Report of the National Advisory Council on Dental Health

The Dental System

The National Advisory Council on Dental Health (the Council) was established as a time-limited group to provide strategic, independent advice on dental health issues, as requested by Minister for Health and Ageing, to the Government. The Council’s priority task was to provide advice on dental policy options and priorities for consideration in the 2012-13 Budget.

Page last updated: 03 September 2012

      Public services

      Dental treatment is provided both in the public and the private sector. States and territories are the current providers of most public dental services. For adults, access is largely determined by eligibility for concession cards (see Appendix D). Eligible adults can generally access public dental services from age 18, with the exception of Queensland where eligibility is from ‘above the age of completion of Year 10’. The type of concession card which allows access to public dental services and the amount of co–payment varies from state to state. However, the type of services available is generally similar across jurisdictions and is limited to emergency dental care and general dental treatment. Waiting times are significant, with the average exceeding two years in some states and up to five years in some locations.

      For children, eligibility criteria, co–payments and level of clinical services available also vary across the states and territories (see Appendix E). There are also differences in the models of service delivery. For example, Western Australia, Queensland and South Australia have dedicated school dental programs. The Northern Territory uses a hybrid model consisting of community–based services and school dental programs. New South Wales, Victoria, Tasmania and the Australian Capital Territory rely predominantly on community–based clinics.

      In the public sector, children are seen as a matter of priority for emergency and general services with no significant waiting periods for care. However, waiting times for services requiring hospital admission can be up to two years – e.g. extractions under general anaesthetic.

      Private services

      The private sector offers services to adults and children and is the only place that non–concession card holder adults can access dental care. A comprehensive range of services are provided in the private sector, including emergency and general dental as well as more complex and costly treatments such as orthodontic and endodontic services. Concession card holders also tend to access private dental care, with approximately two thirds of card holders visiting private dentists.

      Data collected through the National Dental Telephone Interview Surveys, which are conducted every three years by ARCPOH, indicate that over half of Australian children are receiving their dental care in the private sector. The percentage of children who attended a private dental practice for their last dental service increased from approximately 33 per cent in 1994 to 53 per cent in 2005 for 5–11 year olds and fluctuated between 53 per cent and 59 per cent for 12–17 year olds.44

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      44 Ellershaw, A.C. and Spencer, A.J. (2009), Trends in access to dental care among Australian children, AIHW Dental Statistics and Research Series, No. 51, p. 19.

      Expenditure on dental services45

      45 The most recent published consolidated expenditure on dental is sourced from the AIHW. The most recent publication in October 2011 relates to 2009–10 expenditure.

      Public consolidated expenditure on dental services is sourced from the Australian Institute of Health and Welfare (AIHW). The most recent publication in October 2011 relates to 2009–10 expenditure. In 2009–10, total expenditure on dental services in Australia was $7.690 billion. Of this, $4.698 billion was funded by individuals; $1.257 billion by the Commonwealth Government; $1.076 billion by private health insurance funds (which would be funded through the premiums of members); and $628 million by State and Territory Governments. Overall, individuals directly fund a significant proportion (61 per cent) of total expenditure, reflecting the structural nature of the dental system in which the vast majority of practising dentists and services are in the private sector. In terms of public sector financing, the Commonwealth is the dominant funder, although in 2007–08 the split between the Commonwealth Government and states and territories was relatively even (see Appendix F for more detail on Commonwealth Government funded programs).

      Prior to the operation of the Commonwealth Dental Health Program (CDHP) in 1994–1996, states and territories had provided approximately 80 per cent of government funding for dental services. The years between the cessation of the CDHP and the introduction of the Private Health Insurance Rebate (the Rebate) on 1 January 1999 saw the overall level of government funding for dental services maintained, despite the withdrawal of Commonwealth funds.

      The Rebate increased the Commonwealth’s share of funding for dental services from 40 to 48 per cent. This remained steady until the introduction of the CDDS in 2007–08, which has resulted in the Commonwealth’s share of government funding of dental services exceeding that of the states and territories. In 2008–09, the Commonwealth contributed 61 per cent of government expenditure on dental services. This represents a reduction in state and territory funding from 80 per cent in the late 1980s to early 1990s to around 40 per cent in 2008–09. This shift is due to a significant increase in Commonwealth funding – state and territory funding has consistently increased since 2000–01.

      The chart below shows the significant proportion of private expenditure directed toward dental services compared to government funding. The inclusion of private health insurance is largely an indirect extension of private expenditure as it is funded through premiums paid by individuals. With this taken into account, around three quarters of all dental expenditure is funded by individuals.

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      Figure 2.1: Percentage of Expenditure on Dental Services, by source 2009–10.
      Figure 2.1: Percentage of Expenditure on Dental Services, by source 2009–10. D