Chapter 1Introduction and background
Referral and conduct of the inquiry
1.1On 8 March 2023, the Senate resolved that the Select Committee into the Provision of and Access to Dental Services in Australia be established to inquire into matters relating to the nation’s oral and dental health, and access to services. The committee was required to present an interim report by 20 June 2023, and a final report by 28 November 2023. This is the committee’s interim report.
1.2Committee members were appointed on 9 March 2023, including Senators Askew, Cadell, Payman, Marielle Smith and Steele-John. The committee called for submissions to be provided by 4 May. The date was later extended to 4 June to allow time for more people to participate in the inquiry.
1.3The committee advertised the inquiry on its website and wrote to a number of relevant organisations and individuals to invite them to make a submission. Asof 19 June 2023, the committee has received and published 62 submissions, which are available on the committee’s website. The committee continues to process received submissions, and to accept late submissions. A list of submitters will be provided in the final report.
1.4The committee decided to create an online survey to provide another way for people to communicate their experiences. The survey was launched on 17April and closed on 4 June. The survey collected a total of 17 547 responses. A report outlining the findings of the survey is attached at Appendix 1.
1.5A number of additional documents have also been received. These have been published on the committee’s website and will be listed in the final report.
1.6The committee has scheduled public hearings for later in the year. These will inform the committee’s final report.
Acknowledgements
1.7The committee thanks all of the individuals and organisations who have submitted to the inquiry so far. In particular, the committee wishes to thank people who have generously shared their personal stories, contributing to the committee’s understanding of the real-world impacts of these matters.
1.8The committee also wishes to thank the Social Policy Research Team and Statistics and Mapping Section in the Parliamentary Library for the helpful and comprehensive research and mapping services provided to assist the committee.
Notes on terminology
1.9While the inquiry was set up to consider the provision of and access to dental services, many submitters highlighted broader issues associated with oral healthcare. The Australian Institute of Health and Welfare (AIHW) defines ‘oral health’ as ‘the condition of a person’s teeth and gums, as well as the health of the muscles and bones in their mouth’. As well as causing tooth decay, poor oral hygiene can lead to gum disease and periodontitis (a bacterial infection that causes inflammation), and cause functional and wellbeing impacts.
1.10The terminology used in this report is ‘oral health/oral healthcare’. However, submitters have used a variety of other terms, including ‘dental health’ and ‘dental disease’. While the terms ‘oral’ and ‘dental’ may be used interchangeably in this report, the committee recognises that oral healthcare is much broader than just the teeth.
Structure of the report
1.11The interim report contains three chapters. This first chapter introduces the inquiry, provides background information, and outlines the structure of the report. It summarises the current status of dental service provision across Australia, provides a history of Commonwealth involvement in the provision of dental services, and discusses previous inquiries into dental services.
1.12Chapter 2 outlines the unmet need for dental services. This chapter presents the committee’s survey results, alongside research and data from established sources. It looks at the economic costs and social impacts associated with poor oral health, and considers service gaps for specific groups of people.
1.13Chapter 3 looks at emerging issues for the inquiry and provides a high-level summary of key proposals raised in submissions received. The chapter also poses key questions for the committee to consider as it conducts public hearings, and deliberates around its final report.
Background
1.14The World Health Organization (WHO) defines ‘oral health’ as:
…the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions, such as eating, breathing and speaking, and encompasses psychosocial dimensions, such as self‑confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.
1.15The most common oral health problems worldwide are untreated caries (cavities) of deciduous (primary) and permanent teeth, severe periodontal disease, edentulism (total tooth loss) and cancer of the lip and oral cavity.
1.16According to the WHO, oral diseases are ‘the most widespread noncommunicable diseases’ in the world, affecting 45 per cent of people worldwide. People experiencing poverty, prisoners, refugees, disabled people, Indigenous peoples, and those who live in rural and remote areas face a higher burden of disease compared with the general population. The WHO reports a ‘direct and proportional association’ between socioeconomic status and the prevalence and severity of oral diseases.
Status of Australia’s oral health
1.17Oral and dental health in Australia have improved over the last 25 to 30 years, especially as a result of the addition of fluoride to drinking water. However, Australian Government dental health statistics indicate there are still significant problems:
3 in 10 people delay or avoid seeing a dentist because of the cost
1 in 4 children (aged 5 to 10) have untreated decay in their baby teeth
1 in 25 people (aged 15 and over) have no natural teeth left.
1.18According to the AIHW, poor oral health is common among Australian children and adults and contributes 4.5 per cent of the burden of non-fatal disease in the community (2022 figure). People’s oral health deteriorates over time. Australians between 35–54 years old have, on average, 10.3’decayed, missing or filled teeth’. By the time they are 75 years old, most of the average Australian’s teeth are missing, decayed or have been treated/filled.
1.19Key factors contributing to poor oral health include:
consumption of sugar, tobacco and alcohol
a lack of good oral hygiene and regular dental check-ups
a lack of fluoridation in some water supplies
inadequate access to and availability of services, including:
the cost of private dental care, and
long waiting times to access public dental care.
1.20In 2020, the Australian Dental Association (ADA) and the Australian Health Policy Collaboration (AHPC) published Australia’s Adult Oral Health Tracker. This national review found that tooth decay and gum disease have both increased since previous national studies were conducted in 2004–06:
32.1% of adults (aged 15+) have untreated tooth decay, a 6.6% increase from 25.5% in 2004/06.
28.8% of adults (aged 15+) have periodontal pockets (>4mm), a 9% increase from 19.8% in 2004/06.
1.21The Oral Health Tracker also found that less than half of Australia’s adults had a dental check up in the last 12 months, one in five reported experiencing toothache, and almost half do not brush twice daily. The proportion of adults with ‘severe tooth loss’ (less than 21 teeth) was one in ten.
1.22The effects of poor oral health can be profound and impact the whole body, decreasing a person’s general health. Because it destroys tissues in the mouth, dental disease can lead to ‘lasting physical and psychological disability’. Tooth loss reduces functionality in the mouth, making it harder to chew and swallow. This can compromise nutrition and ‘exacerbate existing health conditions’. AIHW notes that poor oral health ‘is also associated with a number of chronic diseases, including stroke and cardiovascular disease’. It can impact pregnancy outcomes, is associated with lung conditions, and can contribute to oral cancers.
1.23Oral disease is linked to diabetes, with periodontitis contributing to complications, such as end-state renal disease, in diabetics. Type 2 diabetes is also a risk factor for periodontitis. Large international studies have linked loss of teeth with ‘coronary heart disease, acute myocardial infarction, diabetes, and early death’; even accounting for other factors, such as smoking. The National Advisory Council on Dental Health (2012) reported that poor oral health affects people’s mental health, contributing to anxiety, depression and poor self‑esteem.
1.24Poor oral health also costs Australia’s healthcare system significantly. According to the Grattan Institute:
there are an estimated 750000 general practitioner (GP) consultations each year for dental problems, primarily for pain relief and antibiotics; and
this costs taxpayers up to $30 million per year, for the consultations alone, with further costs for subsidising prescribed medications.
1.25Dental and oral health problems also impact the hospital system, with AIHW estimating that in 2020–21, there were about 83000 hospitalisations for preventable dental conditions. Hospitalisations are most prevalent among children, people in remote areas and Indigenous Australians:
In 2020–21, the rate of potentially preventable hospitalisations due to dental conditions (per 1,000 population) was highest in those aged 5–9 years (10.9 per 1,000 population).
In 2020–21, the rate of potentially preventable hospitalisations due to dental conditions (per 1,000 population) generally increased as remoteness increased, ranging from 3.0 per 1,000 population in Major cities to 4.8 per 1,000 population in Very remote areas.
In 2020–21, the rate of potentially preventable hospitalisations due to dental conditions (per 1,000 population) was higher for Indigenous Australians (5.4 per 1,000 population) than for Other Australians (3.0 per 1,000 population).
1.26Dental and oral disease costs the economy, reducing productivity and workforce participation. Australians take an estimated 2.4million days or half days off work or study because of oral disease, and the estimated ‘total economic cost of reduced workforce participation due to dental conditions [is] $556million per year’ (2010 data).
1.27In Australia, dental disease and oral health problems disproportionately affect those on low incomes, Aboriginal and Torres Strait Islanders peoples, people in rural and remote areas, prisoners, disabled people, and those with specialised healthcare needs. A discussion of unmet need for dental services, and service gaps for vulnerable cohorts, is included in Chapter2 of this report.
Overview of dental services in Australia
1.28Australia has a universal health care system (Medicare), which provides free or subsidised health services for Australians, and some overseas visitors. When the first iteration of Medicare was introduced in 1974, the Whitlam Government chose to exclude dental services to avoid inflating the cost of the scheme and, reportedly, to avoid conflict with the dental profession.
1.29Australia spent an estimated $220.9 billion on healthcare in 2020–2021. Governments funded the majority of this expenditure (around 70 per cent). Incomparison, around $11.1 billion was spent on dental services that year:
almost 60 per cent (around $6.5 billion) was paid directly by individuals;
around 20 per cent ($2.2 billion) was financed through private health insurance providers; and
the remaining 20 per cent was funded by the Commonwealth (around $1.3billion) and state and territory governments (around $946 million).
1.30According to AIHW data, Australia’s total per capita spend on dental services in 2020-2021 was $432. Figure 1.1 shows the breakdown of expenditure on a per capita basis by source of funding from 2010–2011 to 2020–2021.
Figure 1.1Expenditure on dental services per capita by source of funds, constant prices, 2010–11 to 2020–21
Source: AIHW, Oral health and dental care in Australia, 17 March 2023. Note: Constant prices adjust current prices for the effects of inflation.
1.31The Commonwealth currently supports public dental service provision through:
Child Dental Benefits Schedule (CDBS)—The CDBS allows eligible children aged 0 to 17 years to claim up to the benefit cap every two years for basic dental services. The program is means tested; children must be eligible for Medicare and they and/or their family/carer should receive an eligible Australian Government payment at least once in the calendar year.
Federation Funding Agreement (FFA) for adult public dental services—The Commonwealth offers top-up funding to states and territories to provide adult public dental services. This funding is dependent on achieving activity levels above a baseline level, set in 2013-14. The current 2022-23 FFA agreement ends on 30 June 2023. In the 2023-24 Budget the government announced funding of $215.6 million over two years as an interim measure while decisions on future funding arrangements for dental service provision are finalised through an inter-governmental senior officials working group.
National Health Reform Agreement (NHRA)—The Commonwealth provides funding for public hospital admitted and outpatient dental services.
Private Health Insurance (PHI) rebates—The Commonwealth provides an income-tested private health insurance rebate. The rebate applies to hospital, general treatment (including dental), and ambulance policies.
Grants to the Royal Flying Doctors Service (RFDS)—The Commonwealth funds grants to the RFDS which provides dental outreach services through provision of fly-in/fly-out or drive-in/drive-out outreach dental services, where there are no other private or public dental services in classified areas.
Research—The Department funds population health dental research studies conducted by the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide. The National Health & Medical Research Centre (NHMRC) and the Medical Research Future Fund (MRFF) also provide other funding opportunities for dental research through competitive processes.
The Northern Territory Remote Aboriginal Investment Oral Health Program (NTRAI OHP)—Since 2007, the Commonwealth Government has helped fund oral health services for Aboriginal and Torres Strait Islander children aged under 16 in the Northern Territory through various iterations of National Partnership Agreements (NPA) since the Northern Territory Emergency Response (NTER).
Figure 1.2Summary of Commonwealth funding for dental services
Source: Department of Health and Aged Care, Submission 18, pp. 2-3.
^ Estimated actuals as per relevant Budget Portfolio Statements. Figures for 2023-24 onwards as per Budget 2023-24. ** From 2022-23 onwards, the RFDS grant allocates funding flexibly across all primary care service delivery, which includes dental services. This figure is the indicative amount for dental services and may be used flexibly to provide other primary care services. * PHI Rebates – estimated contribution of PHI rebates being paid out in dental claims. Data from 2021-22 is not available. Source: AIHW. ^^ Additional funding of $0.02m will be provided in 2026/27. #The Indigenous Australians’ Health Programme Primary Health Care Funding Model provides funding ($34.1m from 2020-21 to 2023-24) to the Wurli-Wurlinjang Aboriginal Corporation which provides a range of primary health care activities, including a dental program. Funding for the dental services cannot be disaggregated.
1.32Limited support is also available under Medicare for certain items related to oral surgery, and benefits are paid for eligible children and young people under the Cleft Lip and Cleft Palate Scheme, which is administered by Services Australia.
Legislation
1.33The CDBS represents the majority of Commonwealth spending on dental services, budgeted at almost $350million in 2023–24. The statutory mechanism for Commonwealth funding is the Dental Benefits Act 2008 (cth) (the Act). The only program currently administered under the Act is the CDBS. The Act, and associated Dental Benefits Rules 2014, provide a mechanism by which state and territory public sector dental providers can claim for children’s services until 31December 2026. Section 68 of the Act stipulates that the Minister for Health must instigate an independent review of the operation of the Act after one year, then every three years thereafter. Review reports were published in 2009, 2011, 2015 and 2019, and examined the attainment of the purposes of the Act and its administration.
1.34The Fifth Review of the Act was underway at the time of writing and seeks to review the CDBS more broadly. The review is being undertaken by an independent panel of experts, guided by specific Terms of Reference. The department called for stakeholder input in mid‑2022 and the report is expected to be tabled in Parliament sometime in 2023.
1.35The committee’s final report will consider the legislative architecture, programs and grants provided by the Commonwealth in support of dental services in more detail.
International comparison
1.36Government support for dental and oral health care varies across countries but is generally lower than government support for general health care. According to the Organisation for Economic Co-operation and Development (OECD), on average ‘less than one-third of dental care costs are borne by government schemes or compulsory insurance’, and only three OECD countries provide universal coverage for oral health care (Japan, Germany and the Slovak Republic). Deakin Health Economics reported that Scandinavian countries, Japan, South Korea, Thailand, and Taiwan ‘have funded universal oral healthcare’, but evidence on outcomes is patchy.
1.37As Figure 1.3 demonstrates, the government contribution to spending on dental care in Australia is low by international standards. In2019, only eight out of 38 OECD countries reported a lower share than Australia and, at approximately 16per cent, Australia’s public proportion of spending was around half the OECD average.
Figure 1.3Government and compulsory insurance spending as proportion of total health spending by type of care
Source: ‘Extent of health care coverage’, OECD. See also: AIHW, Oral health and dental care in Australia, 17March 2023.
1.38While government contribution is comparatively low by global standards, members of the Australian community spend a lot on dental care, being in the second highest category of annual spending per capita:
Figure 1.4Per capita dental expenditures in US$ per country, 2019
Source: WHO, Global oral health status report: towards universal health coverage for oral health by 2030, 2022, p.28. Data Source: Jevdjevic & Listl 2022. Economic impacts of oral diseases in 2019. Map Production: WHO NCD/MND unit. Map Creation Date: 30 August 2022. Note: N = 194 countries.
1.39In Australia, higher per capita spending does not necessarily translate to better outcomes. Figure 1.5 and Figure 1.6 below indicate that Australians experience a similar level of dental tooth decay, and a much higher level of edentulism (total tooth loss), as people in a number of countries where individuals spend a lot less on dental care per capita.
Figure 1.5Estimated prevalence of caries of permanent teeth per country
Source: WHO, Global oral health status report: towards universal health coverage for oral health by 2030, 2022, p.35. Data source: Global Burden of Disease Collaborative Network. GBD 2019. Seattle: IHME; 2020. Map Production: WHO NCD/MND unit. Map Creation Date: 30 August 2022. Note. N = 194 countries; data are age standardized, for ages greater than 5 years, both sexes, from GBD 2019 (4).
Figure 1.6Estimated prevalence of edentulism
Source: WHO, Global oral health status report: towards universal health coverage for oral health by 2030, 2022, p.44. Data source: Global Burden of Disease Collaborative Network. GBD 2019. Seattle: IHME; 2020. Map Production: WHO NCD/MND unit. Map Creation Date: 30 August 2022. Note. N = 194 countries; data are for ages greater than 60 years, both sexes, from GBD 2019 (4).
1.40Australians also have higher out-of-pocket costs compared with many comparable countries. The department reported that, at almost 60 per cent, Australia’s out-of-pocket expenses for dental care are significantly higher than Canada (38 per cent) and the United States of America (40 per cent).
1.41The committee’s final report will include a more detailed comparison of international dental care schemes.
Private dental services
1.42Over 85 per cent of dental care in Australia is provided through private, for‑profit dental clinics. These businesses are run by a mix of large companies, private health insurance providers, and individual dentists.The fees charged are not regulated, and treatment costs vary greatly across Australia. While most fees are paid by individuals or private health insurers, government pays for eligible services provided through the CDBS at participating private dental clinics.
1.43Dental practitioners have to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) to practise in Australia. According to AIHW, in 2020 there were 18383 registered dentists in Australia, which equated to 57.9 dentists per 100000 population. Around 95 per cent of dentists worked in private practice. The proportion is higher in major cities, where 52.1 dentists per 100000 population were employed in the private sector. Remote and very remote areas have the highest proportion of dentists employed in the public sector, at 9.5dentists per 100 000 (2020 data). In 2023, there are 26563 registered dental practitioners, of which 19795 are dentists.
1.44Figure 1.7 below provides a state-by-state comparison of dentists employed in the public and private sectors in 2020.
Figure 1.7Full-time equivalent dentists per 100 000 population, public and private sectors, states and territories, 2020
Source: AIHW, Oral health and dental care in Australia, 17 March 2023. Data from the National Health Workforce Dataset.
Cost of dental care
1.45The cost of private dental care can vary significantly depending on where you live, with average prices higher in the Australian Capital Territory (ACT) and Tasmania, and lower in South Australia and Queensland.
1.46Almost 40 per cent of adults avoid or delay visiting a dentist due to cost, almost a quarter experience ‘a lot of difficulty’ paying a $200 dental bill, and around 23per cent of Australians who visit the dentist cannot afford the recommended treatment and do not complete it. Australians with private health insurance are significantly more likely to access dental care than those who are uninsured.
1.47To address these inequities, state and territory governments provide some public dental care, which is partly funded by the Commonwealth.
Public dental services
1.48State and territory governments run public dental clinics for eligible adults, which are partly funded by the Commonwealth through the National Partnership Agreement on Public Dental Services (NPA). Less than 5 per cent of registered dentists work in public practice. In 2020, this was just 787 dentists across all of Australia. At the same time the ADA estimates that the public system provides around 15 per cent of dental care.
1.49An overview of the eligibility requirements, and fees (if any) for public dental services, in each jurisdiction is provided at Appendix 2 of this report.
1.50Due to funding and workforce limitations, public services tend to focus on emergency dental care, rather than preventative treatment, and clinics prioritise patients who are in significant pain, have swelling, significant bleeding, difficulty swallowing, or have an infection.
1.51Consumer surveys indicate that Australians ‘overwhelmingly attend private services’ for dental care, even though they consider private services ‘unaffordable’. Surprisingly, this also applies to people who do not have private health insurance, and people who are eligible for public or subsidised care. This is due to factors including:
a lack of awareness about public dental services;
accessibility issues, including an absence of public services in the area;
failure to meet eligibility requirements; and
long waiting lists for public clinics, which drive people to attend a private provider to have their issues dealt with sooner.
1.52While there is no national data set on public dental clinic waiting times, data from individual states and territories was collected by the AIHW and published in January 2018. This data shows average wait times for treatment that are ‘excessively long’ in most jurisdictions—up to two years, and sometimes longer. In 2022, the government reported that wait times had reduced as a result of Commonwealth-state funding agreements beginning in 2012. Over 10years of investment, wait times had dropped from an average of 20months to 12months. However, submitters also note wait times vary dramatically from state to state and by geography, with patients waiting much longer in Tasmania and the Northern Territory. Wait times are discussed in more detail elsewhere in this report, and will be addressed in the committee’s final report.
1.53Access to oral healthcare is not equitable across the states and territories and this is reflected in outcomes. For instance, national surveys indicate dental decay is higher among children in Tasmania, Queensland and the Northern Territory, than in other states and territories. These differences can be attributed to demographic factors, but may also be ‘partly explained by differences in individual state and territory oral health care funding, service models and eligibility requirements’.
1.54There is extensive evidence that adult public dental services are underfunded and overstretched. COAG Health Council data suggests less than 25 per cent of eligible adults access public dental treatment, with some states and territories performing better than others (Figure 1.8).
Figure 1.8Proportion of eligible adults, by jurisdiction, accessing public dental care services 2014–16 and 2016–18
Source: COTA Australia, Submission 11, p. 11. AIHW data from state and territory health departments. Note data for NSW, ACT and NT unavailable for 2016-18.
1.55Children are more likely to have accessed a public or subsidised dental service. For instance, just under 50 per cent of all children accessed oral healthcare through a government funded program or service in 2016–18 (Figure 1.9).
Figure 1.9Proportion of children accessing oral health care through a government funded oral health program, 2016–18
Source: AIHW, National Oral Health Plan 2015–2024: performance monitoring report, 3 December 2020. Note: data for ACT and NT not available for 2016-18.
1.56However, data from the Department of Health and Aged Care (the department) indicates public services for children are also underutilised. In 2021, the Australian Government paid benefits of around $300 million under the CDBS, for almost fivemillion dental services provided across Australia. While up to threemillion children are eligible for the CDBS each year, less than 40 per cent of eligible children participate.
History of Commonwealth involvement in the provision of dental services
1.57The Australian Government gained the constitutional power to legislate with respect to dental services in 1946, following the success of the referendum on inserting Section 51 (xxiiiA). The amendment explicitly mentioned dental services alongside pharmaceutical and hospital benefits and medical services. The Commonwealth did not directly fund dental services until the 1970s. Dental programs funded since that time have included the Australian School Dental Program (1973–80s); a Commonwealth Dental Health Program (1993–97); the Private Health Insurance Rebate Scheme (1997–present); two iterations of a Medicare-funded chronic disease program (2004–07 and 2007–12); the Medicare Teen Dental Plan (2008–13); and most recently the Child Dental Benefits Schedule (2014–present).
1.58Compared with the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme—which have existed in their current forms since 1984 and 1948 respectively—Commonwealth dental schemes have been patchy and inconsistent. Commentators have noted that Australian governments have had trouble placing oral health ‘within a health framework, and dental services within a medical services framework’.
Previous inquiries and reports
1.59A number of significant inquiries have been conducted that looked at oral and dental healthcare since 1998, when the Senate Community Affairs References Committee published its Report on Public Dental Services. The full list, including links, is provided at Appendix 3. A Parliamentary Library analysis of progress made in implementing key recommendations from these reports is provided in a table at Appendix 4. The following paragraphs are drawn from that table, which provides links to the original sources.
1.60The 1998 Senate report recommended:
better promotion of oral health;
programs to encourage practitioners to work in rural and remote areas;
greater use of ‘dental auxiliaries such as therapists and hygienists’;
a national oral health training strategy;
pilot programs to address priority groups including ‘pre-school age children, young adult Health Card holders (18-25 years), aged adult Health Card holders (65+ years), the homebound, rural and remote, and Indigenous communities’;
the introduction of a national oral health policy which would include ‘minimum service targets’ and ‘monitoring of goals through national data collection’;
resources for a national oral health survey; and
creation of a dedicated section for oral health within the Department of Health and Family Services.
1.61The government response to the committee’s report was not supportive. It identified public dental services as a state responsibility, and suggested the states needed to ‘resolve the structural, management and financial problems in their dental services’. While the committee recommended a national oral health strategy be developed, this was not supported by government at the time. As such, a national strategy was not implemented until 2015, when Healthy mouths, healthy lives—Australia’s National Oral Health Plan 2015–2024 was released.
1.62Submitters, including veteran dentist and academic, Dr Peter Foltyn, commented that, despite ‘considerable goodwill’ at the time, Australia has made ‘little progress’ in the 25 years since the Senate report. Deakin Health Economics said this approach has meant ‘recommendations from previous reviews of the dental program have not been fully implemented in [a] systematic and comprehensive manner’.
1.63In 2003, the Senate Select Committee on Medicare recommended the government recommit to a Commonwealth contribution towards public dental health services and work with the states and territories to implement targets. The recommendation was not supported by the then Coalition government, which reiterated its view that public dental services were the responsibility of the states.
1.64The next five years saw the introduction and amendment of schemes that provided some dental coverage under Medicare for people with chronic conditions. Then, in2008, in response to a Senate report on cost of living pressures for older Australians, the then Labor government outlined a plan to provide $290 million to the states and territories to reduce public dental waiting times.
1.65Shortly after, the National Health and Hospital Reform Commission (June 2009) recommended:
the establishment of a ‘Denticare Australia’ scheme to be funded by a 0.75per cent increase in the Medicare levy;
expanding coverage for children; and
providing funding for oral health promotion.
1.66The government did not provide a systematic response to the Commission’s report, and neither the Australian Labor Party, nor the Coalition, expressed support for a Denticare Australia scheme, as proposed in the report.
1.67In 2012, the National Advisory Council on Dental Health recommended an integrated national oral health system that would provide equitable access to oral and dental healthcare. The government welcomed the report, which likely informed subsequent Commonwealth dental health policies, such as the CDBS and the National Partnership agreement with states and territories to alleviate pressure on adult public dental waiting lists.
1.68In 2013, the House Standing Committee on Health and Ageing published Bridging the Dental Gap: Report on the inquiry into adult dental services, which made recommendations to inform a new Commonwealth funding agreement with states and territories. It proposed a commitment to long-term funding of public dental services, a national framework led by a Chief Dental Officer, and the introduction of performance indicators for public dental care. It also proposed that an implementation plan be established for the National Oral Health Plan, and that governments begin a phased process towards a universal dental scheme.
1.69While some of these recommendations have been actioned, the most significant have not. There is currently no long-term plan for funding public dental services, though work on this is underway. There is no Chief Dental Officer, and governments have yet to express support for any type of universal access scheme for oral and dental healthcare.
1.70In 2015, Australia’s first (and current) National Oral Health Plan was then developed under the auspices of the Council of Australian Governments (COAG) Health Council. The plan, which expires in 2024, identified national goals and priority populations, but did not contain any recommendations for substantive policy reform. A December 2020 performance monitoring report found there had been a favourable trend in improvement for seven indicators, an unfavourable trend for nine indicators, and no change or no new data for the others.
1.71A number of reports followed that considered the performance of the CDBS. The next significant proposals for reform were contained in the Productivity Commission’s 2018 report into reforming human services, which recommended:
measures to increase choice and competition in the system, including the introduction of a new consumer-directed public dental care scheme, utilising private providers and a blended payment model;
adoption of outcome measures;
introduction of a digital oral health record; and
allocation of public funding based on a risk-based model.
1.72There does not appear to be a formal government response to the Productivity Commission’s report.
1.73In 2021, the Royal Commission into Aged Care Quality and Safety recommended the establishment of an Australian Senior Dental Benefits Scheme (SDBS). This recommendation is being considered by government as it works to develop a longer-term approach to funding public dental services.
1.74The most recent relevant report was completed by KBC Australia (2022) and considered strategies to increase dental and oral health training in rural and remote Australia. The government has yet to respond to this report.