Report of the National Advisory Council on Dental Health

Integrated Adult and Child Options

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

      The Council considers that, to improve services across all age cohorts, action should be taken to address both the needs of children and low–income adults by integrating selected options. Four integrated combinations of the child and adult options, which demonstrate various divisions of responsibility between the Commonwealth and the states, are below.

      The extent to which each level of government is responsible for the funding and provision of dental services depends on the policy options pursued. Entitlement options (Options 1 and Option 3) would place the Commonwealth government in a direct relationship with providers and users of dental services. The government would bear the dominant responsibility for such programs (e.g. MTDP and CDDS). Alternatively, the Commonwealth Government might transfer payments or provide block grants to the states for the provision of services (e.g. CDHP).

      In line with the frameworks already described, these integrated options should utilise existing systems in the short term with the potential to expand their reach over time.

      Table 6.5 – Possible combinations of child and adult options.


      No.

      Combination of options in this column with next column

      Combination of options in this column with previous column

      Summary description

      1

      Option 1 (individual capped benefit entitlement for all children)

      Option 3 (access to a means tested individual capped benefit for concession cardholder adults)

      Both children’s and adult’s dental services would be directly funded to eligible individuals by the Commonwealth. Services would be provided in the public and private sectors by states and private providers respectively.

      2

      Option 1 (individual capped benefit entitlement for all children)

      Option 4 (enhanced access to public dental services for lower income adults)

      Children’s services would be directly funded to eligible individuals by the Commonwealth. Services would be provided in the public and private sectors by states and private providers respectively.

      Services for adults would be funded by the Commonwealth through states. Services would be provided in the public sector by states and contracted to the private sector when necessary.

      3

      Option 2 (enhanced public sector child dental services)

      Option 3 (access to a means tested individual capped benefit for concession cardholder adults)

      Children’s services would be funded by the Commonwealth through states. Services would be provided in the public sector by states or contracted to the private sector when necessary.

      Service for adults would be directly funded to eligible individuals by the Commonwealth. Services would be provided in the private sector or by states respectively.

      4

      Option 2 (enhanced public sector child dental services)

      Option 4 (enhanced access to public dental services for lower income adults)

      Children’s services would be funded by the Commonwealth through states. Services would be provided in the public sector by states or contracted to the private sector when necessary.

      Services for adults would be funded by the Commonwealth through states. Services would be provided in the public sector by states and contracted to the private sector when necessary.

      For example, in Combination 3 (‘Option2/Option3’) the states would be responsible for child services (5.4 million children under 18 years of age), on the basis of a COAG agreement that includes consistency of standards and service levels for dental care. The Commonwealth would take responsibility for concession card holder adults (5.1 million adults).

      The states have a long standing involvement in school dental services and could develop the capacity to care for all children, particularly focused on those in most need. This would involve some contracting of dental services to the private sector. The states would be responsible for child services, on the basis of a COAG agreement. The Government could also consider transferring funding for the MTDP to the states and territories as part of their taking responsibility for child dental services. This could assist with freeing up the existing public dental system and state and territory funding to improve services to eligible adults. The Commonwealth would take responsibility for low–income adults and fund adult concession card holders through a dental benefit entitlement scheme with a defined dental benefit schedule. This would be an extension of the framework used by the Commonwealth for the CDDS, but with altered eligibility and scope of dental services provision. The public dental sector could also access the benefit entitlement to provide services to eligible adults.

      This integrated option would use private sector workforce and infrastructure capacity for the highest need and public sector expertise in providing services to children.

      The Commonwealth could also expand eligibility for this entitlement benefit and provide it to chronic disease patients as well as non–concession card low income adults (approximately 2.5 million additional adults). The Commonwealth could also provide short–term assistance to those concession card holders currently on public dental waiting lists (approximately 400,000 additional adults). The total estimated cost for this option as outlined above would be in the order of $10.1 billion over the forward estimates from 2012–13.

      The Council has used the above combination of responsibilities as an example. Other combinations and lines of responsibility are outlined in the table above. Each has a level of plausibility and possible advantages. For instance, Combination One is closest to the Commonwealth’s current involvement in the MTDP and CDDS. Combination Two is the reverse of the combination outlined in more detail above. It would recognise the current limited capacity in some states in directly providing dental services to children. Combination Four would be consistent with the states historical role in dental service provision to children and low income adults, albeit with substantial Commonwealth funding. More detail on such combinations was beyond the scope of the Council in this report. Part of the dental reform process could include discussions between states and territories and the Commonwealth through COAG on responsibility for children and adults or other arrangements including shared responsibility for particular groups.