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Dental Inquiry Shows The Effects of Chronic Underfunding

The Inquiry into Dental Health in NSW, established by the NSW Democrats in 2005, has just reported and here is an outline of some of the evidence and conclusions. The whole report is available at: www.parliament.nsw.gov.au

But First A Bit of History...
Dental Was Never Covered By Medicare. When Medicare was developed, the mouth was excluded from it, resulting in a large and prosperous private dental industry and a comparatively small number of public dentists. This outcome was the result of the negotiations required to get Medicare in the first place, and it should be noted that the Liberals opposed Medicare, as did many dentists. By 1991 it had become impossible to ignore the sad state of dental health in Australia, and the Keating Labor government pitched in with a scheme to reduce the waiting lists to sensible levels.

When the Howard Government came to power in 1996, they stopped the money for the dental scheme. Despite calls from some participants in the Dental Inquiry, there is no political possibility to put the mouth into Medicare. The federal government has stated that it will not take over responsibility Health, and it has certainly not accepted that Dental health should be included. This means that the ball is right back in the State Government's court.

States Have All Responsibility But Some Don't Care
The costs of dentists have risen much faster than the Consumer Price Index (CPI), and it is this failure of the CPI to keep up with the costs of health care that has created a problem.

The CPI determines most wages and pensions, but dental technology has become much more expensive. Dentures are a great example of how this has played out in NSW. One solution offered by the NSW government is to pay private dentists to make dentures and private dentists are happy to do that…until the money runs out.

Government witnesses on the Mid-North Coast told us that they make dentures till they run out of money and then they stop. The rate paid to supply dentures for public patients is so low that the Association of Dental Prosthetitists (specialist denture makers) advises members that they should not make them - at the public rate it barely covers costs. This situation arises because there are no dental prosthetists on the public payroll. It is a new award and the government was not willing to pay it. The outcome is that we pay for fewer dentures than we need and people without teeth suffer from malnutrition because they can't eat properly! These dental patients then become general health patients.

However, not every state has ducked its responsibilities to the extent of NSW. NSW spends $16 for each person, against a national average for of $23. Queensland spends $32 and intendeds to increase it over the next four years. Even if you assume that half of NSW pays it's own dental health costs we are not even close to covering the fee for the most basic dental service.

Federal/State Buck Passing Costs The NSW Public
The buck-passing that has gone on for the past 10 years is no longer acceptable because it does nothing to avert the coming crisis. If nobody agrees to take responsibility in a meaningful and timely manner we are looking at "no dentists now, and no dentists later".

No Salaried Dentists Now
While the average income of dentists has risen, the wages of salaried dentists have not risen much at all, and this trend has been going on so long that public dentists are making about half what private practitioners are making. Once this is understood, it does not take rocket science to figure out the reason that jobs in the public dental system cannot be filled. Who would become a salaried dentist when faced with this choice?

No Dentists Later Either
We are now facing a new threat to public dentistry because the only people left in the public system are about to retire. In spite of this entirely predictable trend, the Federal government, has cut the number of dental graduates, so that in 2005, the number of graduates was half what it was in the mid-1970s. A number of the available places are for foreign fee paying students so that even when they graduate, they are unlikely to practice here.

While Universities have been offered money for some more HECS (Higher Education Contribution Scheme- the student loans scheme) places in dentistry, the faculty had to turn it down, because HECS money just does not cover the costs. The faculty has to raise more money than it gets for each student they train. Due to similar wage issues for academic staff there is also a huge shortage of dental tutors (guiding students through their work in public dental hospitals and clinics), so the universities cannot train any more dentists, even if they agreed to subsidise these students. Crazy eh?

Solutions
Part of any solution will be recognising that prevention costs less than cure. Making dental services like checkups and cleaning affordable will give us a better idea of the state of our dental health and facilitate early intervention. Like most health care problems, the earlier you detect disease the less expensive it will be to fix it up.

Some more practical means of addressing the NSW dental health disaster are included in a 10 point plan put together by the Association for the Promotion of Oral Health, who were asked to come up with a scheme to fix the dental health problem, by Morris Iemma in his capacity as the Health Minister in early 2005. The report which was produced in April of 2005 was subsequently 'lost', a fact that only became known when the recommendations continually failed to appear in any government document, including the report from the Dental Health Inquiry. This has forced the APOH to put their own resources into making their suggestions public. They include an increase of funding for salaried professionals to match private dentists, as well as significant increases of funding for HECS places in Dentistry. They would also like to put their students to work in the public system to address the immediate problem of reducing waiting periods.

With the report of the NSW Dental Inquiry, the problem is fully acknowledged; with the contributions of the participants and the additional proposals from the APOH, the solutions are straightforward and sensible; now it just comes down to spending the money to get on with it. With the next budget coming out very shortly, we will see how the current government intends to spend its money, now that it has reluctantly opened it's mouth.

Yours,
Dr Arthur Chesterfield-Evans M.L.C. (ACE)