Concession card holders
Concession card holders are primarily recipients of the age pension, disability support pension or unemployment payments. In 2011, there were between 7.4 and 7.5 million Australians eligible for PCC and HCC.71 Of these, almost two million were dependent children. These figures show that around one–third of the Australian population is eligible for concession cards. Concession card holders and their dependants are eligible to access public dental services provided by their state or territory. Given the income eligibility requirements for concession cards, most of these Australians are on low incomes, although there are some ‘self–funded’ retirees on part pensions that have access to PCC.72
71 Department of Families and Housing, Community Services and Indigenous Affairs data used for determining eligibility to concessional access to the Pharmaceutical Benefits Scheme.
72 A list of Centrelink supported pensions and their eligibility for concession cards is included in Appendix G.
Survey data for concession card holders is consistent with visiting patterns and oral health status in low income categories. It shows that 41.7 per cent of concession card holders have unfavourable visiting patterns, compared to 23.7 per cent of non–concession card holders.73 This is reflected in the greater rates of untreated decay, moderate to severe periodontal disease and fewer than 21 teeth compared to non–concession card holders.
73 Spencer, A.J. and Harford, J. (2008), Improving Oral Health and Dental Care for Australians, Prepared for the NHHRC, p.23.
Concession card status is a reasonable proxy for need and disadvantage and at a broader level there is considerable overlap with many of the priority groups included in the report. Concession card holders broadly include several high–risk, low–income groups, such as: elderly Australians; the unemployed; disability pensioners; and Indigenous Australians. These groups, because of age and income, are more likely to be suffering from chronic diseases and disability which may also restrict access to regular employment and participation.
Rural and regional residents
Rural residents have a higher incidence of unfavourable visiting patterns (38 per cent) than urban residents (27 per cent).74 These visiting patterns increase the risk of poorer oral health in rural residents compared to urban residents, which is supported by survey data. For example, 31.7 per cent of rural residents have untreated decay compared to 24.8 per cent of urban residents and 32.8 per cent of rural residents have moderate to severe periodontal disease compared to 26.1 per cent of urban residents. Of the dentate population, 18.5 per cent of rural residents have fewer than 21 teeth compared to 13.8 per cent of urban residents.75
74 ibid, p.23.
75 ibid, p.23 and p.25.
Of Indigenous Australians, 40.2 per cent have unfavourable visiting patterns compared to 28.2 per cent of non–Indigenous Australians. This difference is not as great as concession card versus non–concession card holders across the Australian population, but it is significant. Given existing income disparities and disadvantage, it is likely that many Indigenous Australians would be eligible for concession cards. The tendency for Indigenous Australians to have unfavourable visiting patterns increases the risk of poorer oral health. For example, 49.3 per cent of Indigenous Australians suffer from untreated decay compared to 25.3 per cent of non–Indigenous Australians. Periodontal disease is also significantly higher at 34.2 per cent compared to 26.7 per cent of non–Indigenous people. Of dentate Indigenous Australians, 19.6 per cent have fewer than 21 teeth, compared to 14.2 per cent of non–Indigenous Australians.76Top of page
76 ibid, p.23 and p.25.
Frail and older people in the community and in residential care
Australians aged 65 years and older have more favourable visiting patterns than the general population. This age group would appear to be at less risk of oral disease than the broader population.77 This reflects caveats that should be applied to broader population data – visiting patterns are a risk indicator, but do not account for risk groups within a cohort. While the visiting patterns of elderly Australians is generally favourable, there would be particular groups within this cohort where visiting patterns and oral health are poor. Older Australians in low income groups and residential care facilities may be one such group.
77 ibid, p.23.
Low income workers
Survey data shows that there is a link between income and visiting patterns. Low income workers are generally ineligible for concession cards and are not holders of private health insurance. There are various definitions of lower income workers (sometimes defined as the ‘working poor’). A submission to the Council by the Australian Healthcare and Hospitals Association indicated that there were 876,000 (aged over 15 years) ‘working poor’ earning less than $924 per week.78
78 Australian Healthcare and Hospitals Association (2011), Policy Paper on Oral Health, p.5.
There are many causes of homelessness affecting a range of people. Homelessness includes: those without shelter; people that are forced to stay with friends, relatives and in hotels; and those who live in boarding houses and caravan parks with no private facilities or lease. These circumstances make it very difficult for people to be employed or lead a healthy and stable life.79 Dental survey data does not collect visiting patterns and oral health status on homeless Australians. Given the broader concession card holder arrangements and the large eligible population, homeless people are likely to be eligible for these services. However, it may be difficult for dental services to reach these people for a range of reasons, including the lack of a fixed address. The provision of services to homeless Australians may require mobilising existing, new and emerging social assets so that services are delivered where they are needed.
79 The Australian Government (2008), The Road Home: A National Approach to Reducing Homelessness, p.3.Top of page