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Issue #1538      7 March 2012

Editorial

Dental health not optional

It’s almost budget time again. What if there were a suggestion to exclude the eyes or the kidneys from Medicare coverage? How could anyone defend their exclusion? There could be no rational argument. Yet, another vital part of our body is excluded. We use it to eat, to talk to people and when infected could result in serious illness or even death if untreated in extreme cases. Oral health is a key component of general health; it cannot be hived off as somehow unconnected or less important than other parts of the body. Recent research findings indicate more than one in three adults avoid or delay care due to cost. There is a high correlation between poor oral health (including number of teeth lost) and low income. This is an intolerable and indefensible situation.

Last week, yet another report on delivering dental services was released by the government. This latest report is by the National Advisory Council on Dental Health which was set up last year by the government as part of an agreement with the Greens. The Greens health policy calls for universal access to publicly funded primary dental care. The terms of reference for this report were restricted to providing advice on dental policy options and priorities for consideration in the 2012-13 budget.

“In terms of at risk groups 46.7 percent of concession card-holders reported delaying dental treatment compared to 30.2 percent of non-card holders ... ” the report notes. These card-holders include pensioners, unemployed and people with a disability. The public, means tested dental system which is supposed to provide a “safety net” for concession card holders and other low income groups, is overstretched. “Around 400,000 Australians are on public dental waiting lists with average waiting times of up to 27 months and some people waiting up to five years. Many public patients start on public dental waiting lists seeking preventative or restorative treatment but become emergency cases by the time they receive treatment,” the report says. “Limited funding within the public sector is the primary reason for these difficulties.”

The report highlights the importance of oral health care: “International research indicates there are associations between chronic oral infections and heart and lung diseases, stroke, low birth-weight and premature births. … Dental disease negatively impacts general quality of life, affecting not only physical wellbeing but also psychological and social wellbeing.” A healthy mouth also enables people to eat, speak and socialise without pain, discomfort or embarrassment.

The report recommends short-term options that would increase access for children and those on lower incomes at a minimal cost to the government. For children it gives two possible approaches for “a universal scheme”. The first is an individual capped benefit entitlement (voucher type of scheme) for basic preventative and treatment services in either the public or private sector. The second option is “enhancing access to public sector services” for basic dental services. This would necessitate some expansion of the public sector.

For lower income adults, it also offers two approaches. The first is a means tested, individual capped benefit entitlement (voucher style) for each eligible person. The second is “enhanced access to public dental services”. For the longer term it talks in terms of “a universal access program” but does not go into details of what it means by that. There is a real danger the government will go down the means testing path, it has already introduced it for the PHI rebate and could later extend it to other areas of Medicare coverage. (See Guardian 22-02-2012, Issue #1536)

The report goes into costing. The first stage of a means tested scheme, as part of Medicare, would cost between $8.4 billion and $14.4 billion over four years (an average of between $2.1 billion and $3.6 billion per annum). This is peanuts compared with a four-year military budget of more than $120 billion and the outcomes much healthier than fighting US wars. These projected costs do not include millions of dollars in savings from regular checkups, preventative care, and reduction in disease and preventable hospitalisations (over 60,000 pa) or visits to GPs (around 750,000 per annum).

Universal access under Medicare is the only way of guaranteeing everyone the right to the preventative care and treatment they need. Funding is not an issue. There is no defence for not bringing oral health care under Medicare – NOW – with universal access.

Next article – Political prisoner Liliany Obando is freed

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