisks
arounddeskilling.Ergo,measurestoincreasegeneralworkforcenumbersmaynot
necessarilycorrelatewithanincreaseinpublicdentistryworkforcenumbers.
Governmentmeasurestoaffectworkforcesupply
Asmentionedearlierinthischapter,theCommonwealthGovernmenthasseveralmeasures
whichaffecttheworkforcesupply:
governmentpartlyfundsuniversityeducationofdentalpractitionersthrough
CommonwealthsupportedplacesthroughHELP(however,thecontextforsuchsupport
maychangewiththeintroductionofanuncappedsystemofuniversitytrainingplaces);
overthenextthreeyearsfrom1July2011,theGovernmentwillcontinuetosupportsix
AustraliandentalfacultiestoextendormaintaintheDTERPprogram,inorderto
encouragedentalstudentstotakeupacareerinruralpractice;
governmentfundsthePuggyHunterMemorialScholarshipSchemetosupportthe
trainingofIndigenouspeoplestudyinginhealthdisciplines,includingdentistryandoral
healthfields;
mostrecently,Governmentagreedtofundupto50voluntarydentalinternshipplaces
peryear,whichwillpotentiallyincreasethecapacityofdentalservices,particularlyin
thepublicsector;and
therearealsovariousbroadereducationandtrainingscholarshipsandlocumsupport
activities.
StategovernmentsalsorunthePublicSectorDentalWorkforceSchemewhichenables
graduatesfromsomeoverseasdentalprogramstopracticeinthepublicsectorforaperiod
uptothreeyearswhiletheyworktowardscompletingtheADCFinalExaminationtogain
Australiandentalregistration.
However,dentalworkforcemeasuressupportedbygovernmenthavegenerallybeen
adhoc.Theytendtobeshorttermandlackcoordinationwithbroaderhealthworkforce
planning.Forexample,therearenumerousHealthWorkforceAustralia(HWA)projectsthat
currentlydonot,butarguablyshouldconsiderdentistry,including,butnotlimitedto:
WorkforceProfileReportsandDataRecourses;
AboriginalTorresStraitIslanderHealthWorkerProject;
RuralandRemoteHealthWorkforceinnovationandreformstrategy;
Agedcarereform;
Interprofessionallearningandpracticeprogram;
Integratedregionalclinicalnetworks;
InternationalHealthprofessionals;and
NursingandalliedhealthrecruitmentforruralandregionalAustralia.
In2011,HWAcompletedtheDentalTherapy,DentalHygieneandOralHealthTherapy
ScopeofPracticeReview.ThereportofthereviewwasapprovedbyHWAon21October
2011andisyettobeconsideredbytheHealthMinisters.
HWAisundertakinganalysisofthedentalworkforcein2012,aspartoftheNational
TrainingPlanMarkII.HWAsanalysiswillexamineissuesaroundnationallyagreeddataon
thesupplyanddemandofthedentalworkforceandwillprojectthenumberofprofessionals
anddentalstudentsthatwouldberequiredforarangeofplanningscenarios.HWAaimsto
alsofacilitateagreaterdegreeofdialogueandcoordinationbetweenthedentalschools
regardingtrainingandclinicalplacements.Theresultsofthisanalysisarenotexpected
beforetheendof2012.
Conclusion
ThestructureofthedentalsysteminAustraliaislargelyprivate,withbothprovidersand
servicesconcentratedinmajorcities.Thefundingstructureinthedentalsystemisdifferent
totherestofthehealthsystem,inthatindividualspayforthemajorityoftheircare.While
governmentfundingissignificant,thesubsidiesavailablearefarlessthanthoseprovidedin
thegeneralhealthsystem.Theamountoffundingavailabletothepublicsystemisdwarfed
byconsumerexpenditureintheprivatesystem.
Issuessurroundingthedentalworkforcemirrorthegeneralhealthworkforce.Theperiodof
the2000decadewasatimeofestimatedshortageofsupplyagainsteffectivedemand.The
responsehasbeen:adoublingofdentistgraduates;strongrecruitmentofinternational
dentistgraduates;andincreasesinoralhealthpractitionergraduates.Asaresult,supply
capacitymayhavegrownfasterthanprojectedthroughtotheendofthe2000decade.
Thelatestpublishedsupplyanddemandprojectionsindicateasmallshortageofsupplyin
2020.However,supplyanddemandprojectionsshouldbeupdated.Thepreparationofa
nationaldentalworkforceplanbyHWAacross2012willbringforwardsuchinformation.
Therapidexpansionofthenumbersofdentalpractitionersintraininghasaccentuated
concernswiththeinfrastructureavailableforstudentsinuniversitytraining.Thisincludes
bothuniversityfacilitiesandstaffandpublicsectorserviceprovidersandclinicalplacement
facilities.Theconstraintsimposedonappropriatetrainingenvironmentswillbefurther
heightenedbytheintroductionoftheVoluntaryDentalInternProgram,notingthat
infrastructurefundingisbeingprovidedunderthemeasureandthatparticipantswillbe
fullyqualifieddentistswhocanprovideserviceswithouttheneedforsignificantsupervision,
unlikedentalstudents.
Inadditiontotheaggregatesupplyanddemandbalance,thereissignificantmaldistribution
betweenurbanandruralareasandacrossurbanareasaswellasbetweenprivateandpublic
dentistry.Inthisway,workforcemaldistributionaffectstheabilityofpeopletoaccess
dentalcare,eitherinthepublicortheprivatesystems.Thefactorsleadingtothis
maldistributionaremultifaceted,includingdifferencesinincomeandcareeropportunities
betweenthetwosectors.
Introduction
Thereareseveralprioritygroupswithinthelowincomecategorywhoarelikelytohave
unfavourablevisitingpatternsandagreaterriskoforaldisease.Thereasonsforpoor
visitingpatternsarecomplex,butbroadthemesassociatedwithincomeandaffordability,
socialdisadvantage,andinadequatepublicdentalfundingarekeyfactors.Therearemany
groupswhofindaccessdifficult,andseveraloftheseareprioritygroupswhichhavebeen
identifiedintheCouncilsTermsofReference.Forsomeofthesegroups,dataarenot
available.Tocompensateforthelackofmoredetaileddata,theCouncilhasfocusedon
broaderpopulationdata,whichislikelytoincludeprioritygroups.Identifyinggroupswhich
arelikelytomissoutonservicesisimportantindevelopingalongtermstrategyaswellas
moreshorttermtargetedproposals.
Adults
Concessioncardholders
Concessioncardholdersareprimarilyrecipientsoftheagepension,disabilitysupport
pensionorunemploymentpayments.In2011,therewerebetween7.4and7.5million
AustralianseligibleforPCCandHCC. 71 Ofthese,almosttwomillionweredependent
children.ThesefiguresshowthataroundonethirdoftheAustralianpopulationiseligible
forconcessioncards.Concessioncardholdersandtheirdependantsareeligibletoaccess
publicdentalservicesprovidedbytheirstateorterritory.Giventheincomeeligibility
requirementsforconcessioncards,mostoftheseAustraliansareonlowincomes,although
therearesomeselffundedretireesonpartpensionsthathaveaccesstoPCC. 72

Surveydataforconcessioncardholdersisconsistentwithvisitingpatternsandoralhealth
statusinlowincomecategories.Itshowsthat41.7percentofconcessioncardholdershave
unfavourablevisitingpatterns,comparedto23.7percentofnonconcessioncardholders. 73
Thisisreflectedinthegreaterratesofuntreateddecay,moderatetosevereperiodontal
diseaseandfewerthan21teethcomparedtononconcessioncardholders.
Concessioncardstatusisareasonableproxyforneedanddisadvantageandatabroader
levelthereisconsiderableoverlapwithmanyoftheprioritygroupsincludedinthereport.
Concessioncardholdersbroadlyincludeseveralhighrisk,lowincomegroups,suchas:
elderlyAustralians;theunemployed;disabilitypensioners;andIndigenousAustralians.
Thesegroups,becauseofageandincome,aremorelikelytobesufferingfromchronic
diseasesanddisabilitywhichmayalsorestrictaccesstoregularemploymentand
participation.
71
DepartmentofFamiliesandHousing,CommunityServicesandIndigenousAffairsdatausedfordetermining
eligibilitytoconcessionalaccesstothePharmaceuticalBenefitsScheme.
72
AlistofCentrelinksupportedpensionsandtheireligibilityforconcessioncardsisincludedinAppendixG.
73
Spencer,A.J.andHarford,J.(2008),ImprovingOralHealthandDentalCareforAustralians,Preparedforthe
NHHRC,p.23.
Ruralandregionalresidents
Ruralresidentshaveahigherincidenceofunfavourablevisitingpatterns(38percent)than
urbanresidents(27percent). 74 Thesevisitingpatternsincreasetheriskofpooreroral
healthinruralresidentscomparedtourbanresidents,whichissupportedbysurveydata.
Forexample,31.7percentofruralresidentshaveuntreateddecaycomparedto
24.8percentofurbanresidentsand32.8percentofruralresidentshavemoderateto
severeperiodontaldiseasecomparedto26.1percentofurbanresidents.Ofthedentate
population,18.5percentofruralresidentshavefewerthan21teethcomparedto
13.8percentofurbanresidents. 75
IndigenousAustralians
OfIndigenousAustralians,40.2percenthaveunfavourablevisitingpatternscomparedto
28.2percentofnonIndigenousAustralians.Thisdifferenceisnotasgreatasconcession
cardversusnonconcessioncardholdersacrosstheAustralianpopulation,butitis
significant.Givenexistingincomedisparitiesanddisadvantage,itislikelythatmany
IndigenousAustralianswouldbeeligibleforconcessioncards.ThetendencyforIndigenous
Australianstohaveunfavourablevisitingpatternsincreasestheriskofpooreroralhealth.
Forexample,49.3percentofIndigenousAustralianssufferfromuntreateddecaycompared
to25.3percentofnonIndigenousAustralians.Periodontaldiseaseisalsosignificantly
higherat34.2percentcomparedto26.7percentofnonIndigenouspeople.Ofdentate
IndigenousAustralians,19.6percenthavefewerthan21teeth,comparedto14.2percent
ofnonIndigenousAustralians. 76
Frailandolderpeopleinthecommunityandinresidentialcare
Australiansaged65yearsandolderhavemorefavourablevisitingpatternsthanthegeneral
population.Thisagegroupwouldappeartobeatlessriskoforaldiseasethanthebroader
population. 77 Thisreflectscaveatsthatshouldbeappliedtobroaderpopulationdata
visitingpatternsareariskindicator,butdonotaccountforriskgroupswithinacohort.
WhilethevisitingpatternsofelderlyAustraliansisgenerallyfavourable,therewouldbe
particulargroupswithinthiscohortwherevisitingpatternsandoralhealtharepoor.Older
Australiansinlowincomegroupsandresidentialcarefacilitiesmaybeonesuchgroup.
Lowincomeworkers
Surveydatashowsthatthereisalinkbetweenincomeandvisitingpatterns.Lowincome
workersaregenerallyineligibleforconcessioncardsandarenotholdersofprivatehealth
insurance.Therearevariousdefinitionsoflowerincomeworkers(sometimesdefinedas
theworkingpoor).AsubmissiontotheCouncilbytheAustralianHealthcareandHospitals
Associationindicatedthattherewere876,000(agedover15years)workingpoorearning
lessthan$924perweek. 78
74
ibid,p.23.
75
ibid,p.23andp.25.
76
ibid,p.23andp.25.
77
ibid,p.23.
78
AustralianHealthcareandHospitalsAssociation(2011),PolicyPaperonOralHealth,p.5.
Homelessness
Therearemanycausesofhomelessnessaffectingarangeofpeople.Homelessness
includes:thosewithoutshelter;peoplethatareforcedtostaywithfriends,relativesandin
hotels;andthosewholiveinboardinghousesandcaravanparkswithnoprivatefacilitiesor
lease.Thesecircumstancesmakeitverydifficultforpeopletobeemployedorleada
healthyandstablelife. 79 Dentalsurveydatadoesnotcollectvisitingpatternsandoral
healthstatusonhomelessAustralians.Giventhebroaderconcessioncardholder
arrangementsandthelargeeligiblepopulation,homelesspeoplearelikelytobeeligiblefor
theseservices.However,itmaybedifficultfordentalservicestoreachthesepeoplefora
rangeofreasons,includingthelackofafixedaddress.Theprovisionofservicestohomeless
Australiansmayrequiremobilisingexisting,newandemergingsocialassetssothatservices
aredeliveredwheretheyareneeded.
Children
Concessioncardholders
ChildrenintheconcessioncardholdergrouparethosewhoseprimarycarerholdsaPCCor
anCommonwealthGovernmentHCCandthosechildrenwhoholdaHCCthemselves. 80 The
childconcessioncardholdergroupincludeschildrenfromlowincomefamilies,homeless
familiesandthosechildrenwhoseparentsareunemployedordisabled.
Generally,childcardholdersaremorelikelytohaveunfavourableoralhealthhabitsthan
noncardholdersandarethereforeathigherriskofdevelopingoraldisease.Withregardto
frequencyofvisits,noncardholderchildrenaremorelikelytovisitadentalpractitioner
annuallythancardholderchildren.
IntheNationalDentalTelephoneInterviewSurveysfrom1994to2005,noncardholders
were18.8percentmorelikelytovisitadentalpractitioneryearlythancardholders.
Noncardholderchildrenwerealsomorelikelytovisitadentalpractitionerforacheckup
ratherthantotreataproblem.Cardholdersweregenerallyreportedashavingahigher
prevalenceofextractionsandfillings.Fortheyoungercohort,theprevalenceofpreventive
treatment(scaleandclean)declinedovertimeamongcardholdersbutremainedfairly
consistentamongnoncardholders. 81
Ruralandregionalresidents
Childrenlivinginruralandremotelocationsalsofacebarrierstodentalservices.These
includeavailabilityoforalhealthservicesmainlyfromthemaldistributionofthedental
workforce.Childrenfromruralareashaveoftenbeenfoundtohavepoorerhealth
outcomesthantheirurbancounterparts.DatasourcedfromtheNationalDentalTelephone
InterviewSurveysshowedthatchildreninruralandremoteareaswerejustaslikelyas
childreninurbanareastovisitadentalpractitioneratleastonceayearandvisitthedental
practitionerforacheckup.However,slightdifferenceswerefoundinthecourseof
treatmentreceivedbychildrenandwhensuchtreatmentwasprovided.Ingeneral,children
79
TheAustralianGovernment(2008),TheRoadHome:ANationalApproachtoReducingHomelessness,p.3
80
SeeAppendixGforalistofCentrelinkconcessioncards.
81
inruralandremoteareasweremorelikelytoreceivetheircourseoftreatmentinthepublic
sector.Additionally,adolescentsinruralandremoteareasweremorelikelytoreceive
extractions 82 andfillingsthanchildreninurbanareas. 83
Indigenouschildren
IndigenousAustralianshaveconsistentlybeenfoundtohavepooreroralhealththanother
Australians.IndigenousAustraliansaremorelikelytoexperiencetoothloss,gumdisease
andreceivelesstreatmentforcaries. 84 Ingeneral,IndigenousAustraliansalsohavepoorer
oralhealthvisitingpatterns,accessingdentalcarelessfrequentlythantheirnonIndigenous
counterparts. 85
ThepoororalhealthofIndigenouschildrenwasconfirmedthroughtheChildHealthCheck
Initiative(CHCI)undertheNorthernTerritoryEmergencyResponse,whichfoundthat
43percentofchildrenhadanoralhealthproblem.Themostprevalentproblemreported
wasuntreatedcaries(40percentofallchildren),followedbygumdisease(5percentofall
children).86
Childrenoflowincomeearners
Childrenoflowincomefamilies(inhouseholdsearninglessthan$924perweek 87 )maybe
ineligibleforpublicdentalservices,dependingonjurisdictionandage,andarelikelytobe
nonholdersofprivatehealthinsurance.Financialbarriers,particularlythecostsassociated
withpurchasingprivatehealthinsuranceandreceivingdentalserviceswithoutinsurance
benefits,placethisgroupatriskforunfavourablevisitingpatternsandpoororalhealth.
Ingeneral,childrenthathaveprivatehealthinsuranceorarecoveredbytheirparents
privatehealthinsurancepackagearemorelikelytohavefavourablevisitingpatternsandare
henceatlowerriskofexperiencingoraldisease.Ingeneral,childrenwithinsuranceare
morelikelythanuninsuredchildrentovisitadentalpractitioneratleastonceayear, 88 and
aremorelikelytovisitthedentalpractitionerforthepurposeofreceivingacheckuprather
thantreatingaproblem. 89 Uninsuredchildrenaregenerallymorelikelythaninsured
childrentoreceiveextractionsandfillings. 90
82
Inallsurveyyearsexcept2005thepercentageofadolescentsreceivinganextractionwashigherinrural
andremoteregions,butdifferenceswerenotstatisticallysignificant:Ellershaw,A.C.andSpencer,A.J.(2009),
TrendsinaccesstodentalcareamongAustralianchildren,AIHWDentalStatisticsandResearchSeries,No.51,
p.39.
83
ibid,pp.39and41.
84
AustralianHealthMinistersAdvisoryCouncil(2010),AboriginalandTorresStraitIslanderHealth
PerformanceFramework,AHMAC,p.32.
85
Jamieson,L.M.,RobertsThomson,K.,andSayers,S.M.(2010),RiskIndicatorsforSevereImpairedOral
HealthAmongIndigenousAustralianYoungAdults,BioMedCentralOralHealth,Vol10,No.1,p.10.
86
AIHW(2011),DentalHealthofIndigenousChildrenintheNorthernTerritoryFindingsfromtheClosingthe
GapProgram,p.1.
87
AustralianHealthcareandHospitalsAssociation(2011),PolicyPaperonOralHealth,p.5.
88
DentalStatisticsandResearchSeries,No.51,pp.28and30.
89
ibid,pp.3234.
90
ibid,pp.3744.
Conclusion
Nosingleriskfactororindicatorcompletelyexplainswhoismorelikelytomissouton
dentalservices.Unfavourablevisitingpatternsarepresentacrossthepopulation.While
thequestionofwhomissesoutiscomplex,therearecertaingroupsandareaswhereaccess
islowerandriskofpoororalhealthisgreaterthanthegeneralpopulation.Theseinclude
ruralandregionalresidents,IndigenousAustralians,frailolderpeopleinthecommunity,
peopleinresidentialagedcare,andhomelesspeopleandotherswithspecialoralhealth
needs.
Inbroadterms,lowincomegroupshaveahighincidenceofunfavourablevisitingpatterns
and,therefore,followadifferenttreatmentpathwhichincreasesthechanceofpoororal
healthoutcomes.Incomeplaysasignificantroleinassessingwhichpeoplearemorelikely
tomissoutontreatment,especiallyregularpreventiveservices.Socialdisadvantageisan
importantdeterminantoforalhealthaccessandstatuswithlinkstoincomeandeducational
attainment.Thispatternisevidentinboththeadultandchildpopulation.Forchildrenthe
socioeconomicstatusoftheirparentshasanimpactonwhethertheyaccessservices.
Incomeisonlyaroughproxyforwhomissesoutondentalservices.Anumberofissues
relatedtoworkforcedistributionbothwithinurbanareasandbetweenregionalareasand
urbansettingsalsoplayarole.ResidentsofruralandregionalAustraliaareatgreaterriskof
poororalhealthoutcomeswithincomeplayingarole,butwiththeaddedcomplexityof
workforcemaldistributionmakingaccessmoredifficult.IndigenousAustraliansarealsoat
greaterrisk,withaddedcomplexityofserviceaccessinremotelocations.
Introduction
Whattheearlierchaptershaveshownisthatvisitingpatternsareariskindicatorofpoor
oralhealthandthatfavourablevisitingpatterns,whichincludeayearlypreventive
checkup,canhelpreducetheriskofpoororalhealth.Inthissensereducingunfavourable
visitingpatternsandincreasingfavourablepatternscanmakeacontributiontoimproving
oralhealthacrossthepopulation.Identifyingthereasonsforpoorvisitingpatternscanhelp
determinesomeofthekeyreasonsforpoororalhealthandassistinthedevelopmentof
shortandlongtermoptionsforimprovingoralhealth.Factorsotherthanvisitingpatterns
canalsoplayarole.Thereasonsforpooraccessarecomplex,oftenbasedonstructural
issuesofaffordability,geographiclocationandtheorganisation,deliveryandfinancingof
dentalservices.
Access
Affordabilityofprivatecareadults
Accesstodentalservicesisdeterminedbyseveralfactors,includingcost,localityand
behaviour.Withthemajorityofdentalservicesprovidedintheprivatesystem,costof
servicescanbeasignificantbarrierforlowerincomeearners.TheNationalDental
TelephoneInterviewSurveyhasbeenmonitoringthenumberofadultswhoreportthatthey
hadavoidedordelayeddentalcareduetocost.In1994,27.1percentofadultsreportedan
avoidanceordelayinaccessingcareduetocostapercentagewhichremainedrelatively
constantthroughthe1990s.Inrecentyearsthishasincreasedsignificantly,withthemost
recentresultsindicating34.3percentofadultsavoidedordelayedcareduetocost.
Anothermeasureofaffordability,inwhichadultsreportwhethercosthadpreventedthem
fromarecommendedcourseoftreatment,remainedconstantfrom19942005at
20.2percentofadults. 91
Intermsofatriskgroups,46.7percentofconcessioncardholdersreporteddelayingdental
treatmentcomparedto30.2percentofnoncardholders,indicatingtheincreasedeffectof
costforlowerincomeearners.Thishasincreasedsignificantlyforbothcardholdersand
noncardholderssince1994.However,theimpactofcostonavoidingordelayingdental
carewasnotsignificantlydifferentacrossthepopulation,withverylittledifferencebetween
regionalandurbanareas. 92
Australiasdentalserviceprovision,wherebythevastmajorityofservicesareprivately
providedandfunded,providesastructuralimpedimenttolowerincomeearnersaccess.
ThisisnotuniquetoAustralia,butisacommonprobleminhealthsystemsfocusedon
91
Harford,J.E.,Ellershaw,A.C.andSpencer,A.J.(2011),TrendsinaccesstodentalcareamongAustralian
adults19942008,AIHWDentalStatisticsandResearchSeries,No.55,pp.45and49.
92
ibid,p.47.
privateserviceprovisionfordentalservices. 93 ForthevastmajorityofAustralians,the
privatesystemprovideshighqualitydentalcare,whichispartlyreimbursedandsubsidised
foraround50percentofthepopulationwithprivatehealthinsurance.Thisinpart
contributestothegoodoralhealthofasignificantnumberofAustralians.Theproblemis
forthosewhoseaccessislimitedbecauseofcostsandotherbarriers.
Accessinthepublicsectorlackoffundingandwaitingtimesforadults
Underexistingdentalsystemarrangementswherecostremainsanissue,publicdental
servicesprovideasafetynetforconcessioncardholders.However,limitedfundingforthe
publicsectorhasconstrainedaccessthroughthelownumberofservicesavailablerelative
tothenumberofindividualsneedingcare.Thishasledtosignificantwaitingtimesfora
rangeofservices,effectivelylimitingaccesstopeopleinneed.Around400,000Australians
areonpublicdentalwaitinglistswithaveragewaitingtimesofupto27monthsandsome
peoplewaitinguptofiveyears.Manypublicpatientsstartonpublicdentalwaitinglists
seekingpreventiveorrestorativetreatmentbutbecomeemergencycasesbythetimethey
receivetreatment. 94 Thesignificantwaitfordentalservicescanleadtoapiecemeal
approachtocare,withpeopleseekingtreatmentthroughemergencydentalvisits.There
arealsoalargenumberofeligiblepeopleseekingprivatetreatment.
Limitedfundingwithinthepublicsectoristheprimaryreasonforthesedifficulties.The
publicsectordentalpractitionersworkinanenvironmentwithlimitedresources,while
servicingsomeofthemostdisadvantagedpeopleinthecommunitywhooftenexperience
complexhealthproblems.Thelackoffundingexacerbatesworkforcepressure,with
difficultyrecruitingandretainingdentalpractitionersgiventheincentivestoworkwithin
theprivatesectorinstead. 95
Theoralhealthstatusofpublicpatientscomparedtothegeneralpopulationisconsiderably
worseacrossarangeofindicators,includingperiodontaldiseaseandhavingfewerthan
21teeth. 96 Fundingconstraintsandwaitingtimesmaybecontributingfactorstopoorer
oralhealthofpublicpatients.
Lowincomeearners
Accessandaffordabilityforservicesarealsofeltacrossthewidercommunity,extendingto
thosenoteligibleforpublicdentalcare.Manyofthesearelowincomehouseholdswhose
financialcircumstancesmakethemineligibleforpublicdentalservicesbecausetheydonot
qualifyforconcessioncards,yettheirincomeisinsufficientforthemtoaccess
comprehensivedentalservicesintheprivatesystem.TheAustralianCouncilofSocial
93
Leak,J.L.andBirch,S.(2008),Publicpolicyandthemarketfordentalservices,CommunityDentistryand
OralEpidemiology,p.287295.
94
AustralianHealthcareandHospitalsAssociation(2008),PolicyMonograph2008:OralandDentalHealth,
p.37.
95
Leak,J.L.andBirch,S.(2008),Publicpolicyandthemarketfordentalservices,CommunityDentistryand
OralEpidemiology,pp.287295.
96
Brennan,D.S.(2008),Oralhealthofadultsinthepublicdentalsector,AIHWDentalStatisticsandResearch
Series,No.47,p.vi.
Service(ACOSS)estimatesthat23percentofAustralianadults(2.3millionadults)not
eligibleforpublicdentalcaredelayedoravoidedtreatmentbecauseofcost. 97
Access(AvailabilityofServices)
ThegeographicsizeofAustraliaandthedistributionofitspopulationplacespeoplein
regionalandremoteareasatadisadvantageinaccessingarangeofservices,including
dentalcare.Thisisnotuniquetodentalservicesbutabroaderstructuralproblemthat
regionalandremoteresidentsfacewhenaccessingarangeofhealthservices.
Aswithsomemedicalprofessionals,thedentalworkforceisunevenlydistributedacross
Australia.ThesupplyofdentalpractitionersinregionalandremoteAustraliaissubstantially
lowerthaninurbanareas.Eveninlocationswheredentistsareavailable,accesscanbe
affectedbytheavailabilityoftransportanddistancetoservices,aswellassocioeconomic
issues. 98
StructuralimbalancesinworkforcedistributionarehighlightedinARCPOHworkforcedata.
TheDentalLabourForceCollection2006,showedanincreaseinthenumberofpractising
dentistsper100,000peopleacrossallstatesandterritoriesbetween2003and2006.
PractisingdentistsinMajorCitiesincreasedby11percent,butdeclinedinregionaland
remoteareas.Withregardtoallieddentalpractitioners,whichincludedentalhygienists,
dentaltherapists,oralhealththerapistsanddentalprosthetists,workforcedistributions
variedslightlybetween2003and2006:
dentalhygienistspractisingrateshowedadeclineinouterregionalareas;
dentaltherapistspractisingrateacrossallremotenessareasdecreased;and
dentalprosthetistsinthissametimeperioddemonstratedadecreasingpractisingratein
allareasexceptinnerregional.
Fororalhealththerapists,where2006isthefirstyearwheretheyarereportedon
separately,therearenocomparisonswithearlierpointsintime.
Whileaddressinggeographicdistributionamongpractisingdentistsisparamount,the
imbalancesinotherdentalpractitionersalsoneedstobetargetedinanyremedialactivities.
Behaviour
Behaviourcanhaveasignificantinfluenceonoralhealth.Therearearangeofcomplex
socialandbehaviouralchangeswhichcouldleadtolongtermimprovementsinoralhealth
orlongtermdeclinesacrossapopulation.Improvementsinoralhealthmaybereversedby
significantsocialchangesinbehaviourornewfoodproductswhichresultinchangesindiet.
Forexample,increasedbottledwaterconsumptionmayhaveaninfluenceontheoral
healthbenefitsotherwisegainedfromwaterfluoridation. 99 Theseinfluencesarecomplex
97
AustralianCouncilofSocialService(2008),Fairdentalcareforlowincomeearners:nationalreportonthe
stateofdentalcare,p.2.
98
NationalRuralHealthAlliance(2005),PublicdentalserviceinAustralia:whoseresponsibility?,p.25.
99
Mills,K.,Falconer,S.andCook,C.(2010),FluorideinstillbottledwaterinAustralia,AustralianDental
Journal,Vol55,Issue4,pp.411416.
becausetheyarelinkedtootherbehaviourswhichmayalsoinfluencetheoutcome.For
example,bottledwaterconsumptionmaynotbeasinfluentialinpeoplewhovisitadental
practitionerregularlyandhaveahealthybalanceddiet.Forchildreninparticular,
behaviouralinfluencescanestablishlongtermpatternswhichcanaffecttheiroralhealth
intoadulthood.
Dietandbehaviour
Dietandbehaviourcanhaveanimpactonoralhealth.Highacidandsugaryfoodsandpoor
oralhealthhabitscanleadtoanincreasedincidenceofcariesandtootherosion.The
AustralianDentalAssociation(ADA)discussestheestablishedlinkbetweenhighsugarand
aciddietsandcariesandtootherosionandrecommendsthereductioninconsumptionof
thesefoods. 100 Otherbehaviourssuchassmokingandhighalcoholconsumptionincrease
theriskofperiodontaldisease,toothlossandoralcancer. 101
Fearofthedentist
Dentalfearandanxietycancontributetoanindividualvisitingadentistinfrequently,with
thosewhoaremostanxiousleastlikelytovisitadentist. 102 Lessfrequentvisiting,visiting
onlywhenthereisaproblemandcancellingappointmentsortreatmentleadstogreater
treatmentneedsinthelongterm. 103 Additionally,lowerincomeisanindicatorfordental
anxiety,particularlyintermsofaffordingthecostoftreatment,andthiscanleadto
decreasedaccesstodentalcare. 104
Children
Access
Acrossthepopulationaccessforchildrenappearslessofaproblemthanaccessforadults.
Around80percentofchildrenaged517visitthedentisteveryyear,indicatingamuch
morefavourableratethantheadultpopulation. 105 Evenmeasuresofaffordabilityarea
relativelylow,witharound10percentofparentsindicatingthatthelastdentalvisithad
beenafinancialburden. 106 Thisfigurewasslightlylowerfor512yearsoldsandhigherfor
1217yearolds,perhapsreflectingmorepotentialforcomplextreatmentinolderchildren.
Foradultswaitingtimesforpublictreatmentaresignificant,whilethesamewaitsarenot
experiencedbychildren.Childrenaregivenpriorityinaccessingpublicdentalservices,
althoughtherearewaitingtimesofaroundtwoyearsforextractionsunderageneral
anaestheticinpublichospitals.
100
AustralianDentalAssociation(2010),PolicyStatement,CommunityOralHealthPromotion:Dietand
Nutrition,section2.2.2.
101
AustralianDentalAssociation(2010),PolicyStatement,CommunityOralHealthPromotion:Tobacco,section
2.2.4.
102
RobertsThomson,K.F.andSlade,G.D.,(2008),Factorsassociatedwithinfrequentdentalattendanceinthe
Australianpopulation,AustralianDentalJournal,Vol.53,pp.358362.
103
Armfield,J.M.,Slade,G.D.andSpencer,A.J.(2007),DentalfearandadultoralhealthinAustralia,
CommunityDentistryandOralEpidemiology,Vol.7,pp.200230.
104
Armfield,J.M.(2010),TheextentandnatureofdentalfearandphobiainAustralia,AustralianDental
Journal,Vol.55,pp.368377.
105
106
ibid,pp.5761.
Onthesurfacetheaccessissueappearstoindicatelowerriskoforaldiseaseforchildren.
However,theCouncilviewsthisareaasmorecomplex.Earlierchaptersshowedthatthe
burdenofdiseaseintermsofcariesisbornebyaminorityofchildren.Withinthisgroup
theremaybesignificantareasofsocialdisadvantagewhichshouldbeaddressed.
Parentaleducationandawarenessfearofdentistandlackoforalhealtheducation
Theabilityofparentstoprovideappropriateoralcare,suchastoothbrushing,canhavean
impactontheoralhealthoftheirchildren.Lackofparentalconfidenceprovidingand
modellingsuchbehavioursisoftenlinkedtotheirlackofknowledgeoftheriskfactorsfor
earlychildhoodcaries(toothdecay). 107 Parentalrolesandresponsibilitiesinensuring
regularvisitstodentistsorclinicsalsoplayarole.Increasedsugarintakeandchangesin
dietmayalsocontributetoincreaseddecay.Astudyofchildrenwithcaries(aged47)
foundthattheyhadahighermedianintakeofsoftdrinksthanchildrenwithoutcaries. 108
Oralhealthpromotionandeducationcanhelpmitigatesomeofthisrisk.Asoralhealth
statusinchildhoodisoftenapredictoroffuturedentalproblems,poorguidancebyparents
withregardstooralhealthcansetchildrenuptoexperiencepoororalhealthforlife.
Conclusion
Eventhoughparticulargroupsareatgreaterriskofpoororalhealththanthegeneral
population,riskfactorsandpoororalhealtharepresentinallgroupsacrossthepopulation.
Thisshowsthatacomplexinteractionoffactorscanleadtopoororalhealth.Income
distributionhelpsillustratethispoint:lowerincomegroupsaremorelikelytohave
unfavourablevisitingpatternsthanhigherincomesgroups,yetthereareasignificant
proportionofpeoplewithhigherincomesthathaveunfavourablevisitingpatterns.Unlike
lowerincomeearnersvisitingpatterns,thiscannotbesingularlyexplainedbyincomealone
andsootherreasonsmustbepresent.Thisisnottoexcludeincomeandcostasanissue,
butmoretoexplainthatthecausesofpoororalhealtharemorecomplexthananinitial
assessmentmightreveal.Thisindicatesthattherearestructuralandsocialaswellas
individualfactorsaffectingaccess.Dietandbehaviourshapedandmaintainedbysocial
circumstancesacrossthewholepopulationalsoplayaroleindeterminingpoororalhealth.
Surveydatashowsthatcariesoccuracrossthewholepopulationandthattheiroccurrence
isnotcloselylinkedtoincome.However,whetherandhowcariesaretreatedisclosely
linkedtoincome.Thisisevidentinpatternsofuntreateddecaywhicharefargreaterinlow
incomegroups.Whatgenerallyappearstohappenisthatthosewithfavourablepatterns
accessapreventiveregimeandrestorativetreatmentearlier,whilethosewithunfavourable
patternsaccesscarelateroncethecarieshaveprogressedandmorecomprehensiveand
costlytreatmenttosaveatoothisrequired.Theincreasedcostofsavingatoothshapesthe
decisiontonegotiatethealternativetreatmentofatoothbeingextracted.Levelofincome
andotherbarrierstoaccesshaveasignificantinfluenceonoutcomes.
107
Gussy,M.G.,Waters,E.B.,Riggs,E.M.,Lo,S.K.andKilpatrick,N.M.(2008),Parentalknowledge,beliefsand
behavioursoforalhealthoftoddlersresidinginruralVictoria,AustralianDentalJournal,Vol.53,pp.5260.
108
NSWCentreforPublicHealthandNutrition(2009),SoftDrinks,WeightStatusandHealth:AReview,p.22.
Therearedifferencesinaccessbetweenadultsandchildren,withsomeofthekeyaccess
problemsexperiencedbyadultsnotasextensiveforchildren.Childrenhavefarbetter
visitingpatterns,whichprovidesomeindicationofwhychildrensoralhealthhasimproved
overthelastseveraldecades.However,withtheburdenofdiseasebornebyasmall
numberofchildren,andrecentincreasesincariesfollowingyearsofimprovement,
resourcesneedtobefocusedonthosechildrensufferingfromoraldisease.Aswellasthis,
investmentsneedtoensurethathighvisitingpatternsaremaintainedtosupportthegood
foundationoforalhealthforthe80percentofchildrenwithregularaccess.Anydeclinein
theseareasrisksproblemsandincreasedcostsinthefuture.
Goal
Inordertoproperlyframetheproposals,wehavedevelopedalongtermgoal.Thiswill
helpensurethatthedevelopmentandimplementationofdentalproposalsarepartofan
overallframework.WhileGovernmentprioritiesregardingtheconstraintsofthecurrent
fiscalenvironmenthavedeterminedtheshorttermgoalsoftheCouncilanditsproposals
forthe201213Budget,thebroadergoalwillhelptoguidethinkingaroundthefutureof
dentalhealthinAustralia.
TheCouncilagreedthatthefollowingstatementreflectedthelongtermgoalfordental
services:
Anintegratednationaloralhealthsystem,aspartofthebroaderhealthsystem,that
providesequitableaccessforpeopleinAustraliatoprevention,promotionandclinically
appropriate,timelyandaffordableoralhealthcare.
Thegoalembodiestheprincipleofuniversalaccess(equitableaccesstoservicesacrossthe
population)whichwasoneoftheoverarchinglongtermissuesconsideredbytheCouncil.
CouncilDiscussionsonUniversalDentalCare
TheCouncilsdiscussionofaparticularmodelforauniversalschemeintheshortto
mediumtermdidnotreceiveunanimoussupportfromallmembers.Thiswaspartlydueto
concernsaboutwhetherauniversalschemewouldmeetthedentalneedsofallAustralians,
whatitwouldprovidebywayofservices,whatrulesitmayimposeonpractitioners,funding
concernsandanyimpactonsomecurrentservicearrangementsthatareworkingwell.
Manymemberssupportthedevelopmentofauniversalschemebecauseitisseenasan
appropriatewaytodealwiththestructuralinequitywithincurrentarrangementswhere
significantnumbersofpeopleareexcludedfromaccessingservicesbecauseofcost.This
particularuniversalmodelwouldallowaprogressivetaxarrangementtoincreaseand
redistributedentalexpendituremoreequitablythroughthesystem, 109 withtheaimof
improvingaffordabilityandaccessingeneral.
Thedifferencesofopiniononthedesignofauniversalmodelwerebasedmoreonpractical
issuesrelatingtoimplementation.However,thereisnotonlyveryhighsupportinthe
communityforcreatinguniversalaccess,butalsoanacceptancethatincreasedrevenueis
required. 110 Itwasacknowledgedthatanageingpopulationanddecreasededentulism
wouldplacepressuresonfundingfromtheoutset.Inaddition,auniversalschemewouldbe
109
MrLongshawnotedthattherewasnoinformationpresentedordebatedbytheCouncilassociatedwitha
progressivetaxarrangement,andthatsuchanapproachhasnotbeenfullyconsideredoragreedbythe
Council.
110
DentalHealthServicesVictoria(2011),Australiancommunityattitudestodentalservices:researchfindings,
DHSV,Melbourne.

difficulttoimplementoverashortertimeframe,givensupplyconstraintswithintheexisting
system.Therearemanyareaswherecapacitywouldneedtobeimprovedbeforea
universalschemecouldoperate.Maldistributionofserviceproviderswouldstillbeanissue,
asitisforMedicarefundedhealthservices,inregionalandremoteAustraliaandacrossthe
system.
Giventheabove,andtheshorttimeframeforthisreport,theCouncildidnotventureintoa
detailedconversationaboutaparticularuniversalmodel.However,ratherthansupporting
aparticularstyleormodelofuniversality,theCouncilwasinagreementontheprincipleof
universalaccess.ThisreflectsaviewthatthelongtermgoalshouldbeforallAustraliansto
accessaffordabledentalcarewithinacceptabletimeframeswhentheyneedit.This
principleofuniversalitycouldbeappliedinmanyways,includingadesignwhichincludesa
mixofthebestaspectsofexistingarrangements,anexpansionofthesearrangements,
alongwithothermechanismsforthosewhofindaccessaproblem.
TheCouncilbelievessuchanapproachisappropriatebecauseitprovidesflexibility,
accountsfordivergentviewsandconsidersthelongtermnatureofthisgoal.Inthe
Councilsview,thelongtermnatureofthisgoalmakestheendorsementofparticular
modelsredundantatthistimebecauseitcannotaccountforlongtermchangesinthe
dentalsystem.ItwouldbemorepracticalfortheGovernmenttoconsideritspreferred
modelofuniversalityacrossthepopulationwhenitconsidersitappropriate.Thiswould
meanthatitsdesigncouldmoreappropriatelyandeffectivelytakeaccountofchangesto
thesystem.
Anumberofactionswouldsupporttheachievementofthisgoalandarediscussedbelow.
TheseaspirationsarebasedontheprinciplesintheReport.Notallprincipleshavebeen
listedseparatelybecauseinsomecasesanaspirationwillcoverseveralprinciples.In
additionsomeprinciplescanonlybemetbyachievingseveralaspirations.
AspirationOne

Ensuringoralhealthisconsideredpartofgeneralhealthbyincludingoralhealthas
partofthehealthreformprocessesandthehealthcaresystem

TheNationalOralHealthPlan200413highlightstheneedtorecognisethatoralhealthisan
integralpartofgeneralhealth. 111 Dentistryemergedalongside,butindependentof,the
medicalprofession.Dentalschoolsandhospitalsprovidedprofessionalsupportandclinical
experience,likethebroadermedicalprofession,butoperatedindependently.Thismay
havecontributedtotheseparationoforalhealthfrombroaderhealthinboth
onthegroundservicesandinpolicyandfundingterms. 112
111
Healthymouths;healthlives:AustraliasNationalOralHealthPlan20042013(2004),Preparedbythe
NationalAdvisoryCommitteeonOralHealth,p.vi.
112
SpencerA.J.(2001/02),Whatoptionsdowehavefororganising,providingandfundingbetterpublicdental
care,AustralianHealthPolicyInstituteCommissionedPaperSeries2001/02,p.5.
Inpracticalterms,thecommunitysviewoforaldiseaseanditsconsequences,including
infectionandpain,arenotvieweddifferentlytootherbroadermedicalconditions.Aperson
isunlikelytoseemuchofadifferenceintermsoftreatmentandreliefbetweenatoothache
andsevereearache.Yethealthpolicytreatstheseconditionsverydifferently. 113
TheCouncilbelievesthattheongoingpolicyandhealthsystemseparationbetweenoral
healthandgeneralhealthiscontributingtoalackofdirectionandfocus.Seeingoralhealth
andgeneralhealthtogetherisasensibleprinciplewithpracticallongtermbenefits,
includingbenefitstothepatient.Forexample,oraldiseaseisassociatedwithmanydiseases
andsimilarcausalfactorscanoperateindentalasingeneraldisease,suchastobaccoand
alcoholconsumptionanddiabetes.Theselinksshouldberecognisedwithinthesystemby
ensuringoralhealthisintegratedintotheworkofexistinghealthpolicyagenciessuchasthe
AustralianNationalPreventiveHealthAgency.
Includingoralhealthreformaspartofthewiderhealthreformprocessescouldhelpto
alleviatepressuresaroundaccessandcost.Itisforthesereasonsthatoralhealthshouldbe
integratedintogeneralhealth.Practicalintegrationcouldinvolveservicemappingvia
MedicareLocalsandpracticalsupportforserviceproviderstoimplementITandinformation
managementsystems.
AspirationTwo

Improvingequityandaccesstodentalservices

ItiscleartotheCouncilthatequityandaccessarekeyissuesforimprovingoralhealthin
Australia.Accesstoservicesisinfluencedbyarangeofcomplexfactors,withaffordability
forprivatecareandwaitingtimesforpubliccaresignificantplayers.Maldistributionofthe
servicesandworkforceisalsoakeyinfluence.Adoptingalongtermaspirationtoimprove
accesstodentalservicesprovidesaguidingprincipleforpolicyandprogramdevelopment
andwillhelpdesignresponseswhicharefocusedonthekeydeterminantsofaccess.
TheCouncilconsidersthatastartingpointforthisaspirationisanacknowledgementof
whataccessmeansandwhatexpectationsneedtobemetintermsofpatternsofvisiting
andtreatment.Currently,therearenominimumstandardsacrossAustraliaforthe
provisionofdentalcare,includinghowoftenpeopleshouldaccessacheckup.Becauseof
this,somepeoplemaynotvisitadentistregularlyandonlyattendforemergency
treatment.Weacknowledgethatstandardsalonewillnotimproveaccess.However,
definingthisprovidesagoalforthedevelopmentofpolicy.Thesegoalscouldfocuson
standardsofaccess(minimumvisitingpatterns)andstandardsformechanisms(affordability
andworkforcenumbers)whichwouldhelpimproveaccesstominimumacceptablevisiting
patterns.ThiscouldincludesettingagoalthatAustraliansseekingcareshouldhaveaccess
toadentalcheckupandpreventiveserviceseverytwoyearsatleast.
113
ibid,p.5.
Thesetargetscouldbemodified,butthekeyissueisthatwithoutageneralunderstanding
ofwhatconstitutesanacceptablevisitingpatternandwhatareasneedtobetargetedto
achievethis,outcomesonimprovingaccesscouldbelessthandesired.
Overthelongterm,improvingequityandaccesswillrequireaconcertedeffortinanumber
ofareassomewithdifferentcausesanddifferingsolutions.Atthisstage,lowerincome
affordabilityforprivatesectorservices,longwaitingtimesforpublicgeneraltreatmentand
workforceconstraintsinruralAustraliaarehavinganimpact.
AspirationThree

Investinginthefutureoforalhealththroughdentalprogramsforchildren

Existingsurveydatashowsthataround80percentofchildrenhavevisitedadental
practitionerintheprevious12months.Thismaycreatetheimpressionthatchildrenareat
farlessriskthanadultsoforaldiseaseandthatafocusonchildrenmaynotbenecessary,
givenlimitedresources.TheCouncilhasstrongviewsonthedentalhealthofchildren,with
astrongbiasforexpandingandcontinuingservicestochildren.Theimprovementinthe
oralhealthofchildrenovermanydecadesmustcontinuebecauseofthestrongfoundation
itprovidesforfutureoralhealthinAustralia.Oralhealthneedstobeinitiatedinchildhood
whereoralhealthisshaped.Dentaldiseaseinchildhoodisapredicatorofdentaldiseasein
adulthood.
TheCouncilisconcernedthatrecentincreasesindentalcariesinchildrenmaysignala
changeindirectionfortheworse.Ifadeclineinoralhealthofchildrenbecomes
established,childrenwillrequireincreasedservicesinthefuturethiswillhaveimpactson
longtermcostsintoadulthood.TheCouncilalsobelievesthatthegoodoralhealthofall
childrenshouldbeanunderlyingprincipleofanydentalsystem,withchildrenentitledto
livefreefrompainanddiscomfortforconditionswhicharelargelypreventablewithoral
healthpromotion,goodoralandgeneralhealthhabitsandaccesstoservices.
PublicdentalprogramsforchildreninAustraliaarecurrentlyprovidedbythestatesand
territories.Eligibilityfortheseprogramsdiffersbetweenjurisdictionsandcurrent
infrastructurecanlimitthenumberofchildrenseeneachyear.Furthermore,differing
definitionsofwhatagebracketdefineschildrencanmeanthatsomeyoungpeoplebelow
theageof18areunabletoaccesspublicdentalservices.
Easilyaccessibledentalprogramsforchildren,withappropriateinfrastructure,wouldallow
theentirechildpopulationtoaccesstreatment.Bytreatingallchildrenbelowtheageof18,
goodoralhealthislikelytobeattained,leadingtoimprovedoralhealthoutcomesfortheir
futureasadults.Clearly,healthpromotionwillplayanimportantroleinthisapproachand,
giventhecommonriskfactorsanddriversofobesity,healthpromotionshouldbeintegrated
acrossthesetwoissues(seebelow).
Longterminvestmentinchildrenandyoungpeopleisanimportantpartoflongtermoral
health.
AspirationFour

Supportingoralhealthpromotionacrossthepopulation

TheCouncilviewsoralhealthpromotionasanintegralpartofimprovingoralhealthacross
thepopulation.TheCouncilsviewoforalhealthpromotionisbroad,focusingon
integratingoralhealthpromotionacrossarangeofactivitiesandlevelsandusingasimilar
multidimensionalapproachappliedsosuccessfullytotacklingroadaccidents,smokingand
HIVinAustralia.Oralhealthpromotionunderpinsthelongtermimprovementsinoral
health.Theotheraspirationsandoralhealthpromotionareintegrallylinkedandtogether
formpartofabroaderstrategyforimprovementsacrossthepopulation.Thereasonfora
broaderperspectiveoforalhealthpromotionistoimproveeffectivenessandlongterm
outcomes.Forexample,promotionwithoutimprovedaccesstoserviceswouldbeless
effective,becauseindividualscannotaccesspreventiveortreatmentservices.
TheNationalOralHealthPlan200413highlightedthatoralhealthpromotionand
preventionneedstoaddressoralhealthatboththeindividualandpopulationlevels,based
ontheidentifiedneedsofthecommunity.Thisincludes:extendingfluoridationofwater
supplies;timelyaccesstoprimarycare;promotingoralhealth;acommonriskfactor
approach(commonoralandgeneraldiseaseriskfactors);advocacybyoralhealthproviders;
anduptodatedatatohelpwithplanningandevaluation. 114 Promotingoralhealthshould
startatayoungage,beaimedatparentsandchildrenandbeintegratedintoeducation
systemsandservicedeliverymechanisms.Itshouldextendbeyondoralhealthmessages
andbelinkedintobroadergeneralhealthpromotionwithlinkstooralhealth,suchasdiet,
exerciseandsmoking.Bothpopulationoralhealthactivitiesandserviceprovidersshould
playarole.
Anationaloralhealthcampaign,coordinatedwiththestatesandterritories,thatuses
successfuloralhealthmessagingandisunderpinnedbysocialresearchisrecommended.
Thisnationalcampaignwouldalsolinktothegeneralhealthpromotionactivitiesofthe
AustralianNationalPreventiveHealthAgency.
AspirationFive

Clarifyingrolesandresponsibilitiesofthestatesandterritoriesandthe
Commonwealth

TheseparationofgovernmentresponsibilitiesfordentalservicesinAustraliahaslargely
seenstatesandterritoriesprovidepublicdentalservicestoeligiblelowerincome
populations,whilethemajorityofthepopulationisservedthroughtheprivatesystem.The
Commonwealthrolehasbeensporadic,withvaryingformsofinterventionlargelythrough
fundingandsubsidiestosupportaffordabilityofservices.Oneexamplewastheprevious
114
HealthyMouths,HealthyLives;AustraliasNationalOralHealthPlan200413,(2004),Preparedbythe
NationalAdvisoryCommitteeonOralHealth,p.16.
CDHP,whichstartedin1994andwasclosedattheendof1996.Fundingforthisprogram
improvedaccessforpublicpatients,butwhenfundswerewithdrawnin1996waitingtimes
increasedagainandpublicpatientsaccesstoservicesdeclined. 115 Thissporadicapproach
hasinhibitedtheabilitytoimprovethelongtermoralhealthofpublicpatients.In
combinationwithfundingconstraintswithinstateandterritorybudgets,publicpatient
accesshasremainedaproblem,withsubsequenteffectsonoveralloralhealth.Waitinglist
numbersandwaitingtimeshavedecreasedinrecentyearsfollowingsomeincreasesinstate
andterritoryexpenditure.However,accessisstillfarpoorerthanwhentheCDHPwas
operatingin199496.
TheCommonwealthhasinrecentyearsbecomeadominantfunderofdentalservices.
Someofthisistheresultoflegacyprograms.Thisistobeexpected,withchangesin
governmentleadingtovaryingareasoffocusandfunding.Evenchangestolegacy
programs,consistentwiththeGovernmentspriorities,wouldleavefundingallocatedacross
arangeofoverlappingpriorities.Improvedintegrationoftheseprograms,linkedtoclear
objectivesandlinesofresponsibility,shouldbeconsideredaswellasintegrationwithstate
andterritoryprogramsandresponsibilities.
TheCouncilbelievesthatwithlimitedresources,effortsneedtoreduceduplicationand
makeeffectiveuseoflimiteddollars.Thiswouldbeginwithachangeinapproachwith
moreclearlydefinedresponsibilitiesatalllevelsofgovernment.TheCouncilseesthestate
andterritorysystemasthefoundationofpublicdentalserviceprovision.Thestatesand
territorieshaveparticularskillsandefficienciesintheorganisation,deliveryandfundingof
publicdentalservices.Thisresponsibilityshouldcontinuealbeitwithincreasedfunding.
TheCommonwealthsrolehasbeenasafunderofdentalservicesratherthanaservice
provider.Withacleardelineationofresponsibilitiesintermsofserviceprovision,the
questionliesmoreinfocusingfundingresponsibility.Forexample,statesandterritoriesare
fundingpublicdentalservicesforbothchildrenandadults,whilecurrentCommonwealth
programs,theCDDSandtheMTDP,fundrespectivelyadultsandteenagechildren.Asatthe
timeofwriting,thecurrentGovernmentspolicyistoabolishtheCDDSandintroducea
CDHP.
TheCouncilagreesthatforpublicdentalservices,onelevelofgovernmentshouldbe
responsiblefordelivery.Inaddition,fundingshouldbedirectedthroughasinglefunding
poolforadultsandasinglefundingpoolforchildrenwhichshouldimprovecoordination
andintegration.
ClarifyingtherolesofthestatesandterritoriesandtheCommonwealthisessentialin
effectivelydirectingfundingtothosepopulationgroupsidentifiedearlierandtailoring
programstomeetdemandandensureaccess,notjustentitlement,throughoutreach
programsandcollaborationwithothercommunitybasedservices.Thisisalongtermgoal
thatiscrucialinmakingeverydollarworkbyfocusingfundsonthemostefficientservice
deliverymechanism(s).Inanenvironmentwherefiscallimitationsareparamount,sparse
resourcescouldbedirectedtotheneedyandfocusedonimprovementsinaccesstodental
115
Dooland,M.,(1998),TheCessationoftheCommonwealthDentalHealthProgram,NewDoctor(Winter),
pp.48.
services.Alongtermincreaseinresourcesandcommitmenttopublicdentalserviceswould
makeasignificantcontributiontoimprovingchildandadultoralhealthandbuildan
excellentfoundationforfurtheroralhealthinitiatives.
AspirationSix

Enhancingpublicdentalservicesandacademicandoralhealthcentres

PublicdentalservicesarecrucialinhelpingimprovetheoralhealthofAustralians.Without
awellfunctioningpublicdentalsector:oralhealthforAustraliansonlowincomeswill
continuetoworsen;trainingoralhealthpractitionerswillbecomemoredifficult;andoverall
costtothesystem,throughincreasedprivateoutofpocketexpenditure,willcontinue.
AroundonethirdofAustraliansareeligibleforpublicdentalservices.Onlyaminorityof
concessioncardholdersrelyonpublicdentalservices.However,thereisasignificant
numberwhoseonlypointofaccessisapublicdentalclinic.TheCouncilwouldliketo
highlightitssupportforthepublicsectorandtheimportantfoundationitprovidestothe
wholedentalsystemthroughpopulationoralhealthpromotionservicestopublicpatients
andtrainingandeducationofthedentalworkforce.Thepublicdentalsectorprovides
servicestohighneedspatientsand,forthelimitedfundingavailable,workshardatservice
delivery.
TheCouncilrecognisesthatwaitingtimesforservices,especiallyforadults,are
unacceptablylong,withapublicsystemhighlyskewedtoemergencyandurgentcare,which
underminesaccesstotimelypreventivecareandtoearlyintervention.Butattentionneeds
tobefocusedonthekeycause,whichisalackoffunding,notwithstandingCommonwealth
andstatesincreasingfundingoverrecentyears.Thishasbeenablindspotforall
governmentsacrossAustraliaoverdecades.TheCouncilbelievesthatthepublicsectoris
underfundedandthatlongterminvestmentwillimproveaccess.Thiswillalsoshiftfocus
fromcrisismanagementandmitigationofcomplexoraldiseasetooneofpreventionand
morecomprehensivedentalcare,leadingtoanimprovementintheoralhealthofpublic
patients.
Becauseoftheproblemsinthepublicsector,theprivatesectormodelsofdeliverycanbe
seenbysomeassuperiorandmoreefficient,whilethepublicsectorperceivedaslow
qualityandinefficient.TheCouncildoesnotsupportthisproposition.Privateandpublic
sectormodelsshouldnotbeviewedaseitherinferiororsuperior,butratheras
complementary,witheachplayingaroleintheoralhealthofAustralians.TheCouncil
wantstomaintaintheexistingstrengthsofthesystemandensurethattheprivatesector
continuestoprovideservicestoAustralians,whileatthesametimefocusingresources
wheretheyareneededinthepublicsectorsothatboththenumberofpeopleandthe
scopeofpracticeareexpandedtomeetneedmoreefficiently.
Focusingresourcesonbothoralhealthprofessionalsandinfrastructurewillhelpretainand
attractpublicsectorprofessionals,contributetooveralltrainingofneworalhealth
practitionersand,throughinfrastructuresupport,increasethenumberofservices.
RuralandregionalAustraliansaremorereliantonpublicdentalservices,especiallywhere
noprivateservicesareavailable.Theseserviceswillneedtobedevelopedbyencouraging
theworkforcetoworkinareasoutsidewellservicedmajorcitiesandbyproviding
appropriateinfrastructuresothattheoralhealthoutcomesforAustralianslivingin
underservicedcitiesandinregionalandremoteareaswillbeimproved.
AspirationSeven

Buildingworkforcecapacityforbetterservicedeliveryandimprovedaccess

TheCouncilunderstandsthatequityandaccesswillbedifficulttoachieveunlessworkforce
supplyanddistributionisconsidered.Providingtimely,affordableandappropriateoral
healthcaretoallAustraliansrequiresanappropriatedentalworkforce.Maldistributionof
thedentalworkforceremainsakeyproblemforruralandregionalAustraliaanissue
whichisconsistentacrossthehealthsystem.Maldistributionbetweensectorsandsettings
isalsoasignificantissue.Asaresultofworkforcemaldistribution,servicedeliveryfor
certaingroupsisinsufficienttomeetcurrentneedsandcanimpactonoralhealthoutcomes
forthesepopulationgroups.
Improvingworkforcecapacityandflexibilityisessentialtomeetingexistingandincreasing
servicedeliverydemands.Thereisaneedforanadequatenumberofappropriately
educatedandskilleddentalpractitionerswhocanassistinimprovingtheefficiency,
productivityandresponsivenessofthedentalsystem.Thisincludesanappropriatemixof
dentalpractitionersacrossthepublicandprivatesectorsandacrossgeographicallocations
tohelpprevent,identifyandtreatoralhealthconditions.Increasedfundingforservices
alonewillnotnecessarilyimprovethissituation.Moreflexibleuseofdifferentoralhealth
practitionersshouldbeencouraged.Workforceincentivesandincreasedsupportforpublic
sectorserviceswillbeimportant,aswillsupportforacademicandclinicalstafftoeducate
andtrainthedentalworkforce.
Atpresent,largernumbersofdentalpractitionersworkinurbanareasasopposedtorural
andremoteareas.ThishasimplicationsforaccesstodentalservicesforAustralianswho
liveoutsideurbanareas.Giventheincreasingnumberofdentalpractitionersgraduating
eachyear(andsomefromruraldentalschools),thereisthechancethatmorewouldbe
willingtoworkinrural,regionalandremoteareas.Withoutconcertedeffortthisoutcome
isnotassured.Apipelineapproachwithmultiplestrategieswillberequiredtosupport
workforcetomovetoareasofunderservice.Thisincludesrecruitmentofmarginalised
groups(suchasthroughPuggyHunterMemorialScholarshipsandaffirmativeruralentry
schemesforalldentalprofessionals);supportedruralclinicalplacementsandsupportfor
dentalacademicswithinUniversityDepartmentsofRuralHealthandRuralClinicalSchools;
andsupporttoprovidedentalgraduateswithopportunitiestomovetoregionalareas
(accommodationandacademicsupport).
Followinggraduation,byprovidingincentivesfordentalpractitionerstoworkoutsideof
capitalcities,throughschemessuchasthoseprovidedtomedicalpractitionerswhoworkin
ruralareas,itmightbepossibletoincreasetheoverallnumberofdentalpractitioners
practisinginorservicingruralareas.Additionally,maximisingthescopeofpracticeof
dentaltherapists,oralhealththerapistsanddentalhygienists(withappropriateDBA
approvedformaleducationandtrainingprograms)andensuringthatalloralhealth
practitionerscanworktothefullscopeinwhichtheyarecompetent,whichmayallowthem
toprovidetreatmenttomorepeople,notingthatthiswouldneedtobeconsideredbyHWA
andAHPRA.Thismayalleviateaccesspressuresforruralandremoteareasbyincreasing
theuseofthewholedentalworkforce(althoughthereisnoevidencetosupportthe
argumentsthatthisisnotalreadyoccurring).
Innovativeworkforceinitiatives,notnecessarilylimitedtoincreasingthesupplyoforal
healthpractitioners,willneedtobeexplored.Thiscouldincludeconsiderationof
appropriateincentivesforthewholeworkforce,bothfinancialandnonfinancial.Service
deliverymodelsforruralandremoteareas(suchasmobileservices)willneedinfrastructure
support.Thiscouldincludehubandspokemodelswithtrainingandresearchascore
elements.Thiswillprovideopportunitiestotraindentalpractitionersinateambased
environment.
Furthertargetedresearchisrequiredtoconsiderthefactorsthatinfluencedental
practitionerstoworkinruralandremotespecialistareas.Thisworkcanbeintegratedwith
theexistingwiderhealthworkforceinitiativesandknowledgebutthelevelofinfrastructure
andtheworkforcemodelsthatrelatetodentalservicesshouldbereviewedspecifically,as
thedentalworkforcerequiresahighlevelofplanningandcoordinationtoaddressboth
capacityanddistributionissues.
Relevantgovernmentworkforcebodies,suchastheHWA,AHPRAandtheDBA,should
collaborateonbetterunderstandingand,ifappropriate,shapingafuturedentalworkforce.
AsnotedinChapter2,HWAisundertakinganalysisin2012ofthedentalhealthworkforce
andrelatedissuesaspartoftheNationalTrainingPlanMarkII.Thiswillinformbroader
strategicconsiderationofdentalworkforceissues,suchascoordinationofeducation,
employment,accreditationandregulationofworkforce.However,untilHWAreports,there
isstillscopeforgovernmenttoaddressimmediateissuessuchasmaldistributionofthe
workforce.
AspirationEight

Enhancingdatacollection,researchandanalysis

Datacollection,researchandanalysisplayanimportantroleinpolicydevelopment,
programdesignandevaluation.TheCouncilbelievesthisareadoesnotreceivesufficient
emphasisandresourcing,whichlimitstheabilitytopositivelyinfluencepolicydevelopment,
programdesignandevaluation.Whilepopulationleveldataarecollectedthrougharange
ofactivitiessupportedbytheCommonwealthGovernmentthroughtheAIHW,
programmaticorpatientleveldataarefarlessavailable.
Therearealsoinconsistenciesinthewayprogramdataiscollected,whichmakes
comparisonacrossstatesandterritoriesdifficult.Bycollectingpatientleveldatainthe
samewayandincreatingnationallyconsistentdata,anyimprovementsthataremadein
deliveringdentalservicesinthepublicsystemcanbeaccuratelycomparedandcontrasted.
Improvingconsistencyindatacollectionwillalsoaidinpopulationlevelresearch.Overthe
longerterm,theCouncilbelievesmoreconsistentdatacollectionacrossthepublicdental
systemwillhelpimproveanalysisandoutcomesfororalhealthpolicyinAustralia.
Thereisalsoevidencethatdelaysintreatmentfororaldiseasesarehavingasignificant
effectonthehealthsystemandeconomy.Inparticular,theremaybesignificanthealth
coststothegovernmentfrompeopleseekingtreatmentforpainandinfection.Beyondthe
principleoftreatingindividualswhoareinneedofcare,thereisapolicyobligationtotry
andensurethatexistingexpenditureisallocatedefficiently.Furtherdataandresearchinto
theseissueswillnotnecessarilyreduceoverallcoststothehealthsystem,butcould
improvethewaydollarsarespent.
Improvementsindatacollectioninthepublicsystemneedtobematchedbytheprovision
ofpatientleveldataintheprivatesystem.Thisinformationwouldhelptoidentifyservice
patternsforpublicpatientsreceivingtheirtreatmentintheprivatesectoraswellasprovide
informationonprivatesectorpatients.
Australiaisfortunatetohavebroadbasedpopulationdatafromresearchinstitutionssuch
asARCPOH.PopulationbasedresearchofARCPOHhasbeenpartlyfundedbythe
CommonwealththroughAIHWandinkindcooperationfromseveraljurisdictions.
Howeverthevalueofpopulationleveldataisenhancedbybuildinginformationon
longtermtrendswhichrequiressustaineddatacollectionactivity.Further,therearegaps
inpopulationleveldatacollectedwhichshouldbeidentifiedandconsideredfornew
activity.
Atthebroadpopulationlevel,theCouncilbelievesthatfundingshouldbeprovidedfor
moreregularnationalsurveysforchildrenandadults,wheredataaboutvisitingpatterns
andaccesscanbemeasuredagainstclinicalindicatorsoforalhealth.Clinicalcollections
shouldbeundertakeneverytenyearsorsotomeasureimprovementsordeclinesin
populationwideoralhealth.Asoralhealthisslowtochange,moreregularclinicalsurveys
arelesscrucial.However,nationalsurveysareheldtooinfrequentlyduetouncertain
funding.Forexample,Australiahashadtwoadultsurveysonein198788andthelastin
200406.TheCouncilwouldliketoseenationalsurveysbecomeanexpectedpartof
understandingtheoralhealthofAustralians.
ChapterSixOptionsforReform
Introduction
ConsistentwiththeTermsofReference,thischapterprovidesarangeofoptionsforthe
Governmenttoconsiderforthe201213Budget.
Asafirststep,wehaveidentifiedtwoprioritygroups:childrenandlowerincomeadults.
Thischaptersetsoutoptionsforthesegroups.
Forchildrenwehaveproposedtwooptionsforauniversalscheme:
Anindividualcappedbenefitentitlement(Option1),whichwouldcoverbasic
preventiveandtreatmentservices.Thebenefitcouldbeusedinthepublicorthe
privatesector.
Enhancedaccesstopublicdentalservices(Option2),whichwouldincreaseaccessfor
allchildrentobasicdentalservicesbyenhancingexistingpublicsectorservices.
Theseoptionshavebeendevelopedasalternatives,withachoicerequiredbetweenthem.
Bothoptionsincludeanadditionalmeasuretoprovideservicestothosechildrenwhodonot
currentlyaccessadequateservices.
Forlowerincomeadultswehavealsoproposedtwooptions:
Ameanstestedindividualcappedbenefitentitlement(Option3),whichcouldbuildon
thelegislativeframeworkforexistingprograms.Accesstohigherlevelservicesorcaps
couldbeprovidedinexceptionalcircumstances.
Enhancedaccesstopublicdentalservices(Option4).
Theseoptionshavebeendevelopedasalternatives,withachoicerequiredbetweenthem.
Theseoptionsaredesignedasasteppingstoneonapathtoauniversalaccessprogram.
Bothoptionsincludeashorttermmeasuretohelpprovideaccesstoservicesforpeople
whohavefacedlongwaitsforpublicdentalservices.
Anyofthefouroptionscouldpotentiallybescaledand/orphasedinovertime.The
Councilsviewisthatwhiletheoptionscouldbeimplementedgradually,itisimportantto
understandthatthiswouldbeastepontheroadtofullimplementation,notanendpointin
itself.Thechallengewithscaledoptionsistoensurethattargetingisnotsonarrowasto
adverselyimpactonthedevelopmentofabroaderandbetterresourcedpopulationbased
framework.
TheCouncilhasalsoconsideredanexampleofanintegratedoptioncombiningenhanced
accesstopublicdentalservicesforchildrenandameanstestedcappedbenefitentitlement
foradults.Thismodellooksattheresponsibilitiesforfundingandservicedeliveryofstates
andterritoriesandtheCommonwealth.
Thecostestimatespresentedinthischapterareindicativeonly,enablingbroad
comparisonsbetweentheoptions.Theassumptionsincludecomplexinteractions,covering:
relationshipsbetweenprivateandpublicdentalsectors;privatedentalpracticesacceptance
ofschemedesignandbenefits;andchangesinincentivesforandbehavioursof
individuals.Establishingmoreprecisecostestimateswillinvolvefurtherdiscussionwiththe
dentalsector.
Wefurtherrecommendfundamentalsupportingmeasuresasanintegralcomponentforall
options.Theseinclude:
buildingworkforceandinfrastructurecapacity;
improvingdataandresearchcapacity;
oralhealthpromotionandprevention;and
specificmeasuresforpopulationgroupswithspecialoralhealthcareandtreatment
needs.
BasicPreventiveandTreatmentServices
Fortheproposalssetoutbelow,theCouncilconsidersthatbasicpreventiveandtreatment
servicesshouldincludediagnostic,preventiveandroutineservices,butexcludeelective
servicessuchascrownsandimplants.Thisapproachallowsforafocusonoralhealth
preventionandearlyintervention.Theseaccountforapproximately90percentofservices,
butonlytwothirdstothreequartersofthetotalcosts.FormoredetailrefertoAppendixK.
However,somepatientsmayrequiremorecomplexhighenddentalcarewhichisnot
categorisedasdiagnostic,preventiveorroutine.Patientswouldbegivenaccesstoclinically
necessarycomplexcareitemsinexceptionalcircumstances.
OptionsforChildren
TheoptionsforchildrenarebasedontheCouncilsaspirationsinChapterFivethat
investmentinchildrenwillprovidelongtermbenefitsforpopulationoralhealth.Asnoted
inChapterOne,althoughchildrenhaverelativelyhighvisitingrates,thereareworryingsigns
ofincreaseddentalcaries,with45.1percentof12yearoldshavingdecayintheir
permanentteethand24.8percentwithuntreateddecay.Recentstudieshavealso
revealedthatthereisasocialgradientintheprevalenceofchildcaries,withthosechildren
intheleastadvantagedareasexperiencingapproximately1.5timesthenumberofcaries
thanchildreninthemostadvantagedareas. 116 However,theCouncildoesnotsupportan
optiontofocusonlyonlowincomechildren.Cariesanduntreatedcariesareevidentacross
allsocioeconomicgroups.Surprisingproportionsofthosechildrenaffectedarefoundin
middleanduppersocioeconomicgroups.Auniversalprogramisthebestoptionfor
reachingallchildrenandestablishingafoundationforgoodoralhealththroughoutlife.
Auniversalschemeforchildren,includinganadditionalmeasuretoreachouttothosewho
donotpresentlyaccessdentalcarewilladdressthis.Stateshaveindicatedthatintheir
experience,thetreatmentofchildrenactuallybecomeslesscostlyonapercapitabasisover
timeasregularpreventiveservicesandpromotionreducetheneedformorecomplex
procedures.
116
Spencer,A.J.andHarford,J.(2008),ImprovingOralHealthanddentalcareforAustralians,Preparedforthe
NHHRC,p.35.
TheCouncilhasdevelopedtwoalternativeapproachesforauniversalchildrensscheme:
Anindividualcappedbenefitentitlementforindividualstobefundedbythe
Commonwealth.
Thestatesandterritoriesdeliveringservicesforchildren.Thiscouldbefundedand
managedbytheCommonwealth,orbyapartnershipbetweentheCommonwealthand
thestatesandterritoriesthroughintergovernmentalagreements.
Theseoptionshavebeendevelopedasalternatives,withachoicerequiredbetween
them. 117

Option1Anindividualcappedbenefitentitlement
Theobjectiveofthisoptionistoimproveaccesstodentalservicesforallchildrenthrougha
schemewhichfundstheprovisionofbasicpreventiveandtreatmentservices.
Operation
Thisoptionwouldprovideanindividualcappedbenefitentitlementforbasicdentalservices
forallchildrenagedupto18years.ThiswouldbefundedbytheCommonwealth.
Thisentitlementcouldbeusedforarangeofbasicdentalservices,coveringpreventiveand
restorativetreatments.Theservicesavailablewouldbelistedonadentalbenefitsschedule.
TheDentalBenefitsSchedulealreadyinplacefortheMTDPcouldbeusedasastarting
point.AnexampleofaschedulehasalsobeendevelopedbyexpertsfromtheCouncil(refer
toAppendixK).
Thebenefitcouldbeusedtoaccesscareintheprivateorpublicsector.Thiswould
complementexistingarrangementsundertheMTDPandallowspatientchoiceastothe
locationofcare.
Servicesprovidedinthepublicsectorwouldbefreetothepatient.Privatedentistscould
choosetochargeabovetheitembenefit.Inthesecircumstancespatientswouldneedto
meetanyadditionalchargesoutoftheirownpockets.
Theentitlementwouldbeavailableonacalendaryearbasis.Dentalpractitionerswould
provideservicesbasedonthescheduleofbenefits,uptothevalueoftheentitlement.
Asignificantgroupofchildrenaremissingoutonadequatedentalservices.Thesechildren
aredifficulttoidentifyandreach.Duetothedifferencesininfrastructureacrossthe
country,theCouncilproposesaforerunnerprogramforthosechildren.Thisprogram
woulddemonstratewaystoengagetheseindividuals,through,butnotlimitedto,Medicare
Localsandothercommunityorganisations.Thoseindividualsidentifiedbythisprogram
wouldthenreceivetreatmentthroughthepublicdentalsystem.Theprogramcouldthenbe
evaluatedandthemostsuccessfulmethodsincorporatedintotheuniversalscheme.
SomemembersoftheCouncilareexperiencedinlocaldeliveryofservicesandcommunity
developmentandcouldbeconsultedinthedevelopmentofsuchaprogram.
117
TheinteractionofthechildrensoptionswiththeMTDPisconsideredonpage7677.
Timingofimplementation
Movingtoasystemwhereallchildrenvisitadentalpractitionerregularlywillmean
addressingcurrentworkforceandinfrastructurecapacityconstraints.TheCouncil
recognisesthatfullimplementationwilltakesometime.Forthisreason,theindicative
costingsassumethatfoundationalactivitiesandtheprogramstoreachchildrencommence
in201213andtherolloutofthecappedbenefitentitlementoptionwouldcommenceno
laterthan1July2013.
Scalability
Thisoptioncouldbeimplementedinstages.Thetimeframeforscalingdependsonmany
factors,includingworkforceconstraintsandtheGovernmentsdecisiononfiscal
considerations.Thisoptioncouldbescaleddownincostbyinitiallylimitingaccessthrough
ameanstestforexamplefocusingonconcessioncardholders(twomillionchildren)and
expandingaccesstoallchildren(fivemillion)atalaterdate.Thisapproachwouldmeanthe
optionwouldnotofferuniversalaccessinthefirstinstance.TheCouncildoesnotseea
narrowerschemeasapermanentstandalonemeasurebutratherasastagedapproachtoa
morecomprehensiveuniversalmeasure.
Scalinginthiswaywouldreducetheindicativecostoftheprogramfrom$2.5billionto
$827millionoverfouryearsfrom201213.Itwouldresultinthesamefullyimplemented
costastheuniversalaccessscheme(approximately$904millionperyear)from201718,
whenthescaledschemewouldincludeallchildren.
Theindicativecostingbelowincludes:treatmentcostsforallchildren,anddevelopment
costsforimprovingandexpandingcapacitytoreachthosechildrenwhodonotreceive
appropriatecare.
Table6.1ProjectedexpenditureforOption1
Option1 201213 201314 201415 201516 Totalcostover Annualcost
($million) theforward oncefully
estimates implemented
OptionUniversal *51 888 970 1,038 2,946 904
access(treatment
costs)
Plusdevelopmentcosts 5 5 5 5 21
TOTAL 56 893 975 1,043 2,967

OptionPhased *51 133 426 466 1,311 904
introductionstarting
withconcessioncard
holders(treatment
costs)
TOTAL 56 138 431 471 1,332

Note:Estimatesdonotincludethetransitionalcostsassociatedwithanyaffectedlegacyprograms.Numbers
maynotaddtototalsduetorounding.
*In201213,treatmentisonlycostedforthechildrenwhocurrentlydonotreceiveappropriatecare.The
broaderpopulationwouldreceivetreatmentfrom201314.
Comments
UnderthisapproachtheCommonwealthhasfundingandpolicyresponsibilityforthe
program.Thestatesandterritoriesretainaservicedeliveryroleandthedetailsofhowthis
wouldworkinpracticewouldrequireconsiderationataformalintergovernmentallevel.
Ifstatesandterritoriescontinuetoberesponsibleforparticularpopulationsubgroupswith
specialoralhealthcareneeds,wherethenewoutreachactivitieswilldrawmorepeopleinto
activeparticipationindentalserviceprograms,thiswouldrequireconsiderationatthe
intergovernmentallevel.
Thisoptionusesbothpublicandprivatesectorservicedelivery.Statescouldcontinueto
operatetheirexistingmodelsandapproaches,whileprovidingservicesunderthescheme.
Thiswouldalsoprovidesomeflexibilityforthepublicsector,allowingstatestouseeither
communityclinicsand/ordedicatedschooldentalprogramstoprovideservices.
Underthisoption,theCommonwealthGovernmentwouldgainwiderangingpatientbased
servicedatawhichwouldbeavailabletoinformplanningandimprovementstothescheme.
Akeyriskofthisoptionisthatsomechildrenarealreadycoveredbyprivatehealth
insurancefortheseservices.Inthesecasestheschememaynotimproveaccessbutinstead
simplyreplaceaprivatehealthbenefitwithagovernmentbenefit.
Option2Enhancedpublicsectorchilddentalservices
Theobjectiveofthisoptionistoimproveaccesstodentalservicesforallchildrenthrougha
schemewhichfundsbasicpreventiveandtreatmentservices.
Operation
Allchildrenupto18yearswouldbeeligibleforpublicdentalservices.TheCommonwealth
wouldfundthestatesandterritoriestodelivertheservices,throughtheirexistingsystems
includingschooldentalservices,communityclinicsandtheprivatesector.Thedollarvalue
ofdentalservicesperchildwouldbesetatthecostofprovidingtheservicesinthepublic
system.Servicestoconcessioncardholderchildrenwouldbefreeofcharge,whilenoncard
holdersmayneedtomakeacopayment.
ThisoptionwouldrequireagreementstobemadebetweentheCommonwealthandthe
stateandterritories.TheCouncilexpectsthattheseagreementsandfurther
implementationarrangementswouldtakeatleast12months.
Intheshorttomediumterm,thetakeupoftheschemeisexpectedtobelimitedbythe
capacityconstraintsofthepublicsector.Asthiscapacityisbuiltupthroughthe
foundationalsupportactivities,therewillbeagradualincreaseintakeup.Full
implementationandcapacityisexpectedtobereachedaroundtheendof2016.
AsnotedinOption1above,aforerunnerprogramcouldbeimplementedtoidentifyand
reachthosechildrenwhoaremissingoutonadequatedentalcare.
Scalability
Thereissomepotentialtoscaletheimplementationofthisoption.
Theindicativecostingbelowincludes:treatmentcostsforallchildren,anddevelopment
costsforbuildingcapacitytoreachthosechildrenwhodonotaccesscare.
Option2 201213 201314 201415 201516 Totalcost Annualcost
($million) overthe oncefully
forward implemented
estimates
OptionUniversal *51 727 801 860 2,437 717
access(treatmentcosts)
TOTAL 56 732 806 865 2,458

maynotaddtototalsduetorounding.
*In201213,treatmentisonlycostedforthechildrenwhocurrentlydonotreceiveappropriatecare.The
broaderpopulationwouldreceivetreatmentfrom201314.
Comments
AswithOption1,thisassumestheCommonwealthwouldtakepolicyandfunding
responsibilityforchildrenstreatment.Thestatesandterritorieswouldberesponsiblefor
thedeliveryofservices.Thesearrangementswouldneedtobeformallynegotiatedatan
Byusingstateandterritoryexpertise,infrastructure,workforceandsystemarrangements
thisoptionislesscostlythantheuniversalindividualcappedbenefitentitlementfortwo
reasons:
thepublicsystemcanprovideasimilarservicetotheprivatesystematalowercost
therebyreducingthepercapitaexpenditure;and
therearelikelytobeasignificantnumberoffamilieswhowillnotparticipateinthe
programastheywillcontinuetheirexistingvisitingpatternstoprivatedental
practitioners.
Thisarrangementreducesexpenditurebyapproximately$511millionovertheforward
estimatesandisalso$187millionlessperannumoncefullyimplemented,comparedtothe
universalindividualcappedbenefitentitlement.
Itwouldalsobepossibleforstatesandterritoriestoredirecttheirpreviousinvestmentsin
childdentalprogramstomoretargetedapproachesaimedatreachingthechildrenwho
receiveinadequatedentalservicesasdescribedbelow.
OptionsforLowIncomeAdults
Therearesignificantbarrierstodentalcareforlowerincomeadults.AsnotedinChapter
Three,around42percentofadultseligibleforpublicsectordentalcarehavean
unfavourablevisitingpatternandupto400,000adultsareonpublicdentalwaitinglists.
Themainobjectiveoftheadultoptionsistoimproveoralhealthbydealingwiththeexisting
oralhealthproblems,therebylayingafoundationformoreeffectivepreventivemeasures
intothefuture.
TheCouncilhasdevelopedtwooptionstoaddressingtheoralhealthneedsoflowerincome
adults,basedoncurrentsystemsfordentalservicedelivery.Thefirstwoulduseameans
testedindividualcappedbenefitentitlement,buildingonexistinglegislativeframeworks.
Alternatively,thesecondwouldprovidebasicpreventiveandtreatmentservicesthrough
thepublicdentalsystem.Theseoptionsaredesignedasasteppingstoneonapathtoa
universalaccessprogram. 118
Option3Accesstoameanstestedindividualcappedbenefitentitlement
Theobjectiveofthisoptionistoimproveaccesstodentalservicestoconcessioncardholder
adultsbyfundingaccesstobasicpreventiveandtreatment.
Operation
Thisoptionwouldprovideanindividualcappedbenefitentitlementforallconcessioncard
holderadults.ThiswouldbefundedbytheCommonwealth.
Limitedaccesstomorecomplexhighenditems(e.g.bridges,crownsandimplants)couldbe
providedthroughaseparateexceptionalcircumstancesmechanism.
Thebenefitentitlementcouldbeusedtoaccesscareintheprivateorpublicsector.This
wouldcomplementexistingarrangementsundertheCDDSandallowspatientchoiceasto
thelocationofcare.
Patientswouldaccessclinicallynecessaryservicesonacalendaryearbasisfromeitherthe
publicorprivatesector.Dentalpractitionerswouldbeabletoprovideservicesbasedonthe
scheduleofbenefits,uptothevalueoftheentitlement.Servicesprovidedinthepublic
sectorwouldbefreetothepatient.
Theindividualcappedbenefitentitlementwouldcoverascheduleofservices.Anexample
ofaschedulehasalsobeendevelopedbyexpertsfromtheCouncil(refertoAppendixK).
Accesswouldbemeanstestedtoincludeonlycardholderadults.
AsdiscussedinChapterTwo,therearemorethan400,000patientsonpublicdentalwaiting
lists.Astheywait,thesepatientsoralhealthisdeteriorating,andtheymayendupwith
othermedicalconditionsasaresult.Therefore,asafirststep,anoptionthatcanbe
implementedbeforethebroaderadultoptiondescribedabove,istoprovideadditional
fundingtostatesandterritoriesfortreatmentforthesepatients.Themajorityofthe
Councilbelievethatthismustbeimplementedasanintegralpartofbroaderdentalreform.
Withoutanongoingmajorinvestmentinabroaderprogram,thismeasurewouldcreate
increaseddemandforpublicdentalservicesandresultinlongerpublicdentalwaitingtimes.
118
TheinteractionoftheadultoptionswiththeCDDSisconsideredonpage77.
Intheshortterm,workforceandinfrastructurecapacityconstraintswilllimittheextentto
whichdemandcanbemet.Thetakeuprateoftheschemeisexpectedtogradually
increase,ascapacitytoprovideservicesincreases.Thefoundationalsupportmeasures
describedlaterinthischapterwillcontributetothisincreaseincapacity.
Scalability
Thisoptionsetsthefoundationforlongertermincreasedcoverage.Theeligibilitycriteria
shouldbeexpandedovertimetoincludeothergroupssuchaschronicdiseasesufferers
(whoarecurrentlyreceivingservicesundertheCDDSprogram)andlowerincome,
nonconcessionalpatients.Theadditionofbothofthesegroupswouldprovidebenefitsfor
over7.6millionpeople:5.1millionconcessioncardholders;2.3millionlowincome
nonconcessionalpatients;andanestimated176,000chronicdiseasesuffererscurrently
accessingCommonwealthdentalbenefits, 119 notingthatthemajorityofcurrentchronic
diseasepatientswouldbeincludedinthefirsttwogroups.
Theremaybenaturalscalingofthisoption,assomeproportionofconcessioncardholders
holdprivatehealthinsuranceandtheymayprefertoaccessprivateservicesthroughthis
mechanism.
Theindicativecostingbelowincludesboththeindividualcappedbenefitentitlement
programandameasuretoaddresswaitinglists.Themeasureforaddressingwaitinglist
patientswouldbeanadditional$343millionin201213.
($billion) overthe oncefully
forward implemented
estimates
Optionaccessfor 0.3 2.1 2.3 2.5 7.1 2.6
concessioncardadults,
plusawaitinglist
measure
Optionincluding 0.3 2.3 2.7 2.9 8.3 3.1
chronicdiseasepatients,
plusawaitinglist
measure
Optionincluding 0.3 3.2 3.7 4.0 11.4 4.2
chronicdiseaseandother
lowincomeadults,plusa
waitinglistmeasure
maynotaddduetorounding.
Comments
Thekeyadvantageofthisoptionisthatitisasimpleandcoherentscheme,thatoperateson
thescaleandscoperequiredtoredresscurrentdeficitsinaccesstodentalservicesandthe
119
EstimatednumberofCDDSpatientsattimeofadministeringanewscheme.
populationsoralhealth,startingwithconcessioncardholdersandmovingtosupportforall
adults.
UnderthisapproachtheCommonwealthhasfundingandpolicyresponsibilityforthe
program.Thestatesandterritoriesretainaservicedeliveryroleandthedetailsofhowthis
wouldworkinpracticewouldrequireconsiderationataformalintergovernmentallevel.
Ifstatesandterritoriescontinuetoberesponsibleforparticularpopulationsubgroupswith
specialoralhealthcareneeds,wherethenewoutreachactivitieswilldrawmorepeopleinto
activeparticipationindentalserviceprograms,thiswouldalsoneedconsiderationatthe
Underthisoption,theCommonwealthGovernmentwouldgainwiderangingpatientbased
servicedatawhichwouldbeavailabletoinformplanningandimprovementstothescheme.
Thisoptionisaimedatincreasingaccessforlowerincomeadultstobasicpreventiveand
treatmentservicesbyenhancingthepublicsector.
Operation
Allconcessioncardholderadultswouldbeeligibleforpublicdentalservices,includingbasic
preventiveandtreatmentservices.
TheCommonwealthwouldfundservicesandthestatesandterritorieswoulddeliverthem.
Percapitacostsoftheprogramwouldbesetatthevalueofprovidingbasicpreventiveand
treatmentservicesinthepublicsystem.
Serviceswouldbeprovidedfreeofchargeorwithlimitedcopayments.Statesand
territoriescouldpurchaseservicesintheprivatesystemwhereextracapacityisrequired(as
isthecurrentpractice).
Anexceptionalcircumstancesmechanismcouldbeimplementedtoallowaccesstohigher
endservices,whichcouldbeprovidedintheprivatesectorandinteachinginstitutions.
Thisoptionhasthesameobjectivesastheindividualcappedbenefitentitlement;thekey
differenceisthemodelchosentodelivertheservices.
Intheshortterm,programrequirementsandthefundingmodelwouldneedtobe
developedthroughagreementswiththestatesandterritoriesnegotiatedthroughaformal
intergovernmentalprocess.Suchagreementswouldneedtocover:funding;datareporting;
accountabilityforoutcomes;buildingincreasedcapacityinthepublicsystem;andrequiring
consistentservicelevelsacrossthestatesandterritories.TheCouncilexpectsthatthese
agreementsandfurtherimplementationarrangementswouldtakeatleast12monthsto
finalise.
Duringthisperiod,theCouncilwouldexpectthatbroadconsultationwiththepublicand
professionwouldtakeplace.Intheshorttomediumterm,thetakeupislikelytobelimited
bythecapacityconstraintsofthepublicsector,althoughworkcouldbecontractedoutto
theprivatesectorasrequired.Asthiscapacityisbuiltupthroughthefoundationalsupport
activities(seebelow),therewouldbeagradualincreaseintakeup,withfull
implementationandcapacityexpectedtobereachedaroundtheendof2016.
AsnotedinOption3,anoptioncanbeimplementedtoprovideadditionalfundingtostates
andterritoriesfortreatmentforwaitinglistpatients.
Scalability
Thisoptioncouldpotentiallybeexpandedtoincludenoncardholderchronicdisease
patients,whoaccountforaround20percentofthosewhocurrentlyaccesstheCDDS.
Additionallowincomegroupsthatarenoteligibleforpublicdentalservicescouldalso
potentiallybegivenaccess.Togetherthiswouldcoverover7.6millionpatients.Suchan
approachwouldonlybepossibleinthemediumtolongterm,requiringagreementfrom
statesandterritoriesandsignificantadditionalcapitalfundingforpublicinfrastructure.
Theindicativecostingbelowincludesboththeindividualcappedbenefitentitlement
programandameasuretoaddresswaitinglists.Themeasureforaddressingwaitinglist
patientswouldbeanadditional$343millionin201213.
($billion) overthe oncefully
forward implemented
estimates
Optionasdescribedabove, 0.3 0.7 0.9 1.1 3.0 1.3
plusawaitinglistmeasure
Optionincludingchronic 0.3 1.1 1.3 1.6 4.3 1.8
diseasepatients,plusa
waitinglistmeasure
maynotaddduetorounding.
Comments
AswithOption3,theCommonwealthwouldtakepolicyandfundingresponsibilityfor
concessioncardholderadulttreatment.Thestatesandterritorieswouldberesponsiblefor
delivery.Thiswouldneedtobeformallynegotiatedatanintergovernmentallevel.
Byusingstateandterritoryexpertise,infrastructure,workforceandsystemarrangements
thisoptionislesscostlythantheindividualcappedbenefitentitlement.Comparedtothe
cappedbenefitentitlementoption,thisarrangementreducesexpenditureby$4.1billion
overtheforwardestimatesperiod.Onanongoingbasisitwouldcost$1.3billionlessper
annumatfullimplementation.
IntegratedAdultandChildOptions
TheCouncilconsidersthat,toimproveservicesacrossallagecohorts,actionshouldbe
takentoaddressboththeneedsofchildrenandlowincomeadultsbyintegratingselected
options.Fourintegratedcombinationsofthechildandadultoptions,whichdemonstrate
variousdivisionsofresponsibilitybetweentheCommonwealthandthestates,arebelow.
Theextenttowhicheachlevelofgovernmentisresponsibleforthefundingandprovisionof
dentalservicesdependsonthepolicyoptionspursued.Entitlementoptions(Options1and
Option3)wouldplacetheCommonwealthgovernmentinadirectrelationshipwith
providersandusersofdentalservices.Thegovernmentwouldbearthedominant
responsibilityforsuchprograms(e.g.MTDPandCDDS).Alternatively,theCommonwealth
Governmentmighttransferpaymentsorprovideblockgrantstothestatesfortheprovision
ofservices(e.g.CDHP).
Inlinewiththeframeworksalreadydescribed,theseintegratedoptionsshouldutilise
existingsystemsintheshorttermwiththepotentialtoexpandtheirreachovertime.
Table6.5Possiblecombinationsofchildandadultoptions
Combination Summarydescription
1 Option1 Option3(accessto Bothchildrensandadultsdentalserviceswouldbedirectly
(individual ameanstested fundedtoeligibleindividualsbytheCommonwealth.
cappedbenefit individualcapped Serviceswouldbeprovidedinthepublicandprivatesectors
entitlementforall benefitfor bystatesandprivateprovidersrespectively.
children) concession
cardholderadults)
2 Option1 Option4 Childrensserviceswouldbedirectlyfundedtoeligible
(individual (enhancedaccess individualsbytheCommonwealth.Serviceswouldbe
cappedbenefit topublicdental providedinthepublicandprivatesectorsbystatesand
entitlementforall servicesforlower privateprovidersrespectively.
children) incomeadults)
ServicesforadultswouldbefundedbytheCommonwealth
throughstates.Serviceswouldbeprovidedinthepublic
sectorbystatesandcontractedtotheprivatesectorwhen
necessary.
3 Option2 Option3(accessto ChildrensserviceswouldbefundedbytheCommonwealth
(enhancedpublic ameanstested throughstates.Serviceswouldbeprovidedinthepublic
sectorchild individualcapped sectorbystatesorcontractedtotheprivatesectorwhen
dentalservices) benefitfor necessary.
concession
cardholderadults) Serviceforadultswouldbedirectlyfundedtoeligible
individualsbytheCommonwealth.Serviceswouldbe
providedintheprivatesectororbystatesrespectively.
4 Option2 Option4 ChildrensserviceswouldbefundedbytheCommonwealth
(enhancedpublic (enhancedaccess throughstates.Serviceswouldbeprovidedinthepublic
sectorchild topublicdental sectorbystatesorcontractedtotheprivatesectorwhen
dentalservices) servicesforlower necessary.
incomeadults)
ServicesforadultswouldbefundedbytheCommonwealth
throughstates.Serviceswouldbeprovidedinthepublic
sectorbystatesandcontractedtotheprivatesectorwhen
necessary.
Forexample,inCombination3(Option2/Option3)thestateswouldberesponsibleforchild
services(5.4millionchildrenunder18yearsofage),onthebasisofaCOAGagreementthat
includesconsistencyofstandardsandservicelevelsfordentalcare.TheCommonwealth
wouldtakeresponsibilityforconcessioncardholderadults(5.1millionadults).
Thestateshavealongstandinginvolvementinschooldentalservicesandcoulddevelopthe
capacitytocareforallchildren,particularlyfocusedonthoseinmostneed.Thiswould
involvesomecontractingofdentalservicestotheprivatesector.Thestateswouldbe
responsibleforchildservices,onthebasisofaCOAGagreement.TheGovernmentcould
alsoconsidertransferringfundingfortheMTDPtothestatesandterritoriesaspartoftheir
takingresponsibilityforchilddentalservices.Thiscouldassistwithfreeinguptheexisting
publicdentalsystemandstateandterritoryfundingtoimproveservicestoeligibleadults.
TheCommonwealthwouldtakeresponsibilityforlowincomeadultsandfundadult
concessioncardholdersthroughadentalbenefitentitlementschemewithadefineddental
benefitschedule.ThiswouldbeanextensionoftheframeworkusedbytheCommonwealth
fortheCDDS,butwithalteredeligibilityandscopeofdentalservicesprovision.Thepublic
dentalsectorcouldalsoaccessthebenefitentitlementtoprovideservicestoeligibleadults.
Thisintegratedoptionwoulduseprivatesectorworkforceandinfrastructurecapacityfor
thehighestneedandpublicsectorexpertiseinprovidingservicestochildren.
TheCommonwealthcouldalsoexpandeligibilityforthisentitlementbenefitandprovideit
tochronicdiseasepatientsaswellasnonconcessioncardlowincomeadults(approximately
2.5millionadditionaladults).TheCommonwealthcouldalsoprovideshorttermassistance
tothoseconcessioncardholderscurrentlyonpublicdentalwaitinglists(approximately
400,000additionaladults).Thetotalestimatedcostforthisoptionasoutlinedabovewould
beintheorderof$10.1billionovertheforwardestimatesfrom201213.
TheCouncilhasusedtheabovecombinationofresponsibilitiesasanexample.Other
combinationsandlinesofresponsibilityareoutlinedinthetableabove.Eachhasalevelof
plausibilityandpossibleadvantages.Forinstance,CombinationOneisclosesttothe
CommonwealthscurrentinvolvementintheMTDPandCDDS.CombinationTwoisthe
reverseofthecombinationoutlinedinmoredetailabove.Itwouldrecognisethecurrent
limitedcapacityinsomestatesindirectlyprovidingdentalservicestochildren.Combination
Fourwouldbeconsistentwiththestateshistoricalroleindentalserviceprovisionto
childrenandlowincomeadults,albeitwithsubstantialCommonwealthfunding.More
detailonsuchcombinationswasbeyondthescopeoftheCouncilinthisreport.Partofthe
dentalreformprocesscouldincludediscussionsbetweenstatesandterritoriesandthe
CommonwealththroughCOAGonresponsibilityforchildrenandadultsorother
arrangementsincludingsharedresponsibilityforparticulargroups.
FutureofGovernmentDentalPrograms
MedicareTeenDentalPlan
Undertheindividualcappedbenefitentitlementoptionproposedforchildren,(Option1)
theMTDPwouldcontinuetooperate,albeitwithmodifications.Asabasicbenefit
entitlementscheme,theMTDPcouldbeusedasthevehicletoprovideabenefit
entitlementthatcouldbeexpandedtoincludeabroadereligibilitybaseallchildrenunder
theageof18andnotjustteenagersaswellasincludeabroaderscheduleofbenefitsfor
dentaltreatmentnotjustpreventivechecks.Thescheduleofbenefitswouldbesetatthe
costofprovidingservicesinpublicsystem.Thebenefitentitlementcouldpotentiallybe
increasedtoreflectthehighercostoftreatmentoutsidemetropolitanandregionalcentres.
TheMTDPwouldalsonolongerincludeameanstest,astheoptionproposesuniversal
accesstoallchildren.
UnderthepublicsectorapproachinOption2,fundingfortheMTDPwouldbebundledinto
thefundingforthestatesandterritories.
However,whethertheMTDPcontinuesorismodified,therecouldbeanevaluationofthe
programsefficiency,effectivenessandappropriatenessinthecontextoffuturedental
policydirections.TheCouncilisawarethatthesecondreviewoftheDentalBenefitsActs
2008notedthatthereshouldbeanevaluationoftheprogram,giventhetakeupwaslower
thanoriginallyanticipatedatonly30percentin201011.
MedicareChronicDiseaseDentalScheme
UnderapublicsectorapproachforadultsasoutlinedunderOption4,theGovernment
wouldceasefundingservicesthroughtheCDDSandmovetofundingservicesthroughthe
states.
IftheGovernmentchosetouseabenefitentitlementapproachasoutlinedinOption3,a
modifiedversionoftheCDDScouldbethevehicleforservicedelivery,resultingina
significantreductioninexpenditure.Featuresofamodifiedprogramcouldinclude:
restrictingtheprogramtoessentialdentalservices.Thisstillallowsfortheprovisionof
highendlevelservices(crowns,bridges,implants)wherebasictreatmentsare
insufficientandhighcostitemsarevitalforpatienthealth.Accesstohighendservices
couldbecontrolledthroughanexceptionalcircumstancesmechanism,basedonadvice
fromanexpertgroup;
intheshortterm,introducingameanstesttorestrictaccesstoconcessioncardholders.
Asdentalworkforcecapacityincreases,eligibilitycouldbescaledupinthemediumto
longtermtoincludebroadergroupswhosufferfrompooraccesstodentalservices(e.g.
lowincomenonconcessioncardholders);
providingforahigherbenefitentitlementtoreflectthehighercostoftreatmentoutside
metropolitanandregionalcentresand/ortoaccountforincreaseservicecostsfor
certaingroups,e.g.denturepatients;
allowingthebenefitentitlementtobeusedinthepublicorprivatesector,withschedule
benefitssetatthecostofprovidingservicesinpublicsystem;and
ensuringthatanysupportinglegislationallowsforalldentalpractitionerstoprovide
dentalservicestothefullextentoftheirscopeofpractice.
TherearefurthermattersrelatingtopotentialmodificationstotheCDDSthatwouldbenefit
fromexpertconsiderationforexample:howtheclinicalguidelinescouldbeset;howthe
exceptionalcircumstancesforhighenditemscouldoperate;andthescopeofchronic
diseasesincludedinthescheme.
Privatehealthinsurancerebate
TheCouncilrecognisestheroleprivatehealthinsuranceplaysintheassisting11.9million
Australianswithfinancingofhealthcare,includingdentistry.TheCouncilwasnotableto
considerprivatehealthinsuranceinanydepth.TheCouncilhasconcludedthatfurther
considerationneedstobegiventotheinteractionsbetweentheoptionspursuedand
privatehealthinsurance.Thisincludesconsiderationofthepotentialforoverlapinpublic
subsidiesfordentalservicesandprivatehealthinsurance.TheCouncilagreedthatsuch
considerationcouldextendtofuturereformsandincentivesforprivatehealthinsuranceas
wellasothermethodsoffinancingdentalservices.
OtherCommonwealthandStatedentalprograms
ItisunlikelythattherewillbeanyadvantageinchangingotherCommonwealthsupported
measuresorrollingthemintobroaderdentalreformintheshortterm.Suchprogramsare
outlinedinChapterTwoandinclude:theCleftLipandCleftPalateScheme;dentalservices
fortheAustralianDefenceForce,theArmyReserveandeligibleveterans;and
HELPsupporteduniversitycourses.
Stateswouldneedtomaintainexistingresourcingforservicedeliverythroughthepublic
sector.However,stateinvestmentcouldberedirectedtohighneedgroupsdependingon
theoptionschosen.Forexample,iftheCommonwealthtakesfundingresponsibilityfor
childdentalservices,stateandterritoryexpenditureinthisareacouldbefreedupand
directedtowardimprovementstoservicesforadults.Thiswouldbeasignificantincreasein
expenditurewhichcouldhelpreducepublicwaitingtimesforadults.Further,stateswould
bebetterplacedtousefreedupresourcesforspecialactivitiesforthechildpopulationwho
arenotcurrentlyreceivingadequateaccesstoservices.
FoundationalActivities
Allfourmajorservicedeliveryoptionswouldneedtobesupportedbyfoundational
activitiesaroundworkforceandinfrastructure,oralhealthpromotionandspecialaccess
programs.Theseactivitieswouldbespecificallydesignedtosupportsuccessfuland
sustainableimprovementsinoralhealthfortheidentifiedprioritygroups,andeventually
universalaccess.
BuildingonthelongertermaspirationsinChapterFive,theCouncilsuggestssomespecific
activitiesthatGovernmentcouldconsider.
Table6.6Summaryofkeyfoundationalactivities
CoreActivity KeySuggestedActivities
Dentalworkforce Supportforworkforcetomovetoareasofunderservice,including
andinfrastructure ruralareasandthepublicsectorgenerally.
Enabledentalpractitionerstoexpandand/orfullyutilisetheirscopeof
practiceinordertotreatbroaderpopulations.
Considerationofapauseonadditionaldentaleducationprograms
pendingfinalisationofthecurrentHWAreviewofworkforcesupply
anddemand.
Increasedinvestmentinuniversityandpublicsectorfacilities,clinical
placementfacilities,andcapitalinfrastructure.
Dataandresearch Improvingtheevidencebaseforworkforceplanning.
Moreregularnationalsurveysforchildrenandadults.
Identifyandaddressgapsinpopulationlevelmonitoringand
surveillance.
OngoingfundingbyGovernmentoforalhealthandworkforce
research.
Increaseinfundingforclinicalresearchindentistry.
Considerationofehealthinitiativesinmanagingdentalhealth
records.
Oralhealth Significantincreaseinexpenditureonoralhealthpromotion.
promotion DevelopmentofaNationalOralHealthPromotionPlan.
Implementationofasupportivelegislativeandregulatory
environment.
Coordinationoforalhealthmessagesacrossthecountry.
Targetinggroups TheuseofMedicareLocalsandcommunityorganisationstofacilitate
withspecialoral accessforgroupswithspecialoralhealthcareneeds.
healthcareneeds ImprovementsinprogramstoprovideservicestoIndigenouspeople,
ruralandremotecommunitiesandagedcarefacilities.
Possiblemechanismfordeliveringfoundationalactivities
TheMedicareLocalNetworkformspartoftheGovernmentsNationalHealthReform
agenda.MedicareLocalsfunctionascoordinationunitswithinthecommunityandhavea
roleinidentifyinglocalhealthcareneedsandservicegaps.Theyaimtoassistpatientsin
bettermanagingtheirhealthconditionsandtopreventdiseaseinthecommunity.
KeyMedicareLocalactivitiesinclude:linkingGP,alliedhealth,hospitalandagedcare
services;trainingofGPsandalliedhealthprofessionals;maintaininguptodatelocalservice
directoryinformation;workingcloselywithlocalhealthorganisationssuchasAboriginal
MedicalServices,LocalHospitalNetworksandhospitalstoimprovecoordination;
identifyingandaddressinggapsinlocalservicedelivery;supportingafterhoursGPservices;
andsupportinginitiativesaimedatimprovingpreventionandmanagementofdisease.
TheCouncilnotesthateachMedicareLocalisuniqueinitsoperationandhasdifferent
programs,fundingandcapacity.
AppendixHoutlinessomecasestudyexamplesofthetypeofrolethatcouldbefurther
investigated,includingtheWentWestMedicareLocalinNewSouthWalesandtheMarion
GPSuperCentreinSouthAustralia.
Dentalworkforceandinfrastructure
Theterrainofthedentalworkforcehaschangedinrecentyearswiththeestablishmentof
HWA,DBA,AHPRAandadditionaluniversities(includingruraldentalschools)foreducating
dentalpractitioners.Thishasprovidedthecontexttoreexaminepathwaysfor
coordinatedanalysisandplanningforthedentalworkforce.
Themainissuesrelatingtothedentalworkforceareanundersupply,maldistributionand
mixofpractitioners.Thesecreateparticularbarrierstoaccessforruralandremote,urban
fringeareasandspecialneedspatients.TheCouncilnotesthepotentialforutilisationofthe
diversificationoftheworkforcetoaddresstheneedsofthesepatients.Itisalsoimportant
thattheworkofHWAinassessingandmodellingthedentalworkforceisconcludedina
timelywaytoaddresstheseissues.
Workforceutilisation,supplyandmaldistribution
TheCouncilrecognisestheimportantworkoforalhealththerapists,dentalhygienistsand
dentaltherapists.TheCouncilstronglyrecommendstheremovaloflegislativerestrictions
ontheprovisionofdentalservicesbydentaltherapists,dentalhygienistsandoralhealth
therapistsforgovernmentprogramssuchasCDDSandDVADentalProgram.
TheCouncilnotestheHWAiscurrentlyreviewingthescopeofpracticeoforalhealth
therapists,dentaltherapistsanddentalhygienists.TheCouncilsuggeststhatthescopeof
practiceofdentalpractitionersbeconsidered,specificallythatthescopeofpracticeoforal
healththerapists,dentaltherapistsanddentalhygienistsbeexpanded,withapprovalbythe
DBA,toallowfortreatmentandservicestobroaderpopulationgroups.Thiswouldinclude
appropriateDBAapprovedformaleducationandtraining,ensuringthatalloralhealth
practitionerscanworkwithinthefullscopeinwhichtheyarecompetent.Thesemayrelieve
thetimeandcostpressuresofheavilyrelyingondentiststoperformbasicservices.
Inadditiontotheaggregatesupplyanddemandbalancethereissignificantmaldistribution
betweenurbanandruralareas,andacrossurbanareasaswellasbetweenprivateand
publicdentistry.
TheCouncilsuggestsamultiprongedapproachtosupportworkforceredistributiontoareas
ofrelativeunderservice:
recruitmentofmarginalisedgroups(throughscholarshipsandaffirmativeruralentry
schemesforalldentalprofessionals);
supportedruralclinicalplacementsandsupportfordentalacademicswithinUniversity
DepartmentsofRuralHealth(UDRHs)andRuralClinicalSchools,;
enhancementofthefoundationyearfordentalgraduateswithopportunitiestomoveto
regionalareas(accommodationandacademicsupport);and
furtherexpansionoftheDTERPprogramforruralclinicalschools,includingincreasing
thesupportfordentalundergraduatestraininginruralandregionalareas.
TheGovernmentcouldalsoconsidertheuseofincentivesandrewardpaymentsforvarious
sectorsoftheworkforce:
tohelpsupportpublicdentalservicestodevelopretentionstrategies;
tocaterforpatientswithspecialoralhealthcareneeds;and
infrastructuregrantsforclinics,mobiledentalinfrastructure,orforrelocationgrantsfor
ruralandremoteareas.
Coordinationandplanningaroundthedentalworkforce
Intermsoflongtermplanningandcoordinationoftheworkforce,HWAproposeto
developtheNationalTrainingPlanMarkIIin2012,tobeconsideredbyHealthMinisters.In
additiontothiswork,theCouncilconsidersthatthereneedstobeimprovedcooperation
intothefutureacrossrelevantbodiessuchasHWA,AHPRA,DBAandtheAustralasian
CouncilonDentalSchools.
TheCouncilalsosupportsusingtheHWAsnationaltrainingplantoguidethetertiarysector
ontheeducationofdentalpractitioners,potentiallytomodifytherecruitmentof
internationaldentalgraduatesandtostimulatereformmeasureswithinthedental
workforce.TheCouncilalsosuggeststhatHWAworkexplicitlyconsiderthedevelopmentof
aruraldentalworkforcestrategy.
Theestablishmentofthreenewdentalschoolsputsextrastrainonthecapacityofclinical
andtraininginfrastructure.TheCouncilsWorkforceandInfrastructureWorkingGroup
suggestsapauseonnewschoolsandprogramsuntilanewroundofsupplyanddemand
projectionsareavailableandtheHWAhasprepareditsnationalworkforceplanand
submittedittoHealthMinisters.
Academicandclinicaltrainingandinfrastructure
Therapidexpansionofthenumbersofdentalpractitionersintraining,aswellas
introductionoftheVoluntaryDentalInternProgram,willputincreasingpressureonthe
trainingstaffandinfrastructureavailableforstudentsinuniversitytraining.Todealwith
thesepressurestheCouncilproposesthattheGovernmentincreasefundingforbothcapital
infrastructure,facilitiesandstaffforuniversities,publicdentalhospitalandcommunity
placementclinicalfacilities.
Dataandresearch
Policydevelopment,programdesignandevaluationneedstobesupportedbysufficient
ongoingfundingfordataandresearch.TheCouncilwouldliketoseeamaintenanceof
existingsupportforpopulationlevelmonitoringandsurveillanceoforalhealth,useof
dentalservicesandpracticeactivity.
Appropriateresearchactivitiesinclude:
moreregularnationalsurveysforchildrenandadults,sothattheybecomeanexpected
partofunderstandingtheoralhealthofAustralians;
theidentificationofgapsinpopulationlevelmonitoringandsurveillanceand
implementationofactivitiestofillthem;
capturingagreaterscopeofprocess,outputandoutcomemeasuresonindividuals
withinexistingandnewdentalprograms;
targetedresearchinpriorityareasofemergingneed;and
targetedresearchonthefactorsthatinfluencedentalpractitionerstoworkinruraland
remotespecialistareas.
TheCouncilsupportsimprovingtheevidencebaseforworkforceplanningthrough
ongoingresearch.Therecentpublicationofnewdataonpractitionerregistrations
highlightstheneedforongoingmonitoringofthedentalworkforceandtheperiodicrevision
ofdentalworkforcesupplyprojections.TheCouncilbelievesitwouldbeappropriateforthe
Governmenttofundperiodicresearchandanalysis.
Oralhealthpromotion
Australiahasaworldclassrecordinhealthpromotioninsomeareas,includingtacklingroad
accidents(i.e.drinkdriving),smokingandHIV/AIDS.Wealreadyhavethecapacitytobe
highlyeffectiveindeliveringoralhealthstrategiesiffundingandothersupportsare
provided.ThevalueofsuchaninvestmentisreadilyseenintheCommonwealth
Governments2003publication,ReturnsonInvestmentinPublicHealth, 120 whichalso
highlightsanotherkeyprincipleofsuccessfulhealthpromotionwork:planningcollaborative
approachesusingmultiplestrategiesatdifferentlevels.
Expenditureonoralhealthpromotionandnonclinicalpreventionactivitiesisverylow
estimatedtobearoundonepercentofexpenditure,comparedtoeventhehighlymodest
twopercentofexpenditureacrossthewholehealthsystem.Thiscouldbesignificantly
increasedtoreducetheincidenceofdentalcariesandperiodontaldisease.Thiswillboth
improvethequalityoflifeofAustraliansandreducethedemandforfuturedentalcare.
Broadersystemicsupportfororalhealthpromotionrequireslegislative,regulatoryand
fiscalpoliciestoassistinmakinghealthychoiceseasierexamplesintheoralhealtharea
includehealthpromotingfoodsinschoolsorremovaloftaxesonfluoridetoothpaste.
Asisthecaseformanyotherhealthissues,oralhealthstatusisinfluencednotonlyby
individualbehavioursbutstructuralorsocialfactors.Forexample,accesstocareiscrucial
andtheinequitiesinthisarediscussed.Otherstructuralissuesincludethoseinfluencing
dietingeneral,e.g.accesstoaffordablehealthyfoods,heavypromotionofhighsugarfoods
ontelevisionandatpointofsale,andthewaysugartreatsareseenasrewardsinour
culture.Theseandotherfactorsneedconsiderationwhendesigninghealthpromotion
programs.
TheCouncilproposesthedevelopmentofaNationalOralHealthPromotionPlanasthe
cornerstoneforfuturepromotionalactivities.ThisPlancouldinvestigatevarious
opportunitiesandpathwaysfororalhealthpromotionandwouldincludedeveloping:
amultistrategyapproachtooralhealthpromotionthroughcoordinationwiththe
statesandterritoriesbasedoncurrentevidence,underpinnedbysocialresearch,and
underpinnedbycommonthemes,principlesandoralhealthmessaging;
120
AppliedEconomics(2003),ReturnsonInvestmentinPublicHealth:AnEpidemiologicalandEconomic
Analysis,2003.PreparedfortheDepartmentofHealthandAgeing.
closelinkstothegeneralhealthpromotionactivitiesoftheAustralianNational
PreventiveHealthAgency,i.e.theExpertCommitteeonObesity,withanincreasedfocus
onoralhealth;
astrategicsystemtoencompassandsupportalloralhealthpromotionactivities,such
as:
- targetedapproachesinvolvingconveyinginformationandsupportinghealthychoices
tobeorganisedaroundasettingsapproach,forexampledaycarecentresor
residentialagedcarefacilities;
- withinformationandhealthierbehaviourreinforcedthroughmasscampaignsand
encounterswithpublicandprivatedentalservices;
- embeddingoralhealthpromotioninservicedeliverymodelsintheeducationofthe
futuredentalworkforce;
- oralhealthscreeningandeducation:
o uponadmissiontoresidentialagedcare,andincorporatedaspartofthe
clientsoverallcareplan;
o priortooruponcommencementoftreatmentfordiseasesrequiringlengthy
treatment(e.g.cancer),andregularoralhealthchecksandpreventive
treatmentthroughouttreatmentaswellasforaposttreatment;and
o priortooruponcommencementoftreatmentforchronicconditionsby
includingoralhealthassessmentsandpreventiveactivitiesincareplans;
- ongoingsupportfororalhealthpromotionandprevention,includingeducation,
activitiesandcampaignstoensurethatimprovementsinoralhealtharesustained
overtime;
expertiseinresearchthatiscentredonoralhealthproblems;
regularfundingfortheNationalOralHealthPromotionClearingHouseandSteering
Groupandrecognitionoftheirroleasthecoordinatingadvisorybodyfororalhealth
promotionprojects;
designatedpositionsfororalhealthchampions(suchasdentalassistants,dental
practitionersorotherhealthworkers)withinstateoralhealthservicestolinkinto
communitiesandschoolstoraisetheprofileoforalhealthandtodeliverconsistent
nationalmessages;
proposalstoextendwaterfluoridationacrossthewholecountry;and
scopeforleveragingtheMedicareLocalsnetworkfortargetedactivities.
Targetinggroupswithspecialoralhealthcareneeds
TheMedicareLocalNetworkcouldfacilitateaccesstooralhealthservicesforspecialneeds
patientsby:arrangingpatienttransportationforvisits;andassigningacasemanagerto
patientstomanageappointmentsandfollowupvisits.MedicareLocalscouldalsoactasan
informationgatewaybetweenthestatesandterritoriesandlocaloralhealthproviders.This
couldassistthestatesinidentifyingandaddressingoralhealthservicedelivery.
Apilotprogramtodeliveroralhealthpromotioncouldbetrialledinaparticularstateor
regiontoidentifyspecialneedsgroups(refertoAppendixHforacasestudyonMedicare
Locals).
Tofurtherassistthesespecialneedsgroupstoaccesscare,centresofexcellencecouldbe
establishedfordevelopingpublicdentalcapacitytospecialiseinmanagingspecialcases.
Indigenouspeople
IncreasedaccesstodentalservicesforIndigenouspeoplecouldinclude:
improvementstothecoordinationofservicesthroughAboriginalMedicalServicesand
thestatesandterritories;
upskillingIndigenoushealthworkersinoralhealtheducation,utilisingoralhealth
competenciesdevelopedforIndigenoushealthworkersbytheCommunityServicesand
HealthIndustrySkillsCouncil;
supportforIndigenousstudentsacrossdentaldisciplines,includingdevelopingaccess
programsforIndigenousstudentstostudydentistry;
updatingtheDentistryinRemoteAboriginalCommunitiesmanual,whichprovides
informationonculturalandclinicalorientationfororalhealthprofessionalsworkingin
remoteIndigenoussettings;and
MedicareLocalscoordinatingservicesinurbanareasaswellasparticularlyforruraland
remotecommunities.Whereappropriate,MedicareLocalscouldidentifyserviceneeds
andcoordinateAboriginalMedicalServicestomakearrangementswithprivateand
publicdentiststoextendthereachofservicestoIndigenouspeople.
Inaddition,theCouncilalsosuggestsinvestigatingapossiblenationalexpansionof
successfulregionalIndigenousliaisonprograms.TheseprogramslinkwithIndigenous
communitiesandtrainpublicdentalstafftoworkwithIndigenouspeople,withAboriginal
workersactingasalink.Theseprogramshavebeensuccessfulinmakingmainstreampublic
dentalservicesmoreacceptabletoIndigenouspeople,withthenumberofIndigenous
peopletreatedinmainstreampublicclinicsincreasingsignificantly.
Peopleresidinginruralandremoteareas
Theproposalstoaddressworkforcemaldistributionwouldalsoimproveaccessforruraland
remoteareas.Inaddition,ruralMedicareLocalscouldbeusedtoidentifydentalservice
gapsinthoseareasandtoassistwiththecoordinationofdentalservicedelivery.
Apreferredservicedeliverymodelwouldhavedentalpractitionersresideinremoteand
rurallocationsonamorepermanentbasis.Thiscouldbesupportedbyretentionincentives
andinfrastructuregrants.Forsmallcommunities,however,flyinflyoutmodelslikethe
MedicalSpecialistOutreachAssistanceProgramcouldbeappropriate,butwithdesignated
communicationstrategieswithexistingdentalandnondentalprofessionals.
Frailolderpeopleinthecommunityandresidentialcare
Thesepeopleinthecommunityandagedcareresidentshavedifficultiesmaintainingoral
hygieneandaccessingdentalcare.Thefollowingstrategiescouldbeinvestigatedand
developed:
wideruseofalldentalpractitionersinhomeandagedcarefacilities;
thenondentalworkforce,whichareprovidinghealthservicestoolderAustralians,could
receivefurthertraininginoralhealth,includingreintroducingthesuccessfulNursing
HomeOralandDentalHealthPlan(andincludingreferralpathwaysforactivetreatment)
andusingoralhealthcompetenciesdevelopedbyCommunityServicesandHealth
IndustrySkillsCouncil;
existingoralhealthscreening,assessmentandsimplecareplanningcouldbeevaluated
andimprovementscouldbebuiltintoexistingassessmentandcareplanningprocesses
suchasthoseundertakenbyAgedCareAssessmentTeams(ACAT);
ManyoftheexistingACATComprehensiveAssessmentForms(CAFs)havesome
standardquestionstodeterminethebasicOral/DentalHygienestatusoftheclient.
TheDepartmentofHealthandAgeinghasdevelopedanAgedCareAssessment
ProgramToolkitforusebyACATassessorsandincludesan'OralHealthAssessment
Tool'.Atthistimetheuseofthetoolkitisnotmandatory.However,the
DepartmentisintheintheprocessofdevelopingastandardisedNationalACATCAF.
currentaccreditationstandards,underexpectedoutcome2.6and2.15the
AgedCareAct1997,couldbeassessedtoseeiftheyareeffectiveinassessingandcare
planningfororalhealthandintheimplementationofthesecareplansinagedcare
facilities.ThiscouldbeexaminedaspartoftheDepartmentofHealthandAgeingspilot
ofrevisedAccreditationStandards,whichisanticipatedtobeundertakenthisyear.
greateremploymentofmobiledentalclinicsanddentalequipmentinprovidingservices
toagedcareresidentswithmobilityandtransportissues;
attentioncouldbegiventoincludingoralhealthaspartofTAFEanduniversitynursing
coursecurriculums;and
astrategytoeducatethedentalworkforceinmanagingagedcare.Thiscouldincludethe
useofscholarships,suchasthoseavailablethroughrelevantFundsestablishedbythe
Commonwealthinthe201112BudgetandadministeredbytheDepartmentofHealth
andAgeing.Thiscouldincludespecificscholarshipsfordentaltherapistsandoralhealth
therapiststoworkinagedcarefacilities,withaparticularemphasisonworkinginrural
andremotefacilities.
TheCouncilisalsoawarethattheGovernmentprovidesfundingtotheDepartmentof
Education,EmploymentandWorkplaceRelationsundertheNationalWorkforce
DevelopmentFund,whichallowseligibleorganisationstoapplyforfundingtosupportthe
trainingofexistingworkersandnewworkersintheareasofidentifiedbusinessand
workforcedevelopmentneed.AgedCaretraininghasbeenspecificallyidentifiedasanarea
fordevelopmentthroughthisfundingandhasbeenallocated$25milliontowardsskills
developmentin201112.
TheCouncilalsoisawareofotherpolicyinitiativesforimprovingoverallclinicalhealth,
includingdentalhealth,forresidentsinagedcarefacilities.Opportunitiesforsynergies
betweenthisandotheractivitiescouldbeinvestigatedtostrengthenthereachand
effectivenessofdentalhealthinterventionsforthisvulnerablegroup.
Homelesspeople
Thesepopulationgroupsnotonlyfacebarriersaccessingdentalservicesbutalsohave
difficultyaccessingotherhealthservices.Thiswillrequirestrategiesformarshallingsocial
assetsinthecommunity,e.g.theMedicareLocals,theLocalHospitalNetworks,Community
HealthServices,andnongovernmentorganisations.
Itwouldbeworthinvestigatinganexpansionofthecurrentprogramsthatprovidetargeted
promotionalanddentaltreatmenttoallSupportedResidentialFacilities.
TheCouncilalsonotesthephilanthropicworkundertakenbytheADA,itsmembersand
otherorganisationsindeliveringservicestohomelesspeople(seeAppendixJ).
Peoplewithdisabilities
Somepeopleinthecommunityfacesignificantaccessbarrierswhichvarygreatlyinscope
andcomplexity.Accesstoservicesmayrequirespecificprogramsdesignedtomeettheir
needs,whichcouldrequirecoordinatingservicesthroughnewandexistingsocialassets
andsystemsofservice,e.g.MedicareLocalnetworks,communityhealthservices,andnon
governmentorganisations,relevantstatedepartmentsanduniversities.
Inaddition,educationandinformationcouldbedevelopedandprovidedtoassistdental
practitionersinworkingwithvariousdisabledpeople.
Prisoners
TheCouncilnotedthatreportsoftheoralhealthofprisonersgivecauseforconcern.While
statesareresponsibleforthedentaltreatment,Councilrecommendsthatthisissueisraised
intheAustralianHealthMinistersAdvisoryCouncil(AHMAC).
TermsofReference AppendixA
AppendixATermsofReference
NationalAdvisoryCouncilonDentalHealth
TheNationalAdvisoryCouncilonDentalHealth(theCouncil)isbeingestablishedasatime
limitedgrouptoprovidestrategic,independentadviceondentalhealthissues,asrequested
byMinisterforHealthandAgeing,totheGovernment.
RoleandFunction:
TheobjectiveoftheCouncilwillbetoprovidetimely,expert,balancedadviceondental
healthissuesasrequestedbytheMinisterforHealthandAgeing.
TheCouncilsprioritytaskistoprovideadviceondentalpolicyoptionsandprioritiesfor
considerationinthe201213Budget.
Inacquittingthistask,theCouncilwillconsider:
dentalhealthprogramscurrentlyfundedbytheAustralian,StateandTerritory
governments,andthemixandcoverageofservicescurrentlyprovidedbyintheprivate
sector;
howtoimprovetheseprogramsandbettersupportpeoplewithdentalillness,inacost
effectivemanner,includingthroughbettercoordinationandintegrationofexisting
dentalhealthprogramsandservices;and
howtofocusdentalhealthprogramsforpeoplewithparticularneeds,includingyounger
people,olderpeopleincludingpeoplewithchronicillnessandcomorbidconditions,
peoplefromdiverseculturalandlinguisticbackgrounds,IndigenousAustralians,and
peopleinruralandremoteareas.
TheCouncilmaycommissiontargetedresearchasappropriateondentalhealthpolicyand
servicedeliveryissues;andconsultandliaisewiththedentalhealthandrelatedsectors,
includingdentalhealthconsumersandcarers,professionalsandthenongovernmentsector.
InformulatingadvicetheCouncilshouldgiveconsiderationtohowimprovementsindental
healthcouldbephasedinovertime.
Other
TheMinisterforHealthandAgeingmayalsoconveytotheCouncilrequestsforadvicefrom
thePrimeMinister,otherministerswhoseportfolioresponsibilitiesrelatetodentalhealth
issues.TheMinistermayalsoconveyrequestsforadvicefromtheLeaderoftheAustralian
GreensthathavebeenagreedwiththeMinister.
AlladviceandreportsfromtheCouncilwillbeprovidedtotheLeaderoftheAustralian
Greenswithin2daysofbeingreceivedbytheMinister.
TheCouncilwillprovideaninterimreportbytheendofNovember2011,andafinalreport
onoptionsandprioritiesforthe201213BudgetbytheendofJanuary2012.
TermsofReference AppendixA
TheCouncilwillinitiallybeestablishedforoneyear.Considerationwillbegiventoan
ongoingrolefortheCouncilorasimilarbodytoadviseonimplementationofdentalhealth
reforminthe201213Budgetcontext.
Principles AppendixB
AppendixBPrinciples

InprovidingadvicetotheCommonwealthGovernmentondentalhealthissues,theNational
AdvisoryCouncilonDentalHealthrecognisescertainguidingprinciples.
Oralhealthisanimportantpartofgeneralhealth,wellbeingandqualityoflifeand
shouldbeconsideredinthecontextofbroaderhealthreform.

Oraldiseasehasimplicationsforthedaytodaylifeoftheindividualandresultsin
economiccoststothecommunityduetoreducedsocialandeconomicparticipationand
broadercoststothehealthsystem.
Oralhealthpromotionwillbeanintegralpartofimprovinghealthacrossthepopulation.

Childoralhealthisavitalfoundationforlifelongoralhealth.
Equitableaccesstoappropriate,timelyandaffordableservicesisimportantfor
preventingoraldiseaseandimprovingoralhealthacrossthepopulationaswellas
managinginfectionandpainandrestoringfunction,notingthereisaverysignificantlack
ofaccessforsomegroups,particularlylowincomegroupsandregionalandremote
populations.
Availableresourcesshouldfirstfocusonthesegroupsviatargetedapproachesfor
prevention,earlyinterventionandmanagementofestablisheddisease.
Targetedapproachesshouldappropriatelyaddressthedifferingoralhealthneedsof
childrenandadults,andothergroupssuchastheaged,thedisabled,Indigenous
Australians,andpeoplewithchronicconditions.
Jurisdictionsandothersectorshaveparticularrolesandresponsibilitiesinthefunding
anddeliveryoforalhealthservices:
theCommonwealththroughleadershipandfunding;thestatesandterritories
throughfundingandpublicsectorservicedelivery,trainingandeducation;andthe
privateandnongovernmentsectorsthroughservicedelivery.

Dentaleducationalinstitutionshaveaparticularroleintheeducationoftheoralhealth
workforce,includingthroughtheprovisionofdentalservices.
Improvementsinaccesstoappropriateoralhealthserviceswillinvolveimprovementsin
thedentalworkforce,includingthecapacityandbetterutilisationofdentalpractitioners,
andthegeographicdistributionofservices.
Expansionindentalinfrastructurewillleadtoimprovementsinaccesstodentalhealth
services.
Principles AppendixB
Regularundertakingsofdatacollection,research,andevaluationofdentalprogramswill
helptoidentifygapsinserviceprovisionandwillhelptoimproveunderstandingofthe
oralhealthstatusofAustralians.
ServiceDeliveryOptions AppendixC
AppendixCServiceDeliveryOptions
Group TherewouldbespecialarrangementsinalloptionstoovercomebarrierstoaccessforsomesectionsofIndigenous,thosewithmentalhealthissuesordisabilities,homeless,agedcareresidentsandruraland
regionalareas.
Options Costs Issues
Children
Need: General
Thereisanincreasingprevalenceofcariesinchildren. Finalcostswilldependonlevelofservice, Thisoptionwouldinvolveanincreasedinvestmentinchilddental
20%ofallchildrendonothaveadequateaccesstoservices. entitlement,andimplementation.Allestimates services.
Objective: shouldbetakenasindicativeonly. Wouldrequiremeasurestodevelopworkforcecapacitytomeet
Improvedaccessforallchildrenuptotheageof18(5.4millionchildren),coveringbasicdental, increasedservicedemandsandaddressgapsinaccesstoservices.
includingpreventiveandtreatmentservices. Notevariationsinhowservicesaredeliveredbetweenstates,varying
Option1. fromdedicatedschooldentalservicearrangementstocommunity
Implementation
UniversalIndividualCappedBenefitEntitlementforChildren basedonly,suchasNSWandVic.
Implementationcouldbescaledovertimeto
Estimatedcostovertheforwardestimatesfrom201213$3.0b Fullimplementationwouldneedseveralyearstobuildchilddental
recognisecontextoffiscalenvironmentandneed
Fullyimplementedcost$904mperyear systemacrossallstatesandterritories,includingbuildinginfrastructure
forphasedintroductiontoallowdevelopmentof
anddatasystems,andestablishingstandardsofcare.
capacityandsystems.
Operation: WouldrequireengagementthroughCOAGonfundingandservice

Useanindividualcappedbenefitentitlementsystemtoallowaccesstobasicdentalpreventiveand delivery.
Scalingofoptionsappliestoacappedbenefit
treatmentservices(tobedefined)throughascheduleofbenefits. Somestatesandterritoriesalreadyofferservicesforallchildren
entitlement(Option1)assomestatesand
ExistingMTDPcouldbeamodifiedandexpandedasthevehicleforservicedelivery. withoutmeanstest.
territoriesalreadyprovideuniversalaccessto
Entitlementcouldbescaledtoreflectcostsoutsidemetro/regionalcentres. AllScaledOptions
services.
Entitlementcouldbeusedinpublicorprivatesectors,withschedulebenefitssettocostofproviding Assomestatesandterritoriesofferuniversalaccesstoservices,a

servicesinpublicsystem. scaledintroductionwouldneedtoconsiderhowfundingcouldbe
OptionsforScaling(indicativecostsoverthe
Useofthepublicsectorfreeforservicesintheschedule. providedtoensuretargetgroupshaveaccesstoagreedservicelevels.
forwardestimatesfrom201213)
Aspartofthisoption,measurestoidentifyandreachchildrenwhofaceaccessbarrierswouldbe Childrenfromfamiliesnotmeetingmeanstestmaystillhave
A. Eligibilitysettochildreninconcessioncard
implemented,whichmayincludeseparateinvestmentinadditionalinfrastructure(e.g.throughMedicare difficultiesaffordingappropriatedentaltreatmentservicesthiscould
families:
Locals,StateandTerritoryChild/SchoolDentalServices). putpressureonstatesandterritoriesthatprovidenonmeanstested
2millionchildren:$1.3b
Option2. accesstopublicdentalservices.
B. Includechildrenuptolowincomenon
UniversalPublicDentalAccessforChildren ScaledOptionAandB
concessioncardthreshold(tobedefined):*
Estimatedcostovertheforwardestimatesfrom201213$2.5b MeanstestisinconsistentwithMTDPmeanstest,whichsubsidises
2.9millionchildren:$1.7b
Fullyimplementedcost$717mperyear accesstopreventivecareforthosemeetinghigherFTBAthresholds.
C. IncludechildrenuptoFTBAthreshold:
3.4millionchildren:$2.0b
Operation: D. Includeallchildren:
Usepublicdentalsystemtoprovideaccesstonationallyconsistentbasicdentalpreventiveandtreatment 5.4millionchildren:
services(tobedefined)thiswouldbeanenhancementtotheexistingpublicdentalsystem. Option1$3.0b
Statesandterritorieswouldbeabletopurchasefromprivatesectorservicesastheybuildnationally
Option2$2.5b
consistentservicesandcoverage.
Childrenfromcardholderfamilieswouldbeprovidedwithaccesstofreebasicdentalpreventiveand
treatmentservices.
Couldhavelimitedcopaysfornoncardholders,notingthatsomestatesandterritoriesalreadyhaveco
payments. *populationestimateindicativeonlytobe
Aspartofthisoption,measurestoidentifyandreachchildrenwhofaceaccessbarrierswouldbe furtherdeveloped
implemented,whichmayincludeseparateinvestmentinadditionalinfrastructure(e.g.throughMedicare
Locals,StateandTerritoryChild/SchoolDentalServices).
Modellingofcostisbasedonthepublicsystemactingasalimiterofservicesduetocapacityconstraints
ofthesystemandexpectationthatsomepatientswillmaintainprivatesectoraccessandnotswitchto
thepublicsystem.Thisresultsinloweroverallcoststhanthebenefitentitlementoption.
Additionalmeasurestoreachchildrenwhoarereceivinginadequateservice.
TherewouldbespecialarrangementsinalloptionstoovercomebarrierstoaccessforsomesectionsofIndigenous,thosewithmentalhealthissuesordisabilities,homeless,agedcareresidentsandruraland
Group regionalareas.
Need: General
AdultCardholders
Estimatedupto400,000adultsonpublicdentalwaitinglists. Finalcostswilldependonlevelofservice, Thisoptionwouldinvolveanincreasedinvestmentinadultdental

42%ofcardholdershaveanunfavourablevisitingpattern(i.e.,donotvisitthedentisteveryyear). entitlement,andimplementation.Allestimates services.
Only10%ofcardholdersreceivetreatmentinthepublicsysteminanyoneyear. shouldbetakenasindicativeonly. Wouldrequiremeasurestodevelopworkforcecapacitytomeet
Objective: increasedservicedemandsandaddressgapsinaccesstoservices.
Improvedaccessforalladultcardholders(5.1millionadults),coveringbasicdental,includingpreventive Implementationwouldneedseveralyearstobuildpublicdentalsystem
andtreatmentservices. acrossallstatesandterritories,includingbuildinginfrastructureand
Option3. datasystems,andestablishingstandardsofcare.
Implementation WouldrequireengagementthroughCOAGonfundingandservice
MeansTestedIndividualCappedBenefitEntitlementforAdultsConcessioncardeligibleonly Implementationcouldbescaledovertimeto
Estimatedcostovertheforwardestimatesfrom201213$7.1b delivery.
recognisecontextoffiscalenvironmentandneed Administeringanexceptionalcircumstancesschemeforaccessto
Fullyimplementedcost$2.6bperyear forphasedintroductiontoallowdevelopmentof
higherlevelserviceswouldbecostlyatapopulationlevel.
capacityandsystems. ScaledOptionsBandC
Operation: Accesstoentitlementcanalsobescaledupfrom
Useanindividualcappedbenefitentitlementsystemforadultcardholderstoallowaccesstobasicdental Introductionofchronicdiseasepopulationgroupisunlikelytobeable
concessioncardholders(below).Inclusionoflow tooccurintheshorttermincreasedcapacitywouldneedtobe
preventiveandtreatmentservices(tobedefined)throughascheduleofbenefits. incomenonconcessioncardholdersonlyapplies
ExistingCDDScouldbemodifiedasthevehicleforservicedeliveryifchronicdiseasepatientsincludedasa developedtoensureserviceandaccessstandardscouldbemet.
toacappedbenefitentitlement(Option1)asitis Anydifferentialaccessforchronicdiseasepatientswouldputpressure
targetgroup. notexpectedthatthepublicsystemwouldbuild
Entitlementcouldbescaledtoreflectcostsoutsidemetroandregionalcentres,and/ortoaccountfor forequityofserviceslevelsandfundingfortherestofthepopulation.
capacityfordeliveringservicestothisadditional Stilltobedeterminedhowthechronicdiseaseeligibilitygateway
increaseservicecostsforcertaingroups,e.g.chronicdiseasepatients,denturepatients. groupwithinthe4yearBudgetperiod.
Entitlementcouldbeusedinpublicorprivatesectors,withschedulebenefitssettocostofproviding wouldoperate.Tighteningofchronicdiseasetestwouldneedtobe
determinedbasedonclinicaladvicefromanexpertgroup.
servicesinpublicsystem. OptionsforScaling(indicativecostsoverthe
Useofthepublicsectorfreeforservicesintheschedule. Extentofaccesstoexceptionalcircumstancesgatewaytobe
forwardestimatesfrom201213) determined(accesstohigherlevelrestorativeitemsnotincludedin
Eligibilitycouldbescaleduptoincludeothergroups,e.g.,chronicdiseasepatients,lowincomenon A. Eligibilitysettoconcessioncardholders:
concessioncardholders. costings).
5.1millionadults: ScaledOptionC
Accesstohigherlevelservices(e.g.,crowns,bridges,implants)couldbecontrolledthroughanexceptional Option1$7.1b
circumstancesapplicationprocessbasedonadvicefromexpertgroup. UnlikelypublicdentalsysteminOption2(MeansTestedPublicDental
Option2$3.0b AccessforAdults)wouldbeabletoabsorblowincomenonconcession
Introducemeasurestofasttrackservicestopatientsonpublicdentalwaitinglists. B. Includechronicdiseasedentalpatients
Option4. cardholderadultsintheshortorevenmiddletermandhasnotbeen
(eligibilitytobedefined):^ costedincreasedcapacitywouldneedtobedevelopedtoensure
MeansTestedPublicDentalAccessforAdultsConcessioncardeligibleonly 5.1millionadults+chronicdiseasepatients:
Estimatedcostovertheforwardestimatesfrom201213$3.0b serviceandaccessstandardscouldbemet.
Option1$8.3b
Fullyimplementedcost$1.3bperyear Option2$4.3b
C. Includechronicdiseasepatientsandlow
Operation: incomenonconcessioncardholders(tobe
Usepublicdentalsystemtoprovideaccesstofree,orlimitedfee,nationallyconsistentbasicdental defined):*
preventiveandtreatmentservices(tobedefined)thiswouldbeanenhancementtotheexistingpublic 7.6millionadults+chronicdiseasepatients:
dentalsystem. Option1$11.4b
Statesandterritorieswouldbeabletopurchasefromprivatesectorservicesastheybuildnationally
consistentservicesandcoverage,includingaccesstohigherlevelservicesinexceptionalcircumstances.
Eligibilitycouldbescaleduptoincludeothergroups,e.g.chronicdiseasepatients,lowincomenon ^Estimatedcostsofincludingchronicdiseasepatients
includebroadassumptionsaboutmeasurestoconstrain
concessioncardholders,butwouldrequiresimilarlyscaledincreasedinvestmentinpublicsystemfor expenditure.
infrastructureandworkforce.
Accesstohigherlevelservices(e.g.,crowns,bridges,implants)couldbecontrolledthroughanexceptional *Populationestimateindicativeonlytobemodelled.Low
circumstancesapplicationprocessbasedonadvicefromexpertgroup. incomenonconcessioncardholdernumbersindicativeof
thoseonthresholdincomesof$60,000forcouplesand
Introducemeasurestofasttrackservicestopatientsonpublicdentalwaitinglists.
$30,000forsingles.
Modellingofcostisbasedonthepublicsystemactingasalimiterofservicesduetocapacityconstraints

ofthesystemandexpectationthatsomepatientswillmaintainprivatesectoraccessandnotswitchto
thepublicsystem.Thisresultsinloweroverallcoststhanthebenefitentitlementoption.

TherewouldbespecialarrangementsinalloptionstoovercomebarrierstoaccessforsomesectionsofIndigenous,thosewithmentalhealthissuesordisabilities,homeless,agedcareresidentsandruraland
Group regionalareas.
Need: General
AdultCardholdersandChildren(AnexampleofanIntegratedOption)
Estimatedupto400,000adultsonpublicdentalwaitinglists. Finalcostswilldependonlevelofservice, Thisoptionwouldinvolveanincreasedinvestmentinadultandchild

42%ofcardholdershaveanunfavourablevisitingpattern(i.e.,donotvisitthedentisteveryyear). entitlement,andimplementation.Allestimates services.
Only10%ofcardholdersreceivetreatmentinthepublicsysteminanyoneyear. shouldbetakenasindicativeonly. Wouldrequiremeasurestodevelopworkforcecapacitytomeet
Thereisanincreasingprevalenceofcariesinchildren. increasedservicedemandsandaddressgapsinaccesstoservices.
20%ofallchildrendonothaveadequateaccesstoservices. Implementation Notevariationsinhowservicesaredeliveredbetweenstates,varying
Objective: Implementationcouldbescaledovertimeto fromdedicatedschooldentalservicearrangementstocommunity
recognisecontextoffiscalenvironmentandneed basedonly,suchasNSWandVic.
Improvedaccessforalladultcardholders(5.1millionadults)andallchildrentotheageof18(5.4million
forphasedintroductiontoallowdevelopmentof Implementationwouldneedseveralyearstobuildpublicdentalsystem
children),coveringbasicdental,includingpreventiveandtreatmentservices.
capacityandsystems. acrossallstatesandterritories,includingbuildinginfrastructureand
ExampleIntegratedOption.
datasystems,andestablishingstandardsofcare.
Improvedaccesstobasicdentalservicesforadultcardholdersandallchildrenmeanstestedcapped
Accesstoentitlementforadultscanalsobescaled WouldrequireengagementthroughCOAGonfundingandservice
benefitentitlementforconcessioncardadultsonlyanduniversalpublicdentalaccessforchildren
upfromconcessioncardholders(below). delivery.
Estimatedcostovertheforwardestimatesfrom201213$10.1b
OptionsforScalingAdults(indicativecostsover Administeringanexceptionalcircumstancesschemeforaccessfor
FullyImplementedcost$3.3bperyear
theforwardestimatesfrom201213) adultstohigherlevelserviceswouldbecostlyatapopulationlevel.

A. Eligibilitysettoconcessioncardholders:
Operation:
5.1millionadults:$7.1b ScaledOptionsBandC
TheCommonwealthwouldfundacappedbenefitentitlementsystemforadultcardholderstoallowaccess
tobasicdentalpreventiveandtreatmentservices(tobedefined)throughascheduleofbenefits. B. Includechronicdiseasedentalpatients(tobe Introductionofchronicdiseasepopulationgroupisunlikelytobeable
defined):^ tooccurintheshorttermincreasedcapacitywouldneedtobe
o ExistingCDDScouldbemodifiedasthevehicleforservicedeliveryifchronicdiseasepatientsincludedas
5.1millionadults developedtoensureserviceandaccessstandardscouldbemet.
atargetgroup.
+chronicdiseasepatients:$8.3b Anydifferentialaccessforchronicdiseasepatientswouldputpressure
o Entitlementcouldbescaledtoreflectcostsoutsidemetroandregionalcentres,and/ortoaccountfor
C. Includechronicdiseasepatientsandlow forequityofserviceslevelsandfundingfortherestofthepopulation.
increaseservicecostsforcertaingroups,e.g.chronicdiseasepatients,denturepatients.
incomenonconcessioncardholders(tobe Stilltobedeterminedhowthechronicdiseaseeligibilitygateway
o Entitlementcouldbeusedinpublicorprivatesectors,withschedulebenefitssettocostofproviding
defined):* wouldoperate.Tighteningofchronicdiseasetestwouldneedtobe
servicesinpublicsystem.
7.6millionadults determinedbasedonclinicaladvicefromanexpertgroup.
o Useofthepublicsectorfreeforservicesintheschedule.
+chronicdiseasepatients:$11.4b Extentofaccesstoexceptionalcircumstancesgatewaytobe
o Eligibilitycouldbescaleduptoincludeothergroups,e.g.,chronicdiseasepatients,lowincomenon
determined(accesstohigherlevelrestorativeitemsnotincludedin
concessioncardholders.
Noscalingoptionshavebeenprovidedforchild costings).
o Accesstohigherlevelservices(e.g.,crowns,bridges,implants)couldbecontrolledthroughan
applicationprocessbasedonadvicefromexpertgroup. portionofoptionassomestatesandterritories
o Measurestofasttrackservicestopatientsonpublicdentalwaitinglists. alreadyprovideuniversalaccesstoservices.
Thestatesandterritorieswouldmaintainexistingfundinglevelsforallchildrentoaccessnationally
consistentbasicdentalpreventiveandtreatmentservices(tobedefined)thiswouldbeanenhancement UniversalPublicAccessforChildren(indicative
totheexistingpublicdentalsystem. costsovertheforwardestimatesfrom201213)
o Statesandterritorieswouldbeabletopurchasefromprivatesectorservicesastheybuildnationally 5.4millionchildren:$2.5b

consistentservicesandcoverage.
o Childrenfromcardholderfamilieswouldbeprovidedwithaccesstofreebasicdentalpreventiveand
treatmentservices. ^Estimatedcostsofincludingchronicdiseasepatients
o Couldhavelimitedcopaysfornoncardholders,notingthatsomestatesandterritoriesalreadyhaveco includebroadassumptionsaboutmeasurestoconstrain
expenditure.
payments.

o Aspartofthisoption,measurestoidentifyandreachchildrenwhofaceaccessbarrierswouldbe *Populationestimateindicativeonlytobemodelled.Low
implemented,whichmayincludeseparateinvestmentinadditionalinfrastructure(e.g.,MedicareLocals, incomenonconcessioncardholdernumbersindicativeof
StateandTerritoryChild/SchoolDentalServices). thoseonthresholdincomesof$60,000forcouplesand
$30,000forsingles.

PublicDentalServicesAdults AppendixD
AppendixDAdultDentalServicesProvidedbytheStatesandTerritories
Eligibilitycriteria
Age Cardholders* Servicesoffered Cost
QLD Abovetheageof PensionerConcessionCard Emergencyandgeneraldentalcarecheckups,oral Nocosttopatient.
completionof HealthCareCard hygiene,fillings,endodontics,extractiondentures,oral
Year10. PensionerConcessionCard surgeryanddentures
(DepartmentofVeteransAffairs)
QueenslandSeniorsCard Treatmentisprovidedthroughteachingdentalfacilities,
CommonwealthSeniorHealth communityclinicsandtheprivatesector.
Card.
Limitedspecialistdentalservicesareavailable.
NSW 18yearsofageand HealthCareCard Emergencyandgeneraldentalcarecheckups,oral Nocosttopatientforemergencyand
older. PensionerConcessionCard hygiene,fillings,endodontics,extractiondentures,oral generaldentalcare.
CommonwealthSeniorsHealth surgeryanddentures.
CareCard Copaymentsmayapplyforpatientsof
Treatmentisprovidedthroughteachingdentalfacilities, someteachingservices,specialist
Mustbenormallyresidentwithinthe communityclinicsandtheprivatesector. dentalservicesandsomedenture
boundaryoftheprovidingAreaHealth services.
Service. Limitedspecialistdentalservicesareavailableprimarily
throughtwoteachinghospitals.

VIC 18yearsofageand PensionerConcessionCard Emergencyandgeneraldentalcarecheckups,oral Emergencycourseofcare:$25flatfee.
older. HealthCareCardholders hygiene,fillings,endodontics,extractiondentures,oral
Refugeesandasylumseekers surgeryanddentures. GeneralCourseofcare:$100.

Priorityaccessisgiventoanumberof Treatmentisprovidedthroughcommunitydentalclinics, Upto$120fordentures.
groups,including: theRoyalDentalHospitalofMelbourneandtheprivate
- AboriginalandTorresStrait sector. Someexemptionsapply(e.g.ATSI
Islanders(ATSI); clients,homeless,refugeesandasylum
- homeless; Limitedspecialistdentalservicesareavailableprimarily seekers).
- pregnantwomen; throughtheRoyalDentalHospitalofMelbourne.
- refugeesandasylumseekers; Copaymentsforspecialistservicesare
and dependantonserviceuptoa
- registeredclientsofmental maximumof$300percourseofcare.
healthanddisabilityservices.


Eligibilitycriteria
TAS 18yearsofageand HealthCareCard Emergencyandgeneraldentalcarecheckups,oral Copaymentof25%oftheDVALocal
older. PensionCard hygiene,fillings,endodontics,extractiondentures,oral DentalOfficers(LDO)Feetoa
surgeryanddentures. maximumof$366percourseofcare.

SpecialCareDentalUnitsintwoacutehospitalsprovide TreatmentinSpecialCareDentalUnits
medicallynecessarydentalcare isfree.

Verylimitedspecialistdentalservicesareavailable(e.g.
oralandmaxillofacialsurgerythroughtheRoyalHobart
Hospital).Somepatientsneedingotherspecialistservices
arereferredtoVictoria,SAandNSWviathePatient
TransportAssistanceScheme.

SA 18yearsofageand PensionerConcessionCard Emergencyandgeneraldentalcarecheckups,oral Emergencycourseofcare:$52flatfee.
older. HealthCareCard hygiene,fillings,endodontics,extractiondentures,oral
somePensionerConcessionCards surgeryanddentures. Generaldentalcarecheckupand
(DVA). preventivetreatmentisfree.
ReferraltotheAdelaideDentalHospitalforspecialist
dentalcareasrequired. 15%oftheDVALDOFeeforgeneral
restorativetreatmenttoamaximumof
$146foracompletedcourseofcare.

Denturecopaymentsupto$325.50
forfulldentures.

Forspecialistservices,acopaymentof
20%oftheDVALDOFeeapplies.

Someexemptionsapplytoallco
payments


Eligibilitycriteria
NT 18yearsofageand PensionerConcessionCard Emergencyandgeneraldentalcarecheckups,oral Nocopayment.
older. HealthCareCard. hygiene,fillings,endodontics,extraction,denturesoral
surgeryanddentures.

Referralfororalsurgeryandspecialneedsdentistryas
requiredincludinginhospitaltreatmentundergeneral
anaesthesia.

WA 18yearsofageand HealthCareCard Emergencyandgeneraldentalcarecheckups,oral TreatmentissubsidisedbytheWest
older. PensionerConcessionCard hygiene,fillings,endodontics,extraction,dentures,oral CommonwealthGovernmentuptoa
surgeryanddentures. maximumof75%ofthecostofthe
InremotelocationswhereDental treatment.
HealthServiceisthesolehealth ReferraltotheOralHealthCentreofWesternAustralia
provider,allareabletoaccesscare forspecialistdentalcareasrequired. Levelofsubsidyisbaseduponthe
(althoughthosewithoutconcession eligibilityofthepersonandisassessed
cardsarerequiredtopaythefullfee). atthedentalclinic.

ACT 18yearsofageand ACTCentrelinkissuedPension Emergencyandgeneraldentalcarecheckups,oral Maximumcopaymentof$300for
older. ConcessionCard hygiene,fillings,endodontics,extraction,dentures,oral restorativetreatmentinanyyear.
HealthCareCard. surgeryanddentures.
BlueDVACard Freeforspecialneedsgroups,
Refugees includinghomeless,refugeesandsome
rehabilitationclients.


PublicDentalServicesChildren AppendixE
AppendixEChildDentalServicesProvidedbytheStatesandTerritories
Eligibilitycriteria
Age Cardholder Servicesoffered Copayment
QLD Childrenovertheageoffour N/AAllchildrenwhomeet ChildandAdolescentOralHealthServices(formerlyknownas Nocopayment.
andthosewhohavenot theageeligibilityareableto theSchoolDentalProgram).
completedYear10of accessthisprogram.
secondaryschool. Dentalcheckup,informationonoralhealthandnutrition,x
rays,cleaningteeth,fluorideapplication,fissuresealants,
Childrenunderfouryearsof fillingsandextractionsandreferraltodentalspecialistwhere
ageandthosewhohave necessary.
completedYear10arealso
eligibleforpubliclyfunded Usuallyprovidedonsiteatschoolsthroughfixedormobile
oralhealthcareiftheyholda dentalclinics.
ConcessionCardorare
dependentsofConcession Limitedspecialistservicesinsomedistrictsmeanstestedand
Cardholders prioritybased.

NSW Allchildrenundertheageof N/AAllchildrenwhomeet Generaldentalservicesareavailable.TheNSWPriorityOral Nocopayment.
18years. theageeligibilityareableto HealthProgramweightsaccesstodentalservicesonthebasis
accessthisprogram. ofseverityandurgencyofthecondition.Priorityaccessisgiven
tochildrenandthoseaged05yearsreferredundertheEarly
ChildhoodOralHealthProgram.

Servicesaredeliveredindentalclinicsbasedinschools,
communityhealthcentresandhospitals.

Referraltoaprivatedentist(viaavoucher)mayoccurwhere
publicdentalservicesarenotavailable.

Limitedspecialistdentalservicesinsomedistrictsmeans
testedandprioritybased.


Eligibilitycriteria
VIC Childrenaged012years. Afterage12,HealthCare Dentalcheckup,informationonoralhealthandnutrition,x Feesforpublicdentalservicesapply
Youngpeopleaged1317 CardandPensioner rays,cleaningteeth,fluorideapplication,fissuresealants, tochildrenaged012yearswhoare
yearswhoareHealthCareor ConcessionCardholders fillingsandextractionswherenecessary,referraltodental notHealthCareorPensioner
PensionerConcessionCard haveaccesstofreecareand specialist. ConcessionCardholdersor
holdersordependantsof priorityaccesstopublic dependantsofConcessionCard
ConcessionCardholders. dentalclinics. Generaldentalservicesaredeliveredthroughcommunity holders.
Childrenandpeopleupto18 dentalclinicsincommunityhealthservices,ruralhospitalsand Flatfeeof$29perchildforageneral
yearsofageinresidentialcare theRoyalDentalHospitalofMelbourne. courseofcare,whichincludesan
providedbytheChildren examinationandallgeneraldental
YouthandFamiliesdivisionof Specialistdentalservicesareavailableforchildrenwhose treatment.Feesperfamilywillnot
theDepartmentofHuman parentsholdaConcessionCard(mostlyprovidedattheRoyal exceed$116.
Services. MelbourneDentalHospital). Copaymentsapplyforspecialist
Youthjusticeclientsin dentalservicesuptoamaximumof
custodialcareupto18years $300percourseofspecialistcare
ofage. (someexemptionsapply).


Eligibilitycriteria
TAS Children018yearsofage. Thedentaltreatment Dentalcheckup,informationonoralhealthandnutrition,x Freeexaminationforall.
followingexaminationwillbe rays,cleaningteeth,fluorideapplication,fissuresealants,
freeifthechildiscoveredby fillingsandextractionswherenecessary,referraltoprivate Nocopaymentforthosecoveredbya
aHealthCareCard. dentalspecialist. ConcessionCardorunderschoolage
(05years).
ServicesareprovidedatCommunityDentalClinicsandinacute
hospitals(wheregeneralanaestheticisrequired). Forallotherchildrena$50
copaymentfornoncardholders
Nopublicspecialistdentalservicesareavailableforchildren needingtreatment.
withinTasmania.Childrenrequiringspecialistcarehavetouse
theprivatesector(althoughasmallnumberwithsignificant Allclientsneedingdentaltreatment
needsarereferredinterstate). outsidegeneraltreatmentguidelines
(includingspecialistdentalcare)incur
afurthercopayment(dependenton
treatmentrequired).

Asmallnumberofchildrenhave
interstatespecialisttreatment
subsidised.

SA Allpreschool,primaryschool Childrenwhoaredependants Dentalcheckup,informationonoralhealthandnutrition,x Nocopaymentforpreschoolchildren
andsecondaryschool oforholdersofthefollowing rays,cleaningteeth,fluorideapplication,fissuresealants, and.childrenwhoaredependentsof
students,agedlessthan18 concessionsareeligibleto fillingsandextractionswherenecessary,referraltodental ConcessionCardholders.
years,areeligiblefororal receivefreedentalcare: specialist.
healthcarewiththeSchool CentrelinkConcession Thosewhoarenotcoveredbya
DentalService. Card Limitedspecialistdentalservicesareavailableforchildren ConcessionCardmustpayafeeof$39
Childrenovertheageof16 DVAPensioner whoseparentsholdaConcessionCard(mostlyprovidedatthe foreachcourseofgeneraldentalcare
whodonotattendan ConcessionCard AdelaideDentalHospital). provided.
educationalinstitutionanddo SchoolCard
nothaveaHealthCareCard TeenDentalPlan Forspecialistdentalcarecopayments
arenoteligibletoattend Voucher of20%oftheDVALocalDental
schooldentalclinics. Officers(LDO)Feeapply.Some
exemptionsapply.


Eligibilitycriteria
NT Infantsuptoandincluding N/AAllchildrenwhomeet Dentalcheckup,informationonoralhealthandnutrition,x Nocopayment.
primaryschoolagethrough theageeligibilityareableto rays,cleaningteeth,fluorideapplication,fissuresealants,
schoolbasedclinics, accessthisprogram. fillingsandextractionswherenecessary,referraltodental
communityclinicsandmobile specialistifnecessary.
services.
Olderchildren(uptohigh ChildrenwhoseparentsholdaConcessionCardwithsignificant
school)canaccessfreedental needareeligibleforpubliclyfundedspecialistorthodontic
servicesatcommunityclinics. treatment.

WA Childrenfrompreprimary N/AAllchildrenwhomeet Dentalcheckup,informationonoralhealthandnutrition,x Nocopayment.
throughto theageeligibilityandattend rays,cleaningteeth,fluorideapplication,fissuresealants,
Year11(Year12inremote arecognisededucational fillingsandextractionswherenecessary,referraltodental
locations)receivefree institutionareabletoaccess specialist.
preventive,emergencyand thisprogram.
generaldentalcare. Servicesareprovidedfromfixedandmobileschooldental
servicelocatedatschools.

Specialistdentalservicesareavailableforchildrenwhose
parentsholdaConcessionCard(mostlyprovidedattheOral
HealthCentreofWesternAustralia).

ACT Childrenunder5wholivein N/AAllchildrenwhomeet Dentalcheckup,informationonoralhealthandnutrition,x Thereisacopaymentforchildren
theACT. theageeligibilityandattend rays,cleaningteeth,fluorideapplication,fissuresealants, whoseparentsdonothavea
Children513yearsofage arecognisededucational fillingsandextractionswherenecessary,referraltodental ConcessionCard.
wholiveorattendschoolin institutionareabletoaccess specialist
theACT. theprogram. Dentaltreatments,suchasremovableorthodonticappliances, Childrenaged513whoseparentsdo
Childrenundertheageof18 areavailabletoConcessionCardholders. notholdaConcessionCardpaya
yearslivingorattending CentrelinkConcessionCard copaymentof$55percourseofcare.
schoolintheACTandwhoare holderscanaccesssome
coveredbyaCentrelink additionalservices. Childrenunder5yearsofagepaya
ConcessionCard. copaymentof$55forrestorativeor
invasivetreatment.


CommonwealthPrograms AppendixF
AppendixFCurrentCommonwealthGovernmentDental
Programs
MedicareChronicDiseaseDentalScheme(CDDS)
TheCDDSprovidesdentalcareforpeoplewithchronicdiseasesandcomplexcare
needs.EligiblepatientsmayreceiveMedicarebenefitsofupto$4,250perperson
overtwocalendaryearsfordentaltreatment.
TobeeligiblefortheCDDS,patientsmusthaveaGPManagementPlan(Medicare
item721)andTeamCareArrangements(Medicareitem723)inplacetomanage
theirconditionandmustbereferredtoadentistbytheirGP.
Abroadrangeofpreventiveandrestorativedentalservicesareavailableunderthe
scheme.In201011,expenditureundertheCDDSwas$726.4millionincreasing
from$576.5millionin200910and$364.1millionin200809.
MedicareTeenDentalPlan(MTDP)
TheMTDPwasimplementedon1July2008andprovidesupto$163.05pereligible
teenagertowardsanannualpreventivedentalcheck,undertheDentalBenefitsAct
2008.
Approximately1.3millionteenagersareeligiblefortheMTDPeachyear.Tobe
eligible,ateenagermust,foratleastsomepartofthecalendaryear:
beagedbetween12and17years;and
satisfythemeanstestfortheprogram:
o theteenagermustbereceivingeitherAbstudy,CarerPayment,Disability
SupportPension,ParentingPayment,SpecialBenefit,orYouthAllowance;
or
o theteenagersfamily/carer/guardianmustbereceivingeitherFamilyTax
BenefitPartA,ParentingPayment,ortheDoubleOrphanPensionin
respectoftheteenager;or
o theteenagerspartnermustbereceivingFamilyTaxBenefitPartAor
ParentingPayment;or
o theteenagermustbereceivingfinancialassistanceundertheVeterans
ChildrenEducationSchemeortheMilitaryRehabilitationand
CompensationActEducationandTrainingScheme.
In201011,expenditureundertheMTDPwas$59.8millionslightlydecreasing
from$63.4millionin200910and$66.7millionin200809.
DefencePersonnelandVeterans
MembersoftheAustralianDefenceForceandArmyReserveareprovidedwithfree
dentalservicesaspartoftheiraccesstoarangeofhealthservices.Dentalservices
arealsoprovidedtoeligibleveteransbutentitlementsvarybetweenWhiteCardand
GoldCardholders.Afullrangeofdentalservicesareavailableunderthese
programs.
CommonwealthPrograms AppendixF
In200809,expenditurefordentalservicesprovidedbytheDepartmentofVeterans
Affairswas$103million.TheDepartmentofDefencedoesnotreleasefigureson
fundingattributabletodentalservicesforservicepersonnel.
PrivateHealthInsuranceRebate
TheCommonwealthGovernmentprovidesarebateof3040percentonthe
premiumchargedtopeoplewithprivatehealthinsurance.
Therebatewasintroducedon1January1999.Althoughtherebateisbasedonthe
healthinsurancepremiumpayable,itistreatedasasubsidybytheCommonwealth
GovernmentontheexpensesincurredbyindividualAustralianstowardstheirprivate
healthinsurance,includingbenefitsforhealthservices.In201011,expenditure
underthePrivateHealthInsuranceRebateattributabletodentalserviceswas
$555million(whichequatesto$46perperson).
TheCommonwealthGovernmentislegislatingtointroducemeanstestingfor
recipientsoftheprivatehealthinsurancerebates.Themeanstestwould
proportionallylowertheprivatehealthinsurancerebateforthoseinhigherincome
tiers,andincreasetheMedicareLevySurchargeforthoseonhigherincomeswho
electnottopurchaseahospitalproduct.
MrAdamLongshaw'sviewwasthatsincegeneraltreatmentpolicies,includingthose
thatpaydentalbenefits,arenotsubjecttothepenaltiesassociatedwiththe
MedicareLevySurcharge,theimpactsassociatedwithdowngradesorcancellations
ofthesepoliciesarelikelytobegreaterthanthosemodelledfortheimpactonthe
numberofindividualswhomaydroporreducetheirhospitalcover.Shouldthis
occur,MrLongshawconsidereditwilladverselyimpactdentistryforthose
individualsandsubsequentlyleadtoincreasedpersonalcostsfordentalcare.This
viewwasnotsharedbythemajorityoftheCouncil.
ConcessionCards AppendixG
AppendixGAListofCentrelinksupportedPensionsandtheir
EligibilityforConcessionCards121
PensionerConcessionCard(PCC)
APCCisautomaticallyissuedto:
Allincomesupportpensioners,whichincludes:AgePension,DisabilitySupport
Pension,WifePension,CarerPayment,ParentingPayment(Single),Bereavement
AllowanceandWidowBPension.
DepartmentofVeteransAffairsservicepensionersandwarwidowsreceivingan
incomesupportsupplement.
NewstartAllowance,ParentingPayment(Partnered)andYouthAllowance(job
seeker)customersassessedashavingapartialcapacitytoworkorwhoareasingle
principalcarerofadependentchild.
Olderbenefitcustomers,thatis:
customersaged60andoverwhoarereceivingNewstartAllowance,Partner
Allowance,WidowAllowance,ParentingPayment(Partnered),Sickness
Allowance,orSpecialBenefit,andhavebeenincontinuousreceiptofoneor
moreoftheabovepayments(oranincomesupportpension)forninemonthsor
more.
ParticipantsofthePensionLoansSchemewhoarequalifiedtoreceiveapartrate
pension.
CommunityDevelopmentEmploymentProject(CDEP)participantswhoare
qualifiedforanincomesupportpensionbutthatpaymentisnotpayabledueto
theresultofeithertheassetstestortherulesrelatingtoseasonalorintermittent
workers,andwhothereforequalifyfortheCDEPSchemeParticipantSupplement
(CPS).
CDEPparticipantswhoarequalifiedforNewstartAllowance,PartnerAllowance,
WidowAllowance,ParentingPayment(Partnered),YouthAllowanceorSpecial
Benefit,butwherethatpaymentisnotpayableduetotheresultofeitherthe
assettestorrulesrelatingtoseasonalorintermittentworkers,andwhotherefore
qualifyfortheCDEPCPS.Notethatthesecustomersmustbeaged60yearsor
over,andhavebeenincontinuousreceipt,orhavebeentakentobeincontinuous
receiptofoneormoreoftheabovepayments(oranincomesupportpension)for
ninemonthsormore.
Oncecustomersarenolongerqualifiedforthesepayments,theymustgenerally
stopusingtheirPCC.However,insomecircumstances,certaincustomerscanretain
theirPCCforashortperiodafterreturningtowork.Theseprovisionsaredesignedto
assistcustomerstomakethetransitionfromincomesupporttowork.
121
Takenfrom:AguidetoAustralianGovernmentpayments:onbehalfoftheDepartmentofFamilies,
Housing,CommunityServicesandIndigenousAffairsandtheDepartmentofEducation,Employment
andWorkplaceRelations(20September31December2011).
DisabilitySupportPensioners(DSP)
RetaintheirPCCfor52weeksafterlosingqualificationforthepensiondueto
commencingemploymentof15hoursormoreperweekorbecauseofthelevelof
earningsfromemployment.
WifePension(DSP)customers
RetaintheirPCCfor52weeksafterlosingqualificationforpaymentiftheirpartner
hasbeenreceivingDSP,andtheirpartnerlosesqualificationforthepensiondue
tocommencingemploymentof30hoursormoreperweek,orbecausetheir
partnersincomefromemploymentcausesthemtolosequalificationforDSP.
Olderbenefitcustomers(asdefinedearlier)
RetaintheirPCCforafurther26weeksiftheirpaymentstopsduetothepersonor
theirpartnercommencingemployment,orduetothelevelofearningsfromthis
employment.
ParentingPayment(Single)customers
RetaintheirPCCfor12weeksafterlosingentitlementtoParentingPayment
(Single)duetoanincreaseinincomeduetoemployment.AHealthCareCardis
issuedforthebalanceof26weeks,thatisafurther14weeksprovidedthe
customerhasbeenincontinuousreceiptforthelast12monthsofeither:
anincomesupportpension(exceptforaSpecialNeedsPension),or
anincomesupportbenefit(otherthanAustudyorYouthAllowancepaidto
students).
NewstartandYouthAllowance(jobseeker)
RetaintheirPCCfor52weeksafterlosingqualificationduetoemployment
income,iftheyhavebeenassessedashavingapartialcapacitytowork,or
RetaintheirPCCunderthesameprovisionsasParentingPayment(Single)
customers(seeabove),iftheyarethesingleprincipalcarerofadependentchild.
APCCextensionisalsoavailable,undercertaincircumstances,topeopleunder
pensionagewhoremainqualifiedforcertainpaymentsduringanilrateperiod
undertheWorkingCreditScheme.
AutomaticissueHealthCareCard(HCC)
TheHCCisautomaticallyissuedtopeoplewhoarenotqualifiedforaPensioner
ConcessionCardwhoarereceiving:
NewstartAllowance(NSA),PartnerAllowance(PA),SicknessAllowance(SA),
SpecialBenefit(SpB),WidowAllowance(WA)andYouthAllowance(jobseeker
only)(YA)
ParentingPayment(Partnered),ExceptionalCircumstancesReliefPayment,Farm
HelpIncomeSupportandthoseentitledtoreceivethemaximumrateofFamily
TaxBenefitPartAbyfortnightlyinstalments.
MobilityAllowance.
CarerAllowance(CA),paidtoparents/carersinrespectofachildwithadisability.
Thecardisissuedinthechildsname.Otherparents/carersofchildrenwitha
disabilitywhodonotreceiveCAmayreceiveaHCCsubjecttolessstringent
disabilityrelatedeligibilitycriteria.
CommunityDevelopmentEmploymentProjectSchemeParticipantSupplement
wheretherecipientisqualifiedforanincomesupportpayment(attractingaHCC),
butthatpaymentisnotpayableduetoeithertheassetstest,ortherulesrelating
toseasonalorintermittentworkers.ThesecustomersreceivetheHCCapplicable
tothepaymenttypeforwhichtheyarequalified.
Oncepeoplearenolongerreceivingthesepayments,theymustgenerallystopusing
theirHCC.However,insomeinstances,peoplecanretaintheirHCCforupto26
weeksafterreturningtowork.Thisprovisionisdesignedtoassistpeopletomake
thetransitionfromincomesupporttowork.Theprovisionappliestolongterm
recipientsofNSA,SA,PA,SpB,WA,andYA(jobseeker).Formerlongtermrecipients
ofPPS,NSAandYA(jobseeker)whoareasingleprincipalcarerofadependentchild
alsoqualifyforaHCCextension(inadditiontoa12weekPCCextension).
AHCCextensionisalsoavailable,undercertaincircumstances,topeoplewho
remainqualifiedforcertainpaymentsduringanilrateperiodundertheWorking
Creditscheme.
ClaimrequiredHealthCareCard(HCC)
SpecifictypesofHCCscanbeclaimedinthefollowingcircumstances:
AlowincomeHCCisavailableonapplicationtopeoplewithincomebelowcertain
levels.Onceeligible,thequalifyingincomelimitsmaybeexceededbyupto
25percentbeforeeligibilityforthecardislost.Theincometestappliestoaverage
weeklygrossincomefortheeightweeksimmediatelypriortoapplyingforthe
card.Incomelimitsfortheperiod20March2011to19September2011are:
single(nochildren) $480.00pw
couple,combined(nochildren) $834.00pw
single,onedependentchild $834.00pw
foreachadditionaldependentchildadd $34.00pw

Theselimits(exceptforthechildaddon)areindexedtwiceyearly,inMarchand
September,basedonmovementsintheConsumerPriceIndex.
ThereisnoassetstestforthelowincomeHCC.
AfosterchildHCCisavailable,onapplication,toassistfosterchildrenandcarers.
Thecardcanbeclaimedbythefostercareronbehalfofthechild.Thefosterchild
HCCisissuedonlyinthenameofthechild,andcanonlybeusedtoobtain
concessionsonservicesusedbythechild.ThefosterchildHCCisnotmeans
tested.
AnexCAHCCisavailable,onapplication,to1625yearoldfulltimestudentswith
adisabilityoraseveremedicalcondition.Thecardcanbeclaimedbystudents
whowereinreceiptofaCAHCConthedaybeforetheir16thbirthday.TheexCA
HCCisissuedinthenameofthestudentandisnotmeanstested.
CommonwealthSeniorsHealthCard(CSHC)
TheCSHCistargetedatselffundedretireesofagepensionage(seechartunderAge
Pension)whodonotqualifyforanAgePensionbecauseofassetsorincomelevels.
ToqualifyforaCSHCapersonmustmakeaclaimforthecard,andmeetthe
followingcriteria:
notbereceivinganincomesupportpensionorbenefitoraDepartmentof
VeteransAffairsservicepensionorincomesupportsupplement,and
beofagepensionage,and
belivingpermanentlyinAustraliaandbe:
anAustraliancitizen,or
aholderofapermanentvisa,or
NewZealandcitizenwhoarrivedonaNewZealandpassport.
availabletonewlyarrivedmigrantsafter104weeksinAustraliaasanAustralian
residentorSpecialCategoryVisaholder(someexemptionsmayapply).
mustbeinAustraliatoretaincard,ortemporarilyabsentfornotmorethan13
weeks.
haveanannualadjustedincomeoflessthan$50,000forsingles;$80,000for
couples(combinedincome);and$100,000combinedforcouplesseparatedby
illness,respitecareorprison.Anamountof$639.60peryearisaddedforeach
dependentchild.Thereisnoassetstest.
Residencerequirements
CertainresidencerequirementsmustbemettoqualifyforanytypeofHCC.
ConsultationProcess AppendixH
AppendixHNationalAdvisoryCouncilonDentalHealth
ConsultationProcess
Tohelpinformourdeliberations,wehaveundertakenaconsultationprocesswith
keydentalhealthbodies,consumergrouprepresentatives,peakIndigenous
organisationsandleadingacademicsinthefield.Wewereinterestedinconsulting
aswidelyaspossible,butgiventheshorttimeframesforourdeliverables,wehave
conductedaprivateconsultationprocesslimitedtokeystakeholders.Todate,the
consultationprocesshasinvolvedroundtableconsultationsessions,written
submissions,directengagementwithcliniciansandotherkeystakeholders,andvisits
topublicdentalfacilities.
Thefollowingstakeholderswereinvitedtotakepartinourconsultationprocess:
AustralianDentalCouncil
AustralianDentalBoardofAustralia
TheRoyalAustralasianCollegeofDentalSurgeons
DentalHygienistsAssociationofAustralia
AustralianDentalProsthetistsAssociation
AustralianDentalProsthetistsandDentalTechniciansEducationalAdvisory
Council
NationalAboriginalCommunityControlledHealthOrganisation
NationalOralHealthPromotionSteeringGroup
ConsumersHealthForumofAustralia
AustralianPreventiveHealthAgency
HealthWorkforceAustralia,CEOMrMarkCormack
IndigenousDentistsAssociationofAustralia
NationalCongressofAustraliasFirstPeoples
StateandTerritoryDentalDirectors
AustralianResearchCentreforPopulationOralHealth
AdelaideDentalHospital,SouthAustralia
MarionGPPlusClinic,SouthAustralia
NewSouthWalesMinisterialTaskforceonDentalHealth
WestmeadHospital,NewSouthWales
WentWestMedicareLocal,NewSouthWales
RoyalDentalHospitalofMelbourne
DentalHealthServicesVictoria
DrSandraMeihubers,DentistandIndependentDentalHealthConsultant
DrGlenHughes,Dentist,CasinoAboriginalMedicalService
Inconductingtheconsultationprocesswewereparticularlyinterestedinseeking
viewson:
thegapsinservicedeliveryandunmetneed;
howcurrentdentalprogramscouldbeimproved;
howthecurrentdentalworkforcecouldbeimproved;
oralhealthpromotionandpreventionstrategies;
thecapacityofthepublicdentalsector;and
howthedentalsystemcouldbeimprovedasawhole.
Unmetneed
ThroughouttheconsultationprocessIndigenousAustralians,specialneedsadults,
childrenandtheagedwereidentifiedasprioritygroupsinneedofaccessibleand
affordableoralhealthcare.
IndigenousAustralians
StakeholdersacknowledgedthatIndigenousAustraliansinbothurbanandruraland
remoteareasexperiencepooreroralhealththantheirnonIndigenouscounterparts.
Stakeholdersidentifiedseveralissueswiththecurrentsystemofservicedeliveryfor
Indigenouspatients.ForruralandremoteIndigenouscommunitiesinparticular,
stakeholdersnotedthatmostmodelsofservicedeliveryareintermittent,donot
receiveongoingfundingandinvolvetheuseofdifferentlocumdentists.Itwas
acknowledgedthatsuchmodelscreatedistrustbetweenthecommunitymembers
andtheprovidersandinconsistenciesinpatientrecords.Tohelpreducethese
inconsistencies,stakeholdersidentifiedtheneedfortheCommonwealthsroleinthe
oralhealthsectortobeclearlydefinedandforbettercoordinationbetween
Commonwealth,state,universityandAboriginalMedicalServices/Aboriginal
CommunityControlledHealthOrganisationsoralhealthactivities.Itwasalso
suggestedthattheCommonwealthfundthedevelopmentofamanualtoassist
dentalpractitioners,particularlylocumstaff,inservicingIndigenouscommunitiesin
ruralandremoteAustralia.
SeveralissuesrelatingtothedentalworkforceanditsimpactonIndigenousoral
healthcarewerealsoraised.Itwasrecommendedthatmodelsofcareusea
multidisciplinarycareapproachandthescopeofserviceprovisionforAboriginal
HealthWorkersbeextendedtocoveroralhealthpreventiveservices.Stakeholders
alsoexpressedconcernsaboutthedifficultiesinrecruitingandretainingstaff.
AsafurtherprioritygroupwithintheIndigenouscommunity,peakIndigenous
organisationssuggestedfutureactionforimprovingtheoralhealthofIndigenous
children.StakeholdersidentifiedthatinsomeIndigenouscommunities,children
thatrequireimportant,butnoturgent,oralhealthcarecanbewaitingforuptofour
yearstoreceivetreatment.ImprovingtheoralhealthofIndigenouschildrenwill
helpinimprovingtheoralhealthofIndigenousAustraliansintothefuture.Itwas
recommendedthatIndigenouschildoralhealthbetargetedthroughtheuseof
effectiveandconsistentschooldentalprograms.
Adultwithspecialoralhealthneeds
Specialneedsadultsincludethosepatientswho,inadditiontotheiroralhealth
condition,sufferfromacomplexmedicalconditionsuchascancer,HIV,hepatitis,
mentalillnessandotherchronicdiseases.Thedeliveryoftreatmenttospecialneeds
patientsisresourceintensive,complexandoftenlimitedtothepublicsector.The
facilitationofsuchtreatmentneedstobedeliveredbyspecialistproviderswho
understandthemedicalimplicationsofthepatientshealthcondition
unfortunatelythereisashortageofthesespecialistsinthepublicsector.Tohelp
thistargetgroup,stakeholdersrecommendedincreasingCommonwealthfundingto
thepublicsector.
Frailolderpeopleinthecommunityandagedcareresidents
Theagedwereconsistentlyidentifiedasaprioritygroupingreatneedofaccessible
oralhealthcare.Itwasnotedthataccesstooralhealthservicesisofparticular
concernforthoseagedAustraliansinnursinghomesandresidentialagedcare
facilities.Stakeholderssuggested:includinganoralhealthcheckaspartoftheentry
assessmenttoagedcarefacilities;embeddingoralhealthbenchmarksintotheaged
carebestpracticestandards;andeducatingrelatedprofessionalssuchascarersand
agedcareworkerstoperformbasicoralhealthchecks.Somestakeholders
recommendedtheimplementationofamobiledentalprogramutilisingboththe
publicandprivatesectors,wherebydentistscouldtraveltoagedcarefacilitiesand
usemobiledentalequipmenttotreattheresidentsonsite.
Children
Allstakeholdersacknowledgedchildrenasaprioritytargetgroup.Stakeholders
communicatedtheneedtoinstilgoodoralhealthhabitsinchildrenasearlyas
possibleintheirlifetime.Theneedforauniversalprogramforchildrenwas
identifiedandstakeholdersnotedthatparticularattentionneedstobepaidtothose
childrenaged04yearswhoarecurrentlymissingoutonpublicoralhealthservices
insomestateandterritories.
Targetedapproach
Somestakeholderssuggestedthatnongovernmentorganisationscouldbeusedto
aggressivelytargetthesegroupsandthatfuturestrategiescouldbebuiltupon
existingprogramsthathaveprovedtobesuccessfulinthisspacee.g.LifttheLip,
SipandCrunch,SupportedResidentialServicesProgram.
BelowisacasestudyofafacilitythatwasconsultedinthecourseoftheCouncils
workandcouldbeusedtotargetspecialneedsgroups.
CaseStudy1:MarionGPPlusHealthCareCentre,SouthAustralia

TheMarionGPPlusHealthCareCentre(theGPPlusCentre)servesasagood
modelforintegratingoralhealthintobroaderprimaryhealthcareinitiatives.

TheGPPlusCentrecontainsa24chairdentalfacility,12chairsofwhichare
reservedforpermanentstaff,andtheremaining12usedbydentalstudents
undertakingcommunitybasedclinicalplacementsaspartoftheirundergraduate
clinicaltrainingprogram.Thedentalclinicemploysarangeofdental
professionals,including:dentists;dentaltherapists;anddentalhygieniststogether
withsupportstaffwhichincludesdentaltechnicians.Inordertobeeligiblefor
oralhealthservicesattheclinic,patientsmustbeeligibleforpublicdental
services.Thisincludesallchildrenandthoseadultswhoholdaconcessioncard
issuedbyCentreLink.

Inadditiontoprovidingoralhealthservices,theGPPlusCentrealsoprovides
servicesbyalliedhealthprofessionals,nurses,doctorsandcommunityhealth
workers.Theclinicadoptsacoordinatedapproachusingstreamlinedreferral
processesforservicesbetweenthesedifferenthealthcareproviders.TheGPPlus
Centrealsoworksinclosepartnershipwithlocalgeneralpracticesandservesasa
referralpointfordoctorsandotherhealthprofessionalsandserviceswithinthe
community.

OneofthebenefitsoftheGPPlusCentreisitsprimelocationtheCentreis
locatednexttoamajortransporthubinOaklandsParkinSouthAustralia,which
makesithighlyaccessibletopatients.Itisalsoclosetoamajorshoppingcentre
andothercommunityservicecentreswhichmakesitanattractiveandconvenient
siteforpatients.

TheGPPlusCentreisparticularlyhelpfulforpatientswhosufferfromcomplex
andchronichealthconditionsandrequirearangeofhealthservicestomanage
theircondition.Giventheemergingevidencelinkingoralhealthtoseveralmajor
chronicdiseases,enablingpatientstoaccessthedentalclinicatthesamesite
wheretheymayreceivetreatmentfortheirgeneralhealthconditionassistsinthe
bettercoordinationoftheirtreatment

Dentalprograms
MedicareChronicDiseaseDentalScheme
SomestakeholdersmaderecommendationsonhowtheCDDScouldbeimproved.
Recommendationsincluded:
limitingtheservicestobasicdentalcareitems;
implementingaspecialapprovalprocessforallhighenddentalitems;
reducingthecap;
streamliningthepaperworkinvolvedinthegeneralapprovalprocess;
limitingtheeligibilitycriteriatocertainchronicconditions;
includingchronicoralhealthdiseaseaspartoftheeligibilitycriteria;
introducingameanstest;
addinghygieniststothelistofprovidersunderthelegislationforthescheme;
and
quarantiningapercentageofthecappedbenefitforpreventiveoralhealth
services.
MedicareTeenDentalPlan
RecommendationsonhowtheMTDPcouldbeimprovedincluded:
extendingtherangeofservicestocoverdentaltreatment;and
introducingarulethatrequiresproviderstogiveoralhygieneadviceaspartof
thepreventivecheck.
Dentalworkforce
Stakeholdersraisedconcernsaboutthedistribution,compositionandutilisationof
thedentalworkforceandqueriedwhetherthepublicandprivatesectorshavethe
capacityandinfrastructuretosupportthecurrentandfuturedentalworkforce.
Stakeholdersnotedthatthedentalworkforceisexpanding,withhighernumbersof
studentsgraduatingfromdentalcoursesandincreasingnumbersofoverseas
dentistsregisteringtopracticeinAustralia.Withtheexpandingworkforce,
stakeholdersexpressedconcernabouttheneedtoensurethereissufficient
infrastructuretomeetthedemandandthatstudentclinicalplacementsare
supported.
Stakeholdershighlightedthedifficultyinrecruitingdentalstafftoworkinruraland
remotelocations.Issuessurroundingtheretentionofstaffinthepublicsectorwere
alsoraised.SomestakeholdersacknowledgedthatthenewCommonwealth
VoluntaryDentalInternProgrammayhelpinaddressingsomeoftheworkforce
distributionissuesandsuggestedtheimplementationoffurtherincentiveprograms.
Somesuggestionsincludedcompulsoryrotationsforpublicsectorstaffandhousing
reimbursementsfordentalhygienistsandtherapists.
Withregardtothecompositionandutilisationofthedentalworkforce,stakeholders
commentedontheneedtoreviewthescopeofpracticeforcertainpractitioners.In
particular,stakeholdersrecommendedanexpansionofthetypesoforalhealth
servicesandaliftontheagerestrictionsforserviceprovisionbyoralhealth
therapistsandhygienists.Thiswouldallowforbetterutilisationofthewholedental
workforce,provideefficiencyofserviceandreducecoststoconsumers.Onthis
note,stakeholdersrecommendedthattheidealnumberandmixofdentalhealth
providersbeidentifiedandstrategiesputinplacetoreachthis.
Itwasalsorecommendedthatotherprofessionalsandhealthproviders,suchas
GeneralPractitioners,maternalhealthworkers,AboriginalHealthWorkers,carers,
agedcareworkersandschoolteachersbetrainedtoprovidebasicoralhealthchecks
andpossiblepreventiveservicestoassistinpromotinggoodoralhealthamongst
targetgroups.Thiswouldalsoassistwithintegratingoralhealthintogeneralhealth.
MrMarkCormack,CEOofHWA,addressedtheCouncilontheworkthatHWAwould
beundertakingoverthenext18monthsonassessingthesupplyanddemandofthe
dentalworkforce.
Oralhealthpromotionandprevention
Inorderfororalhealthpromotiontobesuccessfulstakeholdersrecommended
includingmultipleinterlinkedstrategiessupportedbystrongpolicyandsocial
marketing.Reachingthesegoalswouldrequirestrongworkingpartnerships
betweengovernments,providersandindustry.
Oneofthemultiplestrategiesrecommendedbystakeholderswastointegrateoral
healthintobroaderpopulationhealthcampaigns,suchasthosetargetingobesity,
alcoholconsumptionandsmoking.Toensureoralhealthisconsideredaspartof
generalhealthpromotion,stakeholdersalsorecommendedtakingstepstotrain
otherhealthprofessionalstoperformoralhealthchecks.
SomestakeholderssuggestedthatonestepcouldinvolvefundingtheMedicareLocal
NetworktoincludeoralhealtheducationinitsprogramsthattrainGPsandallied
healthprofessionals.HealthprofessionalsineachMedicareLocalNetworkwould
thenhavetheskillstoeducatepatientsongoodoralhealthpractices,andcheck
patientsandreferthemontolocaldentistsforanytreatmentneeded.The
MedicareLocalNetworkwasalsorecommendedasanavenuetopromoteoral
healthandtargetspecialneedsgroups.OneroleoftheMedicareLocalNetworkis
toidentifyservicegapsandtakestepstoaddressthosegaps.Itwassuggestedthat
anyprimaryhealthcareinitiativesalreadybeingadministeredbyMedicareLocals
couldbeusedtosendoutconsistentandcomprehensiveoralhealthpromotion
messages.Thiswouldnotonlyimproveoralhealthpromotionbuttargetpriority
groups.AcasestudyisbelowofoneMedicareLocalconsultedinthecourseofthe
Councilswork.
CaseStudy2:WesternSydneyMedicareLocal

TheWentWestHealthDivisioninNewSouthWaleswasestablishedin2002to
provideGeneralPracticevocationaltraininginWesternSydney.From2006
WentWestalsotookontheroleofprovidingDivisionofGeneralPracticesupport
servicesandworkedinclosepartnershipswithorganisationsinWesternSydneyto
notonlysupportGPsbutalsoprimaryhealthcareworkers.

From1July2011,theWentWestDivisionbecametheWesternSydneyMedicare
Local,coveringanareawithapopulationofover800,000people.TheWestern
SydneyMedicareLocal(WSMedicareLocal)continuestoprovidetrainingtoGPsand
supportforGPsandprimaryhealthcareworkers,buttheWSMedicareLocalhasa
morecommunityapproachtohealthcare.

AsaMedicareLocal,itisexpectedtodevelopakeyroleovertimeinbuilding
effectivecollaborationsacrossprimaryhealthandwithLocalHospitalNetworks,and
supporttheimplementationofkeyinitiativesinareassuchasehealth,afterhours
primarycareandagedcare.

TheWSMedicareLocalworkscloselywithlocalhealthprofessionalsandcommunity
organisationstocreateamorestreamlinedandefficientprimaryhealthcaresystem.
ThisinvolvesusinglocalpartnershipnetworkstheWSMedicareLocalhas
establishedsixlocalpartnershipnetworksandworkscloselywiththeLocalHealth
DistrictandotherorganisationssuchastheAboriginalMedicalServiceWestern
Sydney,theLocalHealthDistrict,HealthOneandLocalCouncils.
Italsoinvolvesintegratingandexpandingnewandexistingserviceswhicharewell
targetedtotheresidentsoftheWesternSydneycommunity.Forexample,theWS
MedicareLocalmanagesprogramsspecificallytargetedatprioritygroupssuchas
schoolchildren,theAgedandpregnantteenagers.Someoftheseprogramsinclude:
theKeepFitSchoolProgram,whichaimstoeducatechildrenaboutnutritionandthe
importanceofphysicalactivity;AgedCareProgramswhichprovideonsitesupportto
agedcarepeoplelivingintheirhome,todelayentryintocostlyagedcarefacilities;
andprogramsthatencouragematernalhealthcareworkerstomanageand
coordinateservicedeliveryandappointmentsforyoungpregnantwomen.

TheWSMedicareLocalservicespatientsresidingintheBlacktown,BaulkhamHills,
Parramatta,HolroydandAuburncommunities.Thesecommunitieshaveahigh
numberofIndigenousresidents,sociallydisadvantagedresidentsandresidentsfrom
culturallyandlinguisticallydiversebackgrounds.Byadoptingacoordinatedand
communityfocusedapproachtohealthcare,theWSMedicareLocalisproviding
residentsingreatneedwiththebestchanceofmanagingtheirhealthconditions.
Asapriority,stakeholdersrecommendedtargetingoralhealthpromotionto
children.Stakeholdersrecommendedthatthebestwaytotargetchildrenistouse
theschoolnetwork,notingthataholisticapproachencompassinghealthyfoodat
theschoolcanteen,oralhealtheducationintheschoolcurriculum,onsitevisitsby
oralhealthprofessionalsisessential.Stakeholdersalsosuggestedthe
implementationofprogramslikeLifttheLipandCrunchandSiponanational
level.Stakeholdersalsostressedtheimportanceoftargetingchildrenasearlyas
possibleandrecommendedincludinganoralhealthcheckaspartofachilds
18monthimmunisationappointmentasonemechanismtotargetinfants.Targeting
youngchildrenandeducatingparentsearlyincreasestheprobabilityofchildren
carryinggoodoralhealthhabitsintoadolescenceandadulthood.
Thevalueoforalhealthpreventionstrategiesinclosingthegapinincidenceoforal
healthdiseaseamongstIndigenousAustralianswasacknowledged.Stakeholders
emphasisedtheimportanceofpreventiveactivitiessuchaswaterfluoridationand
theapplicationoffluoridevarnishesandrecommendedtheimplementationof
additionalpreventiveactivities.Forexample,itwassuggestedthattheGovernment
workcloselywithcommunitystoresonissuesaffectingoralhealth,suchasnutrition,
andfororalhealthtobeintegratedintobroaderpopulationhealthcampaigns.
Toimproveoralhealthpromotionandpreventionstrategiesintothefuture,
stakeholdersidentifiedtheneedforeffectiveresearchandfornationallyconsistent
oralhealthmessages.Tothisend,stakeholdersrecommendedthecontinuationof
fundingfortheNationalOralHealthPromotionClearingHouseandthe
administrationofnationalconsensusworkshops.
Capacityofthepublicdentalsector
ConsultationswiththestateandterritoryDentalDirectorsraisedseveralissues
regardingthecapacityofthepublicdentalsystemtodelivertimelyservices.The
demandforservicesinthepublicsectorishighandasaresultthewaitinglistsfor
treatmentarelong,withpatientsinsomestateswaitingupto25monthsforgeneral
oralhealthtreatment.Directorssuggestedincreasedfundingfromthe
Commonwealthtoassistthestateandterritoriestoreducetheselongwaitinglists.
Concernsaboutworkforceinthepublicsectorwerealsoraised.Directorsnotedthe
difficultiesinretainingstaffinthepublicsectorasawholeandinencouragingstaff
toworkinruralandremotepublicfacilities.Theneedtoensurethereissufficient
infrastructuretomeetdemandandtosupportstudentclinicalplacementswerealso
identified.Directorsnotedthattherelationshipbetweenthepublicsectorand
universitiesneedstobeimprovedinorderforstudentplacementstobeeffectively
plannedandsupported.Onerecommendationtoimprovesupportforstudentswas
toimplementatutoringprogramtoencourageprivatedentiststotakeon
supervisoryrolesinthepublicsector.
Anotherpotentialavenuetoincreasepublicsectorcapacityinvolvesreshapingthe
publicsectorapproachtoservicedelivery.Itwassuggestedthatthepublicsector
couldbemouldedintoaspecialisedunitservicingthecomplexspecialneedscases
onlyandtheprivatesectorusedformoregeneralcoursesofcare.
Thedentalsystem
Whenprovidingrecommendationsonthedentalsystemasawhole,some
stakeholdersexpressedsupportfortheimplementationofauniversaldentalmodel.
However,itwasnotedthatauniversalsystemwouldneedtobephasedinovertime
andtherewouldneedtobeadequateworkforceandinfrastructuretosupportthe
system.Asafirststep,stakeholdersrecommendedprovidinguniversalaccessto
children.
Oncommentingonthecurrentsystem,stakeholdersraisedconcernsaboutthe
intermittentfundingandoperationofdentalprogramsandadvisedthatthesystem
needstohavecontinuity.Stakeholdersalsoadvisedthatthereneedstobebetter
communicationandintegrationbetweentheexistingCommonwealthandState
programstopreventpatientsdoubledippingandensureappropriateuseof
resources.Itwasalsonotedthatcommunicationbetweenpublicdentalfacilities
anddentaleducationalfacilitiesalsoneedstobeimproved.
TheMedicareLocalNetworkwasidentifiedasonemechanismforimprovingpatient
accesstooralhealthcareonalocallevel.ItwassuggestedthatMedicareLocals
couldactasacoordinationunitandassignacasemanagertopatientstomanage
appointments,arrangepatienttransportationfordentalvisitsandoutsource
servicestoprivatedentists.
Itwasalsonotedthatthecurrentsystemfocusesontreatment,withpatientsmainly
visitingadentistwhenaproblemarises.Itwassuggestedthatthesystemadopta
populationoralhealthapproachwhichincludespreventivestrategies.
LetterfromtheMinisterforHealthandAgeingAppendixI
regardingtheInterimReport
AppendixILetterfromtheMinisterforHealthandAgeing
regardingtheInterimReport
ProbonoservicesprovidedbydentalpractitionersAppendixJ
AppendixJProBonoServicesProvidedbyDental
Practitioners

Dentalpractitionersprovidearangeofprobonoservicesacrossthecountry.These
areprovidedinvariousgeographicareasandtargetdifferentsocialgroupsdepending
ontheneedsoftheparticularcommunity.Thedentalprofessionissupportiveof
volunteerworkinordertoensurethatAustraliansinneedareabletoreceive
appropriatedentalcare.

Itisnotpossibletocalculatewithprecisionthedollarvalueofdentalpractitioners
probonowork.Anysuchcalculationmustrecognisethatthebenefitsarenotonlyto
thepatientsimmediateoralhealth,butthatitflowsontoimpactontheiroverall
healthandmentalwellbeing.Assistanceinpatientsoralhealthalsohasapositive
bearingonpatientsselfesteem,work,familyandcommunityrelationships.

Dentalpractitionersappropriatelyprovidearangeofprobonoassistance,
commensuratewiththeircapacityandresources.Theprofessionhasandwillalways
aimtoprovideoralhealthcaretothoseinthecommunitythataremostinneed.The
kindofassistancedentistsproviderangesfrom:
deliveringserviceswithintheirownclinictoprovideprobono/freedental
services.Inthissituations,itisdentalpractitionerthemselvesthatpayforthe
runningcostsofthepractice,thusreceivingnoothercompensatorybenefit;to
dentalpractitionersprovidingtheirtimetoperformadentalserviceoran
educationalfunctionthisisadonationoftime,whichdentalpractitionerscould
otherwisebededicatingtoseeingpatientsatcommercialrates.

Currentactivities

TheNationalDentalFoundationcoordinatessomeprobonoworkinmoststatesand
territories,providingservicesthroughcharitiestothoseindividualsinneedofdental
carewhowouldotherwisebeunabletoaffordit.Thisorganisationreceivesfunding
fromarangeofsourcesinordertoundertakethiswork. 122 Aprimaryaimofthe
Foundationistocoordinatetheinvolvementofallpartieswhoareinvolvedin
philanthropicworkwithintheAustraliandentalindustry. 123

FillingtheGapprovideservicestoAboriginalandTorresStraitIslandercommunities
throughapartnershipwithWuchopperenHealthServicesinCairns.Volunteerdentists
andhygienistsprovidetheservices. 124

TheSchoolofDentistryattheUniversityofAdelaidebeganacommunityoutreach
projectin2009toprovideeducationandclinicalservicestoAdelaideresidents,in
particularvulnerableanddisparatepeopleinthecommunity.Thisprojecthasalso
involvedresearchtoidentifytheneedsofthecommunity,aswellasfundingforcapital
122
http://www.nationaldentalfoundation.org.au/index.html
123
ShaneFryer,pers.comm.09/02/2012.
124
http://www.fillingthegap.com.au/
ProbonoservicesprovidedbydentalpractitionersAppendixJ
works.However,ithasidentifiedthatongoingfundingisrequiredtoensure
remunerationformanagementstaff.

Additionally,theAustralianDentalAssociation(ADA)supportsprobonoworkby
dentists.Theyhaveidentifiedarangeofschemesandarrangementswherebydentists
undertakeprobonowork:
GiveaSmile(GAS)isthecharitablearmoftheAustralianSocietyof
Orthodontists.GASorthodontiststreatpublicpatientsrequiringorthodontic
treatment.Theirtreatmenttakesapproximatelytwoyears.Thisreduces
pressurefrompublicwaitingliststhesepatientsaretreatedprivately.
VolunteerdentiststreatrefugeesthroughtheTzuChiFoundation.
Probonoservicesprovidedtoclientsofvariouscharities.

Whiledentalpractitionersmayprovidetheseservicesatnocost,theservices
themselvesarenotfree;instead,therearearangeofcosts(i.e.infrastructure,
consumablematerials,etc.)thatmustbefunded.Thesecostsaregenerallycovered
bygrantsfromresearchorganisationsanduniversities.Theabilityforprobono
activitiestocontinueisconstrainedbytheavailabilityofthisfundingwithoutit
theprogramsandthoselikeitarelikelytobeunsustainableinthelongerterm.
Scheduleofdentalservices AppendixK
AppendixKScheduleofDentalServices
Inprinciple,thescopeofnecessarydentalservicesshouldbedeterminedby
requirementsforconsultationandcomprehensiveexaminations,followedbydecisions
onwhatdiagnosesareofdentalandpublichealthimportance(includingboth
preventiveandtreatmentservicesforthosediagnoses),aswellasestablished
standardsofcare.However,thereisconsiderabledebatewithinthedentalprofession
ontheseareasandwhatconstitutesnecessarycare.

TheapproachtakenbytheCouncilhasbeentoclassifydentalservicesintothree
broadtiers:diagnosisandpreventive;routine;andelective.Theareasofservicewhich
mightbeincludedagainsteachtierarenotedinTable7.1below.

Uponexaminingthethreetiers,itistheCouncilsviewthatanessentialdentalcare
scheduleshouldincludediagnosticandpreventiveaswellasroutineservices.This
approachallowsforafocusonoralhealthpreventionandearlyintervention.These
arethebulkofexistingservices,withdiagnostic,preventiveandroutineservices
accountingforapproximately90percentofalldentalservices.However,only
approximatelytwothirdstothreequartersofthetotalcostsofdentalservicesaredue
tothesetwotiers.

However,somepatientsmayrequiremorecomplexhighenddentalcarewhichisnot
categorisedasdiagnostic,preventiveorroutine.Inthiscase,webelievethatany
programusingaprimarydentalcareschedulewouldneedtohaveamechanismwhere
bypatientscouldaccessacategoryofcomplexcareitemsinexceptional
circumstances.

Importantly,theinclusionorexclusionofspecifictiersofservicesshouldbeguidedby
thephilosophybehindadentalprogramforexample,thephilosophymightbeto
emphasisepreventiveclinicalservices,diagnosedentaldiseasesearlyandencourage
promptlowlevelinterventionstoaddressdiseaseandrestorefunctioninthemost
costeffectivemanner.
Table7.1Scopeofdentalservicesdiagnosticandpreventive,routineandelectiveservices
Tiersof Areasofservice %of %of
service current current
services costs
Diagnostic Consultations 1.7 0.7
and Dentalexaminations 18.2 6.7
preventive Radiographs 13.1 3.9
Scaling/cleaning 11.6 8.0
Specificpreventiveservices,including 6.3 1.9
fluoridetreatments
Routine Consultations 0.1 0.1
Servicesassociatedwithdentalcaries 34.9 37.6
Restorationsandendodontics
(some)
Servicesassociatedwithperiodontal 0.5 0.4
disease
Periodontics(some)
Servicesassociatedwithreplacementof 2.7 6.5
lostteeth
Partialandcompletedentures
(some)
Subtotal 89.1 65.8
Elective CrownsandInlays 2.5 19.8
Bridgework 0.2 0.9
Implants 0.1 0.8
Orthodontics 1.0 0.4
Cosmeticdentistry 1.2 1.7
includingrestorationsplaced
withoutadiagnosisofcariesand
issuesliketoothwhitening
Laserdentistry 0 0
Other 5.9 10.6
Subtotal 10.9 34.2
Source:Spencer,AJ&Harford,J2008,ImprovingoralhealthanddentalcareforAustralians,discussion
papercommissionedbytheNationalHealthandHospitalsReformCommission,ARCPOH,basedon
LSDPA2003/04;DVAFeeScheduleofDentalServicesforDentistsandDentalSpecialists.Note:totals
willnotaddduetorounding

UsingtheacademicandpracticalclinicalexpertiseofCouncilmembers,ascheduleof
diagnostic,preventiveandroutinedentalserviceshasbeendevelopedbytheCouncil
(seeTable7.2below).

However,dependingonthespecificreformoptionstheGovernmentchoosesto
implement,thisschedulemayneedtobefurtherrefined.Suchfollowonanalysis
wouldcoveralsocoverthehighendservicesthatshouldbeprovidedunder
exceptionalcircumstances.
Table7.2Scheduleofdentalservices
Item
ServiceType Description
Number
ExaminationDiagnosticServices Comprehensiveoralexamination 011
Periodicoralexamination 012
Oralexaminationlimited 013
Consultation 014
ExtendedConsultationDiagnostic Consultationextended(30minutesormore) 015
Services
ReferralConsultationDiagnostic Consultationbyreferral 016
Services
LetterofreferralDiagnosticServices Letterofreferral 019
RadiographDiagnosticServices Intraoralperiapicalorbitewingradiographper 022
exposure
Intraoralradiographocclusal,maxillary, 025
mandibularperexposure
Panoramicradiographperexposure 037
ExaminationDiagnosticServices Biopsyoftissue 051
PreventiveandProphylacticServices Removalofplaqueand/orstain 111
Recontouringrestorations 113
Removalofcalculusfirstvisit 114
Removalofcalculussubsequentvisit 115
Topicalapplicationofremineralizingand/or 121
cariostaticagents,onetreatment
Concentratedremineralizingand/orcariostatic 123
agent,applicationsingletooth
Dietaryadvice 131
Oralhygieneinstruction 141
Fissuresealingpertooth 161
Periodontics Treatmentofacuteperiodontalinfectionpervisit 213
Rootplaningandsubgingivalcurettagepertooth 222
ExtractionOralSurgery Removalofatoothorpart(s)thereof 311

Sectionalremovalofatooth 314
Surgicalremovalofatoothortoothfragmentnot 322
requiringremovalofboneortoothdivision
Surgicalremovalofatoothortoothfragment 323
requiringremovalofbone
Surgicalremovalofatoothortoothfragment 324
requiringbothremovalofboneandtoothdivision
EmergencySurgeryOralSurgery Repositioningofdisplacedtooth/teethpertooth 384
Splintingofdisplacedtooth/teethpertooth 386
Replantationandsplintingofatooth 387
Drainageofabscess 392
Endodontics Directpulpcapping 411
Pulpotomy 414
Item
Number
Endodontics Completechemomechanicalpreparationofroot 415
canalonecanal
Completechemomechanicalpreparationofroot 416
canaleachadditionalcanal
Rootcanalobturationonecanal 417
Rootcanalobturationeachadditionalcanal 418
Extirpationofpulpordebridementofrootcanal(s) 419
emergencyorpalliative
Resorbablerootcanalfillingprimarytooth 421
Additionalvisitforirrigationand/ordressingofthe 455
rootcanalsystempertooth
Interimtherapeuticrootfillingpertooth 458
RestorationRestorativeServices Metallicrestorationonesurfacedirect 511
Metallicrestorationtwosurfacesdirect 512
Metallicrestorationthreesurfacesdirect 513
Metallicrestorationfoursurfacesdirect 514
Metallicrestorationfivesurfacesdirect 515
Adhesiverestorationonesurfaceanteriortooth 521
direct
Adhesiverestorationtwosurfacesanterior 522
toothdirect
Adhesiverestorationthreesurfacesanterior 523
toothdirect
Adhesiverestorationfoursurfacesanterior 524
toothdirect
Adhesiverestorationfivesurfacesanterior 525
toothdirect
Adhesiverestorationonesurfaceposterior 531
toothdirect
Adhesiverestorationtwosurfacesposterior 532
toothdirect
Adhesiverestorationthreesurfacesposterior 533
toothdirect
Adhesiverestorationfoursurfacesposterior 534
toothdirect
Adhesiverestorationfivesurfacesposterior 535
toothdirect
Provisional(Intermediate/temporary)restoration 572
Metalband 574
Pinretentionperpin 575
Metalliccrowndirect 576
Cuspcappingpercusp 577
Restorationofanincisalcornerpercorner 578
Bondingoftoothfragment 579
RecementingRestorativeServices Recementingofinlay/onlay 596
RestorationRestorativeServices Postdirect 597
Item
Number
RestorationProsthodontics Preliminaryrestorationforcrowndirect 627
RecementingProsthodontics Recementingcrownorveneer 651
RecementingProsthodontics Recementingbridgeorsplintperabutment 652
OtherrestorativeProsthodontics Removalofbridgeorsplint 656
NewdentureProsthodontics Completemaxillarydenture 711
Completemandibulardenture 712
Completemaxillaryandmandibulardentures 719
Partialmaxillarydentureresinbase 721
Partialmandibulardentureresinbase 722
Partialmaxillarydenturecastmetalframework 727
Partialmandibulardenturecastmetalframework 728
OtherdentureProsthodontics Provisionforcasting 730
NewdentureProsthodontics Retainerpertooth 731
Occlusalrestperrest 732
Tooth/teeth(partialdenture) 733
Immediatetoothreplacementpertooth 736
Metalbackingperbacking 739
DentureeaseProsthodontics Adjustmentofadenture 741
DenturerelineProsthodontics Reliningcompletedentureprocessed 743
Reliningpartialdentureprocessed 744
Relinecompletedenturedirect 751
DenturerepairProsthodontics Reattachingpreexistingtoothorclasptodenture 761
Replacing/addingclasptodentureperclasp 762
Repairingbrokenbaseofacompletedenture 763
Repairingbrokenbaseofapartialdenture 764
Replacingtoothondenturepertooth 765
Addingtoothtopartialdenturetoreplacean 768
extractedordecoronatedtoothpertooth
Repairoradditiontometalcasting 769
Impressiondentalappliancerepair/modification 776
Identification(ielabellingdenture) 777
MiscellaneousGeneralServices Palliativecare 911
Provisionofmedication/medicament 927
Splintingandstabilizationdirectpertooth 981
Postoperativecarenototherwiseincluded 986
AbbreviationsandAcronyms
ACAT AgedCareAssessmentTeams
ACHI AustralianClassificationofHealthInterventions
ACOSS AustralianCouncilofSocialService
ADA AustralianDentalAssociation
ADC AustralianDentalCouncil
AHPRA AustralianHealthPractitionerRegulationAgency
AIHW AustralianInstituteofHealthandWelfare
AIHWDSRU AustralianInstituteofHealthandWelfaresDentalStatistics
ResearchUnit
ARCPOH AustralianResearchCentreforPopulationOralHealth
ATSI AboriginalandTorresStraitIslanders
CA CarerAllowance
CAFS ComprehensiveAssessmentForms
CDDS MedicareChronicDiseaseDentalScheme
CDEP CommunityDevelopmentEmploymentProject
CDHP CommonwealthDentalHealthProgram
CHCI ChildHealthCheckInitiative
CSHS CommonwealthSeniorsHealthCard
COAG CouncilofAustralianGovernments
CPS CDEPSchemeParticipantSupplement
DBA DentalBoardofAustralia
dmft decayed,missingandfilledteeth(deciduousteeth)
DMFT decayed,missingandfilledteeth(permanentteeth)
DSP DisabilitySupportPensioners
DTERP DentalTrainingExpandingRuralPlacements
DVA DepartmentofVeteransAffairs
DVALDO DepartmentofVeteransAffairsLocalDentalOfficers
FTBA FamilyTaxBenefitPartA
GAS GiveaSmile
GP generalpractitioner
HCC AutomaticissueHealthCareCard
HELP HigherEducationLoanProgram
HWA HealthWorkforceAustralia
MBS MedicareBenefitsSchedule
MTDP MedicareTeenDentalPlan
NHHRC NationalHealthandHospitalsReformCommission
NRAS NationalRegistrationandAccreditationScheme
NSA NewstartAllowance
PA PartnerAllowance
PBS PharmaceuticalBenefitsScheme
PCC PensionerConcessionCard
PPH potentiallypreventablehospitalisations
SA SicknessAllowance
SpB SpecialBenefitAllowance
theCouncil NationalAdvisoryCouncilonDentalHealth
theRebate PrivateHealthInsuranceRebate
UDRH UniversityDepartmentsofRuralHealth
WA WidowAllowance
YA YouthAllowance(jobseeker)

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$20,000<$40,000 28.9 34.6 36.5

$40,000<$60,000 38.7 33.0 28.2

Prosthodontics Other services

Preventative dental 11%

Resorative dental 26%

Dental extractions and

State and local governments

Private - group practice 22.6%

0 1000 2000 3000 4000 5000

TOTAL 56 893 975 1,043 2,967

TOTAL 56 138 431 471 1,332

TOTAL 56 732 806 865 2,458

Estimatedupto400,000adultsonpublicdentalwaitinglists. Finalcostswilldependonlevelofservice, Thisoptionwouldinvolveanincreasedinvestmentinadultdental

Estimatedupto400,000adultsonpublicdentalwaitinglists. Finalcostswilldependonlevelofservice, Thisoptionwouldinvolveanincreasedinvestmentinadultandchild

ExtractionOralSurgery Removalofatoothorpart(s)thereof 311

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