Report of the National Advisory Council on Dental Health

Chapter Six - Options for Reform

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

      Introduction

      Consistent with the Terms of Reference, this chapter provides a range of options for the Government to consider for the 2012–13 Budget.

      As a first step, we have identified two priority groups: children and lower income adults. This chapter sets out options for these groups.

      For children we have proposed two options for a universal scheme:

      • An individual capped benefit entitlement (Option 1), which would cover basic preventive and treatment services. The benefit could be used in the public or the private sector.
      • Enhanced access to public dental services (Option 2), which would increase access for all children to basic dental services by enhancing existing public sector services.

      These options have been developed as alternatives, with a choice required between them. Both options include an additional measure to provide services to those children who do not currently access adequate services.

      For lower income adults we have also proposed two options:

      • A means tested individual capped benefit entitlement (Option 3), which could build on the legislative framework for existing programs. Access to higher level services or caps could be provided in exceptional circumstances.
      • Enhanced access to public dental services (Option 4).

      These options have been developed as alternatives, with a choice required between them. These options are designed as a stepping stone on a path to a universal access program. Both options include a short–term measure to help provide access to services for people who have faced long waits for public dental services.

      Any of the four options could potentially be scaled and/or phased in over time. The Council’s view is that while the options could be implemented gradually, it is important to understand that this would be a step on the road to full implementation, not an end point in itself. The challenge with scaled options is to ensure that targeting is not so narrow as to adversely impact on the development of a broader and better resourced population–based framework.

      The Council has also considered an example of an integrated option combining enhanced access to public dental services for children and a means tested capped benefit entitlement for adults. This model looks at the responsibilities for funding and service delivery of states and territories and the Commonwealth.

      The cost estimates presented in this chapter are indicative only, enabling broad comparisons between the options. The assumptions include complex interactions, covering: relationships between private and public dental sectors; private dental practices acceptance of scheme design and benefits; and changes in incentives for and behaviours of individuals. Establishing more precise cost estimates will involve further discussion with the dental sector.

      We further recommend fundamental supporting measures as an integral component for all options. These include:

      • building workforce and infrastructure capacity;
      • improving data and research capacity;
      • oral health promotion and prevention; and
      • specific measures for population groups with special oral health care and treatment needs.

      Basic Preventive and Treatment Services

      For the proposals set out below, the Council considers that basic preventive and treatment services should include diagnostic, preventive and routine services, but exclude ‘elective’ services such as crowns and implants. This approach allows for a focus on oral health prevention and early intervention. These account for approximately 90 per cent of services, but only two–thirds to three–quarters of the total costs. For more detail refer to Appendix K.

      However, some patients may require more complex high–end dental care which is not categorised as diagnostic, preventive or routine. Patients would be given access to clinically necessary complex care items in exceptional circumstances.