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A universal dental care scheme for Australia by Stephen Duckett Australia should introduce a Medicare-style universal insurance scheme for primary dental care, to ensure all Australians can go to the dentist when they need to, according... more

A universal dental care scheme for Australia
by Stephen Duckett

Australia should introduce a Medicare-style universal insurance scheme for primary dental care, to ensure all Australians can go to the dentist when they need to, according to a new Grattan Institute report.

Filling the gap: A universal dental care scheme for Australia calculates the scheme would cost an extra $5.6 billion a year, suggests it could be paid for in part by a rise in the Medicare levy, and recommends it be phased in over 10 years.

It’s needed because about 2 million Australians who required dental care in the past year either didn’t get it or delayed getting it because of the cost – and the poor and disadvantaged are most likely to miss out on care.

This is because most spending on dental care comes straight out of patients’ pockets.

“When Australians need to see a GP, Medicare picks up all or most of the bill. But when they need to see a dentist, Australians are on their own,” says the Grattan Institute’s Health Program Director, Stephen Duckett.

The consequence is widespread poor oral health. About a quarter of Australian adults say they avoid some foods because of the condition of their teeth; for low-income people, it’s about a third. Low-income people are more likely to have periodontal disease, untreated tooth decay, or missing teeth.

Bad oral health has painful and costly consequences. Oral health conditions can contribute to other health problems, including diabetes and heart disease. Most oral health conditions are preventable, yet people often end up going to a GP or hospital emergency department to be treated for conditions that could have been arrested with earlier care.

Existing public dental schemes are inadequate, uncoordinated, and inequitable across states and territories. Most states have waiting lists of well over a year for public dental care – and if people need to wait a year for care, their conditions are only going to get worse.

The Commonwealth Government should announce that it will take responsibility for funding primary dental care – just as it takes responsibility for primary medical care.

“There’s no compelling medical, economic, legal or logical reason to treat the mouth so differently from the rest of the body,” Dr Duckett says.

But it would be impractical to move to a universal scheme overnight. It would cost a lot of money – about $5.6 billion in extra spending each year – and more dentists and oral health professionals would need to be trained locally or recruited from overseas.

So, the Commonwealth should announce a roadmap to a universal scheme, including plans to expand the dental health workforce, followed by incremental steps towards a universal scheme.

First, the Commonwealth should take over funding of services for people eligible for existing public dental schemes, fund them properly, and enable private-sector providers to deliver publicly-funded care. Then the scheme should be expanded – first to people on Centrelink payments, then all children. Within a decade, the Commonwealth should take the final step to a universal scheme.

“Universal dental care is a big idea whose time has come,”
“All Australians should be able to get the care they need, when they need it, without financial barriers.”
Why oral health must be part of UHC
Oral health is essential to general health and well-being at every stage of life. However, essential oral health
services remain out of reach for millions of people. The integration of essential oral health services into UHC
will help improve health outcomes and reduce inequalities in access to care.
DID YOU KNOW:
• More than half of the world’s population (3.5 billion) suffer from untreated oral diseases, which can
result in pain, infection, tooth loss and loss of productivity.3
• In 2010 direct treatment costs due to oral diseases worldwide were estimated at US$298 billion
yearly, corresponding to an average of 4.6% of global health expenditure.4
Leveraging the UN High-Level Meeting on UHC
The first-ever United Nations High-Level Meeting on UHC (UN HLM on UHC) will take place on
23 September 2019 in New York to secure political commitment from countries on UHC. The meeting will
result in a Political Declaration, negotiated by UN Member States, that will form the basis for global efforts to
provide universal access to affordable and quality health-care services.
DID YOU KNOW:
• All UN Member States have agreed to try to achieve UHC by 2030, as part of the Sustainable
Development Goals (SDGs). SDG 3 - the health goal - includes a target to “achieve UHC, including
financial risk protection, access to quality essential health care services, and access to safe, effective,
quality, and affordable essential medicines and vaccines for all.”5
References
1. World Health Organization. Fact sheet on Universal Health Coverage. Available from: https://www.who.int/news-room/fact-sheets/detail/
universal-health-coverage-(uhc) [Accessed 22 March 2019].
2. Mathur MR, Williams DM, Reddy KS, Watt RG. Universal health coverage: a unique policy opportunity for oral health. J Dent Res. 2015;
94(3 Suppl 1): 3S-5S.
3. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a
systematic analysis for the Global Burden of Disease Study 2016. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Lancet.
2017; 390(10100): 1211-59.
4. Listl S, Galloway J, Mossey PA, et al. Global economic impact of dental diseases. J Dent Res. 2015; 94: 1355–61.
5. United Nations. UN Sustainable Development Goals. Available from: http://www.un.org/sustainabledevelopment/ [Accessed 22 March 2019].
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Key asks for oral health
The Political Declaration for the HLM on UHC must address the following priorities in order to improve oral health and UHC:

  1. Integrate oral health into primary healthcare and UHC
    • Add essential oral health services to national essential packages of health services.
    • Commit to provide at a minimum the World Health Organization (WHO) Basic Package of Oral Care, which includes
    access to emergency care and pain relief, affordable fluoride toothpaste and tooth decay management.
    • Ensure access to adequately trained oral health professionals and strengthen oral health systems based on a
    people-centered healthcare approach as a part of primary healthcare.
  2. Strengthen health surveillance systems to monitor oral health
    • Commit to improve data collection and surveillance systems for noncommunicable diseases (NCDs) that integrate
    oral health indicators.
    • Commit to produce data for SDG 3.8.1 (Coverage of essential health services) and go beyond the list of tracer topics
    to include oral health.
  3. Increase investment in NCDs, oral health and UHC
    • Recognize that investment in NCDs including oral health is critical to achieving UHC.
    • Encourage the implementation of taxation on unhealthy products — such as tobacco, alcohol, and sugar-sweetened
    beverages — to assist in financing UHC. These interventions are cost-effective fiscal policies recommended in the
    WHO Best Buys.