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Access to dental care in Australia: a bit more

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(10)2007
Author(s): 
Gallego, Gisselle
Health Policy Issues: 
Funding / Pooling, Benefit Basket, Access
Reform formerly reported in: 
Access to dental care in Australia
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no

Abstract

In 2004, the Australian Commonwealth Government announced for the first time that Medicare would cover dental procedures. Subsidies for private dental care and Medicare rebates for dental services for people with a chronic condition were introduced in 2004 (See Survey No.5 2005). However data showed that the level of referrals under this plan and uptake of this measure fell short of government expectations.

Recent developments

In March 2004 the government introduced Medicare rebates for dental services for patients whose dental problems were "significantly exacerbating" an existing chronic condition (e.g. heart disease, diabetes or cancer). This meant that patients could be referred by a general practitioner (GP) to a dentist for an assessment and two other services within a 12-month period. However data showed that the level of referrals under this plan and uptake of this measure fell short of government expectations (Marshall and Spencer, 2006). As a result an increase in the extent of Medicare benefits for dental services for patients with chronic conditions was announced in the 2007-08 Budget. It initially expanded funding of A$377.6 million over four years and proposed that benefits be capped at A$2000 per calendar year. However only three months after the initial announcement was made further changes were introduced. The new four year scheme which is scheduled to start on the 1st November 2007, subject to the passage of legislation, includes:

  • Expansion of dental items to include diagnostic services         
  • Extended eligibility to residents of aged-care facilities if managed by a general practitioner under a multidisciplinary care plan. 
  • Up to A$4,250 worth of Medicare-funded dental treatment over two consecutive calendar years (including benefits under the Medicare Safety Net)        
  • Medicare benefits to be payable for dental prostheses, including dentures
  • AU$384 million over four years

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Characteristics of this policy

Degree of Innovation traditional traditional innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low very low very high
Transferability strongly system-dependent strongly system-dependent system-neutral
current current   previous previous

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no

Initiators of idea/main actors

  • Providers
  • Scientific Community
  • Media

Stakeholder positions

The Australian Medical Association (AMA) expressed "its desire that further funding initiatives be rolled out to broaden access to dental care beyond those with chronic conditions and complex care needs".

The Australian Dental Association (ADA) and the Oral Health Alliance (a broad grouping of organisations concerned about the adequacy of oral health services in Australia) were "pleased" with the announcement. However "the provision of financial assistance for dental care to those that can afford such treatment" is in the ADA's view an inappropriate use of the limited funds on offer. The ADA is also concerned about the schedule fee for dentists. According to some ADA representatives the fee might preclude some dentist from adopting the Scheme. The CEO of ADA argues that low-income Australians are victims of a struggle between the state and federal government as to who should pay for public dental health programs.

Actors and positions

Description of actors and their positions
Providers
Providers of public dental servicesvery supportivesupportive strongly opposed
Scientific Community
Scientific Communityvery supportivesupportive strongly opposed
Media
Mediavery supportivesupportive strongly opposed
current current   previous previous

Actors and influence

Description of actors and their influence

Providers
Providers of public dental servicesvery strongweak none
Scientific Community
Scientific Communityvery strongneutral none
Media
Mediavery strongneutral none
current current   previous previous
Providers of public dental servicesScientific Community, Media

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

N/A

Monitoring and evaluation

No formal evaluation of the policy has been announced. However one of the recommendations of the Parliament enquiry was that "early monitoring and evaluation of the scheme be undertaken to ascertain who is accessing the rebates and for what conditions, and ascertain if the criterion that a 'patient's oral health must be impacting on, or likely to impact on, their general health' is well understood and consistently applied. Monitoring and evaluation should cover both the immediate recipients of Medicare dental services and the broader population level" (Biggs, 2007).

Expected outcome

According to the Minister for Health Tony Abbott the expanded measure would assist up to 200 000 patients with chronic conditions to access dental services in the private sector over the first four years of the measure (Biggs, 2007). The government expects that the new provisions will also give more flexibility for patients to receive dental treatment when required.   

The issues that acted as barriers to referral for dental care (and which were possibly responsible for the low uptake of the initial measure) are not addressed by this new initiative. The time and costs involved might act as barriers to doctors, patients and dentist. This may include but are not limited to

  1. administrative requirements faced by GPs, 
  2. dentists' unfamiliarity with the Medicare remuneration system and 
  3. the level of remuneration offered.  

The current proposed changes do not seem to provide a simple or effective pathway for dental referral and treatment. Patients might incur out of pocket expenses which could act as a disincentive to those considering using the scheme.

Impact of this policy

Quality of Health Care Services marginal marginal fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low very low very high
current current   previous previous

References

Sources of Information

1.  Marshall RI, Spencer AJ. "Accessing oral health care in Australia." Medical Journal of Australia. 2006;185(2):59-60.  

2. Biggs A. Health Insurance Amendment (Medical Dental Services) Bill 2007. Parliamentary Library 2007;35(2007-08).  

3. Spencer A. What options do we have for organising, providing and funding better public dental care? Commissioned Paper Series 2001/02. Sydney, NSW: Australian Health Policy Institute at the University of Sydney; 2001. www.ahpi.health.usyd.edu.au/pdfs/colloquia2001/optionspaper.pdf

4.  AIHW Dental Statistics and Research Unit. Australia's dental generations: the National Survey of Adult Oral Health 2004-06. Canberra: Australian Institute of Health and Welfare; 2007.

Reform formerly reported in

Access to dental care in Australia
Process Stages: Evaluation

Author/s and/or contributors to this survey

Gallego, Gisselle

Suggested citation for this online article

Gallego, Gisselle. "Access to dental care in Australia: a bit more". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/au/a10/3