Amanda Biggs
Child and Adult Public Dental
Scheme (caPDS)
On 23 April 2016, the Minister for Health Sussan Ley announced
the establishment of a new Child and Adult Public Dental Service (caPDS) to
replace existing Commonwealth-funded dental arrangements from 1 July 2016.[1]
The caPDS will be established under a five year National Partnership Agreement
(NPA) to be negotiated with the states and territories, worth $2.1 billion.[2]
The Budget allocates $1.7 billion over the first four years of the scheme from
2016–17.[3] Funding of $415.6 million
is allocated for 2016–17, with state allocations being finalised when the NPA
is agreed.[4]
The NPA will replace two existing programs: the one year National
Partnership on Adult Public Dental Services which provided $155 million in
2015–16 to the states and territories but only for adult concession card
holders, and the means-tested Child
Dental Benefits Schedule (CDBS).[5] The CDBS provides
eligible children aged 2 to 17—receiving Youth Allowance, ABSTUDY or other
government benefits or whose family is in receipt of Family Tax Benefit A—with
a voucher entitling them to dental benefits, capped at $1,000 over two years,
for basic dental services. The CDBS was introduced by the former Labor
Government as part of a dental health reform package and following advice from
National Advisory Council on Dental Health.[6] Until recently, the CDBS
had been supported by the Coalition, so this announcement represents a
significant shift in their view.[7]
The caPDS is intended to provide expanded access to
state-run public dental services for all children under 18 as well as to adult
concession card holders. States and territories will also contribute funding.
The Commonwealth contribution to the caPDS will be
calculated at 40 per cent of the national efficient price (NEP) for dental
services provided under the scheme, until 2019–20.[8]
The states and territories will meet the cost of the remaining 60 per cent. The
NEP is also used as the basis for calculating the Commonwealth’s contribution
to public hospitals. From 2019–20, the funding methodology will change and indexation
of the scheme will be capped at growth in the consumer price index (CPI) and
population.
The budget papers show savings in the first three years due
to the closure of the CDBS.[9]
An independent review ‘noted the success of the CDBS in
targeting the oral health of young Australians at an age where preventative
measures can be most effective’.[10] In its first full year
of operation (2014–15), 898,797 children (or 29.4 per cent of those eligible)
accessed services and $312.5 million in benefits was paid. Services were primarily
delivered by private dentists, although in South Australia and Tasmania a
majority of services were delivered in the public sector. Ninety seven per cent
of children were bulk billed, meaning they paid nothing for the service. Lower
than forecast uptake was acknowledged by the review. To address this it recommended
greater promotion of the scheme.[11] Problems with low uptake
were also noted in a separate Australian National Audit Office (ANAO) review,
which recommended improvements in communication and promotion.[12]
The low uptake led to pre-budget speculation that the Government might move to
close the CDBS.[13]
Poor oral health impacts on overall health and wellbeing and
can lead to poor nutrition, discomfort and pain. If oral disease is left
untreated it can result in infection and even hospitalisation. Although there
have been improvements in recent decades, some Australians still experience
poor oral health with three out of ten adults experiencing untreated tooth
decay and 40 per cent of young children having had tooth decay. Dental
conditions were the third leading cause of preventable hospitalisations in
2013–14, with more than 63,000 Australians hospitalised in 2013–14. [14]
Response
Labor claims the announcement represents a $1 billion cut to
health services and that few children will benefit under the new scheme.[15]
The Greens, who supported the introduction of the CDBS and want to see it
expanded, have stated they reject the plan.[16] The Australian Dental
Association (ADA) described the proposal as a ‘back of the envelope approach’
which will leave many patients ‘high and dry’ and called for the expansion of
the CDBS.[17]
Some have welcomed the increased funding for public dental
services. The Australian Healthcare and Hospitals Association (AHHA) endorsed
the Government’s commitment to support public dental services, but voiced
concern that the funding is ‘not as generous as suggested’ and ‘won’t underpin
equitable access to care’.[18] The National Oral Health
Alliance (NOHA) supports the move to legislate the scheme, but claims the
funding ‘represents a cut, not an increase’.[19]
Wait times for public dental services across jurisdictions
can be long. In Victoria wait times for general treatment are 12.6 months
(although emergencies are prioritised under a triage system).[20]
The public dental workforce represents only a small proportion of working
dentists. The vast majority of dentists (85 per cent nationally) work in
private practice.[21] The Minister indicated
in her press release that where service gaps exist, arrangements for accessing
private dental services will be allowed.[22] However, the majority of
private dentists work in metropolitan areas, so service gaps in rural and
regional areas are likely.[23]
While the adequacy of funding levels and the capacity of the
public dental workforce to absorb additional demand remain key concerns, others
may emerge. For example, services currently provided under the CDBS reflect its
focus on prevention (44 per cent of services) and early diagnosis of dental
disease (37 per cent of services).[24] It is not yet clear if
the new NPA will require public dental services to dedicate sufficient
resources to ensure the continuation of such services, or how they will address
the specific needs of children.
The closure of the CDBS requires the passage of legislation.
The Dental
Benefits Amendment Bill 2016 was introduced on 5 May 2016.[25]
It contains provisions that would close off the use of CDBS vouchers after 30
June 2016. There are also provisions that would establish that the Commonwealth
can make capped grants to the states and territories for the provision of
dental services. However, with an election announcement imminent it would seem
unlikely that the Bill will have time to progress.
[1].
S Ley (Minister for Health), Turnbull
govt to double public dental investment, media release, 23 April
2016.
[2].
Ibid.
[3].
Australian Government, Budget measures:
budget paper no. 2: 2016–17, p. 102.
[4].
Australian Government, Federal financial
relations: budget paper no. 3: 2016–17, p. 27.
[5].
Australian Government, Federal
financial relations: budget paper no. 3: 2015–16, p.26; Department
of Health, ‘Child
Dental Benefits Schedule’, webpage.
[6].
T Plibersek (Minister for Health), $4
billion dental spend on children, low income adults and the bush, media
release, 29 August 2012. National Dental Advisory Council, Report
of the National Advisory Council on Dental Health, 2012.
[7].
P Dutton (Minister for Health), Shorten
lies defy dental facts too, media release, 16 May 2014.
[8].
Efficient growth is explained in the National Health Reform Agreement
at clause A3. Efficient growth consists of the national efficient price for any
changes in the volume of services provided the growth in the national efficient
price of providing the existing volume of services. Council of Australian
Governments (COAG), National
Health Reform Agreement, 2011.
[9].
Budget
measures: budget paper no. 2: 2016–17, op. cit., p. 102.
[10].
Department of Health, Report
on the third review of the Dental Benefits Act 2008,
Commonwealth of Australia, 2016, p. ix.
[11].
Ibid., p. 23.
[12].
Australian National Audit Office (ANAO), Administration of the Child
Dental Benefits Schedule, ANAO report no. 12 2015–16, 2015, p.39.
[13].
J Power, ‘Free
dental scheme under threat despite glowing review’, Sydney Morning
Herald, 30 March 2016.
[14].
Australian Government, Healthy
mouths, healthy lives: Australia's National Oral Health Plan 2015–24,
COAG Health Council, Adelaide, 2015, p. ix.
[15].
C King (Shadow Minister for Health), Turnbull
Government cuts another $1 billion from kids dental care, media
release, 23 April 2016.
[16].
Australian Greens, Liberal’s
dental shocker undermines universal care, media release, 23
April 2016.
[17].
Australian Dental Association, New Dental
Scheme. Was it given a moments thought?, media release, 23 April
2016.
[18].
Australian Healthcare and Hospitals Association, Bipartisan
support for dental care welcome; but devil is in the detail,
media release, 23 April 2016.
[19].
National Oral Health Alliance, New
Federal plan is trying to do dental care using smoke and mirrors,
media release, 24 April 2016.
[20].
Department of Health (Victoria), ‘Statewide
- average time to treatment for general dental care - quarterly data,’
Victorian Health Services Performance webpage.
[21].
Australian Institute of Health and Welfare, Oral
health and dental care in Australia: key facts and figures 2015, AIHW,
2016, p. 67.
[22].
S Ley, op. cit.
[23].
Australian Institute of Health and Welfare, op. cit., p. 67.
[24].
Department of Health, op. cit., p 26.
[25].
Dental
Benefits Amendment Bill 2016 (Cth).
All online articles accessed May 2016.
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