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Universal Dental Health Scheme

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(13) 2009
Author(s): 
Gallego, Gisselle
Health Policy Issues: 
System Organisation/ Integration, Funding / Pooling, Access
Reform formerly reported in: 
Access to dental care in Australia
Access to dental care in Australia: a bit more
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no no no no no no

Abstract

As part of an overhaul of the current healthcare system, a proposal has been released to introduce a AUS$4 billion universal dental scheme. The proposed scheme to be called ?Denticare? would be funded through a taxpayer levy and would provide access to preventative and restorative care and dentures.

Purpose of health policy or idea

In Australia dental services are provided in both public and private sectors. Public dental services, which are the responsibility of the States, have traditionally been directed towards children and low income adults and their capacity is limited. (Brennan 2008) Around 650,000 adults are on public dental waiting lists, with a two year average waiting time. (National Health and Hospitals Reform Commission 2009)  

The Commission report recommends the creation of a Denticare scheme funded by an increase in the Medicare levy of 0.75% of taxable income. Under the Denticare proposal Australians will have to opt to "become a member of a dental health plan (with a private health insurer) or to use public dental services". In other words Denticare would pay the insurance premiums fees, but patients will get reimbursed 85% of the fees, incurring in a 15% out-of-pocket cost. Those who want to avoid the 15% gap payment could elect to be covered under the public dental system, where treatment could be totally free but with a waiting time.    

The proposed reform also recommends (National Health and Hospitals Reform Commission 2009):

  • The introduction of a one year internship scheme prior to full registration, for oral health practitioners (dentists, dental therapists and dental hygienists). This means that newly graduated practitioners will not be able to work without supervision as soon as they graduate but must spend one year in either a public or private practice being supervised in their work by an experienced practitioner.
  • The National expansion of the pre-school and school dental programs.
  • That additional funding is made available for improved oral health promotion.

Main points

Main objectives

To establish a universal dental scheme that provides access to preventative and restorative dental care and dentures, regardless of a person's ability to pay.

Type of incentives

Financial

Groups affected

Goverment, Dentists, Taxpayers

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Characteristics of this policy

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

The ratings above indicate that this proposal is rather traditional. Other countries such as the United Kingdom have already implemented Universal dental schemes. However, increased taxes that go into a general revenue pool and that would give everyone the option of taking private dental insurance (people already have this choice without the proposed extra levy increase) make the proposal highly controversial. The transferability from Australia to other systems seems unlikely.

Political and economic background

In early 2008 the National Labor Government appointed the National Health and Hospital Reform Commission (NHHRC) (also see the report Reforming the Australian Health System (13)2009). The commission is looking at the long-term health needs of the nation and has identified dental services as a priority area. Denticare is only one of 116 proposed medical reforms contained in the interim report. It is expected that the final plan will be delivered to Canberra mid- 2009.  

Shortly before the 2007 federal election the previous Liberal Government initiated a Medical Dental Scheme, for chronically ill patients (see Health Monitor report  Access to dental care in Australia: a bit more (10) 2007). The current government has unsuccessfully attempted to stop this scheme in federal parliament. The current government considers that before a national dental care system is introduced the current medical dental scheme has to disappear. But political parties such as the Greens do no support the initiative because "it would leave Australia with only the promise of a full national dental plan at some time in the future and with no publicly funded dental care at all in the meantime". (Cresswell and Ryan 2009)

Purpose and process analysis

Current Process Stages

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

Origins of health policy idea

Since the establishment of Medicare in the early 1980, this is the first time there is an open discussion about a national dental healthcare system. As previously described Denticare is one of the recommendations of the National Health and Hospital Reform Commission (NHHRC).  

The proposed Denticare reform differs from the existing Medicare funding arrangements. Medicare covers medical services by acting as an insurer, and medical services covered by Medicare cannot be covered by private insurance. There is no opting out as everyone is covered by Medicare. Under Denticare everyone will be eligible for the public insurance scheme. But individuals can choose to retain their private insurance cover, in which case Denticare will provide a risk adjusted payment to the insurer with individuals able to increase their cover. This is a managed competition model, and quite different to the existing relationship between insurers and the government funding.

Initiators of idea/main actors

  • Government
  • Providers
  • Private Sector or Industry
  • Opinion Leaders

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

The Australian Dental Association (ADA-peak group for private dentists) described "Denticare" as too complex, inefficient and impractical. Dr. Neil Hewson (president of the ADA) commented that that the Government should focus on the delivery of health care to those who needed it the most, 35% of the community who cannot afford proper dental care. Dr. Hewson also warned that Denticare could nearly double the cost of dentistry. (Australian Dental Association 2009)  However the ADA supports the proposed one year internship scheme for dentists prior to full registration. Interns will be required to practice in the public sector or in rural and remote areas. It also supported the initiative of improved health promotion.  

The Association for the promotion of oral health described the initiative as a two tier system "where federal funding would be simply given to the private system".  

Professor John Spencer who has studied the dental industry for more than two decades is in favour of Denticare. He considers that the Denticare proposal could lead to national standards of care being established with an emphasis on preventative rather than emergency treatments. (ABC 2009)  

The chief executive of NIB (a private health insurance) described "Denticare" as "inefficient and lacking competition" The nationalisation of dental services was described a "disaster"

Actors and positions

Description of actors and their positions
Government
Commonwealthvery supportiveneutral strongly opposed
Providers
Australian Dental Associationvery supportiveopposed strongly opposed
Private Sector or Industry
Private health insurersvery supportiveopposed strongly opposed
Opinion Leaders
Academicsvery supportivesupportive strongly opposed

Actors and influence

Description of actors and their influence

Government
Commonwealthvery strongvery strong none
Providers
Australian Dental Associationvery strongstrong none
Private Sector or Industry
Private health insurersvery strongstrong none
Opinion Leaders
Academicsvery strongweak none
AcademicsCommonwealthAustralian Dental Association, Private health insurers

Positions and Influences at a glance

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

Adoption and implementation

Public consultation is now closed for the interim report. It is expected that the final plan will be delivered to Canberra mid- 2009. It is important to note that the Commission has an advisory role. Therefore the Government is not compelled to implement the recommendations provided by the NHHRC. However it is expected that the Government will respond to this once the final report is released. 

Expected outcome

In its interim report the commission asserts that introducing "Denticare" will improve oral health and equitable access to dental care. The final report is expected to be release in mid June 2009. The Government would need to respond to the final recommendations. However Health Minister Nicola Roxon commented "They (the commission) have put forward a fairly radical proposal, obviously the way of delivering the services, and a tax, an extra levy attached to it, it is a fairly ambitious proposal." (Australian Associated Press 2009)

Impact of this policy

Quality of Health Care Services marginal rather marginal fundamental
Level of Equity system less equitable two system more equitable
Cost Efficiency very low low very high

The proposed measures are unlikely to deliver quality dental care. It is also unlikely that the proposed changes will result in a more equitable/efficient system.  

References

Sources of Information

  1. Brennan DS. Oral health of adults in the public dental sector. Dental statistics and research series no. 47. Cat. no. DEN 192. Canberra: Australian Institute of Health and Welfare 2008.
  2. National Health and Hospitals Reform Commission. A healthier future for all Australians: Interim report December 2008 Canberra Commonwealth of Australia 2009.
  3. Cresswell A, Ryan S. Greens poke holes in Rudd's dental scheme. In: The Australian. Sydney: The Australian 2009.
  4. Australian Dental Association. Media Release: National Health and Hospitals Commission Interim Report. In: Australian Dental Association 2009.
  5. ABC Online. Universal dental scheme wins qualified support. Transcript of PM news story. In: ABC 2009.
  6. Australian Associated Press. Dental plan "needs Medicare levy raise". In: Livenews.com.au 2009.

Reform formerly reported in

Access to dental care in Australia
Process Stages: Evaluation
Access to dental care in Australia: a bit more
Process Stages: Legislation

Author/s and/or contributors to this survey

Gallego, Gisselle

Suggested citation for this online article

Gallego, Gisselle. "Universal Dental Health Scheme". Health Policy Monitor, April 2009. Available at http://www.hpm.org/survey/au/a13/3