Affordability of private care – adults
Access to dental services is determined by several factors, including cost, locality and behaviour. With the majority of dental services provided in the private system, cost of services can be a significant barrier for lower income earners. The National Dental Telephone Interview Survey has been monitoring the number of adults who report that they had avoided or delayed dental care due to cost. In 1994, 27.1 per cent of adults reported an avoidance or delay in accessing care due to cost − a percentage which remained relatively constant through the 1990s. In recent years this has increased significantly, with the most recent results indicating 34.3 per cent of adults avoided or delayed care due to cost. Another measure of affordability, in which adults report whether cost had prevented them from a recommended course of treatment, remained constant from 1994–2005 at 20.2 per cent of adults.91
91 Harford, J.E., Ellershaw, A.C. and Spencer, A.J. (2011), Trends in access to dental care among Australian adults 1994–2008, AIHW Dental Statistics and Research Series, No.55, pp.45 and 49.
In terms of at risk groups, 46.7 per cent of concession card holders reported delaying dental treatment compared to 30.2 per cent of non–card holders, indicating the increased effect of cost for lower income earners. This has increased significantly for both card holders and non–card holders since 1994. However, the impact of cost on avoiding or delaying dental care was not significantly different across the population, with very little difference between regional and urban areas.92
92 ibid, p.47.
Australia’s dental service provision, whereby the vast majority of services are privately provided and funded, provides a structural impediment to lower income earners’ access. This is not unique to Australia, but is a common problem in health systems focused on private service provision for dental services.93 For the vast majority of Australians, the private system provides high quality dental care, which is partly reimbursed and subsidised for around 50 per cent of the population with private health insurance. This in part contributes to the good oral health of a significant number of Australians. The problem is for those whose access is limited because of costs and other barriers.
93 Leak, J.L. and Birch, S. (2008), ‘Public policy and the market for dental services’, Community Dentistry and Oral Epidemiology, p.287–295.Top of page
Access in the public sector – lack of funding and waiting times for adults
Under existing dental system arrangements where cost remains an issue, public dental services provide a safety net for concession card holders. However, limited funding for the public sector has constrained access through the low number of services available relative to the number of individuals needing care. This has led to significant waiting times for a range of services, effectively limiting access to people in need. Around 400,000 Australians are on public dental waiting lists with average waiting times of up to 27 months and some people waiting up to five years. Many public patients start on public dental waiting lists seeking preventive or restorative treatment but become emergency cases by the time they receive treatment.94 The significant wait for dental services can lead to a piecemeal approach to care, with people seeking treatment through emergency dental visits. There are also a large number of eligible people seeking private treatment.
94 Australian Healthcare and Hospitals Association (2008), Policy Monograph 2008: Oral and Dental Health, p.37.
Limited funding within the public sector is the primary reason for these difficulties. The public sector dental practitioners work in an environment with limited resources, while servicing some of the most disadvantaged people in the community who often experience complex health problems. The lack of funding exacerbates workforce pressure, with difficulty recruiting and retaining dental practitioners given the incentives to work within the private sector instead.95
95 Leak, J.L. and Birch, S. (2008), ‘Public policy and the market for dental services’, Community Dentistry and Oral Epidemiology, pp.287–295.
The oral health status of public patients compared to the general population is considerably worse across a range of indicators, including periodontal disease and having fewer than 21 teeth.96 Funding constraints and waiting times may be contributing factors to poorer oral health of public patients.
96 Brennan, D.S. (2008), Oral health of adults in the public dental sector, AIHW Dental Statistics and Research Series, No.47, p.vi.
Low income earners
Access and affordability for services are also felt across the wider community, extending to those not eligible for public dental care. Many of these are low income households whose financial circumstances make them ineligible for public dental services because they do not qualify for concession cards, yet their income is insufficient for them to access comprehensive dental services in the private system. The Australian Council of Social Service (ACOSS) estimates that 23 per cent of Australian adults (2.3 million adults) not eligible for public dental care delayed or avoided treatment because of cost.97
97 Australian Council of Social Service (2008), Fair dental care for low income earners: national report on the state of dental care, p.2.