Teeth’s time has come, says Grattan

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The Grattan Institute has recommended a Medicare-style universal insurance scheme for primary dental care, in a move welcomed by health stakeholders

Stephen Duckett, Matt Cowgill and Hal Swerissen write that a universal scheme, which would cost an extra $5.6 billion a year, could be paid for by a rise in the Medicare levy.

It should be phased in over 10 years, they say.

The recommendation echoes the Australian Greens’ announcement earlier this month of its policy to invest $5.8 billion in a similar scheme.

“Untreated dental disease can dramatically impact on a person’s health and quality of life, and it is the most vulnerable people in our community who are impacted the most,” Greens leader Senator Richard Di Natale said at the time.

“The Greens will invest $5.8 billion to provide Medicare-funded dental care to all young people, aged pensioners, full benefit recipients and concession card holders.

“Millions of Australians have delayed visiting the dentist because of high out of pocket costs.”

The Grattan Institute report puts this figure at “about two million Australians who required dental care in the past year”.

The consequence of delaying dental visits is widespread poor oral health, Grattan says.

“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.”

Such a scheme would be impractical if implemented overnight, however.

As well as the cost, more dentists and other oral health professionals would need to be trained locally or brought in from overseas.

Thus the Commonwealth should announce a roadmap to such a system, Grattan says.

The Consumers Health Forum and Australian Dental Association welcomed the recommendation.

The suggested $5.6 billion “is a lot of money but it is a fraction of the current cost of Medicare and would contribute to a fundamental improvement in the health of millions of Australians,” said CHF’s Leanne Wells.

“Poor oral health can lead to pain, discomfort, hospitalisation and disease all combining to put additional cost burdens on the system in the form of subsidized medicines, GP visits and avoidable hospitalisations”.

The ADA said that as identified in the National Oral Health Plan 2015-24, more than 90% of adults and 40% of young children have experienced tooth decay.

Only four out of every 10 have a favorable visiting pattern (to a dentist) and there are many Australians who require specific strategies to improve access to treatment, it said.

“Targeted funding that supports those Australian’s that are often least likely to attend a dentist regularly is sorely needed if we are to improve oral health in our community,” said federal president Dr Carmelo Bonanno.



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