Updated 8 December 2009

Amanda Biggs

Social Policy Section

Contents

Introduction

Citing long waiting lists for public dental services and financial barriers to timely dental care, the National Health and Hospitals Reform Commission (NHHRC) proposes the establishment of the Denticare Australia scheme, to provide a 'universal scheme for access to basic dental services' in its final report to government.[1] Supplementing this, the NHHRC also proposes an expansion of existing state-based school dental programs, more funding for oral health promotion and an internship scheme for dental graduates. The Denticare scheme and related dental health proposals, were first suggested in the NHHRC's interim report. These remain essentially unchanged in its final report.[2]

The Denticare scheme was one of the 'most welcomed' of all the reform proposals contained in the Commission's interim report, issued in November 2008.[3] Nevertheless, the response to the Denticare proposal has not been universally positive. Issues that were raised in the wake of the interim report, such as the cost of the scheme, access for disadvantaged groups, and the capacity of the dental workforce, continue to be of concern.[4]

This Background Note provides an outline of the proposed Denticare scheme, including the dental services to be covered, cost estimates and financing arrangements. Responses to the proposal and some key issues for further discussion are highlighted.

What is Denticare Australia?

The final report recommends, among other dental and oral health proposals, the establishment of Denticare Australia, through which all Australians would have access to a 'basic package' of dental services. These dental services would be provided through either the public or private sector and be funded by Denticare Australia at no or at subsidised cost to users.

The basic package of dental services would include preventive work (such as scaling and cleaning of teeth), diagnostic (x-rays), extractions and restorative work (such as fillings of cavities) as well as the provision of dentures. People could choose to have the basic package of dental services provided through a private dental plan or under public dental arrangements.

Full details of what services would be covered are not provided in the report, but it makes clear that certain 'additional' services such as orthodontics would not be included under the basic package. Individuals wanting additional dental services, the NHHRC suggests, would have the option of purchasing additional health insurance products.[5] Purchasing dental services directly, that is, without buying insurance, is not an option canvassed in the final report.

These proposed arrangements are outlined below.

Those who choose the private option would purchase a health plan from a private health insurer to cover a 'basic package' of dental services. Denticare Australia would pay the premium for these plans, which would meet approximately 85 per cent of private dental costs; representing a significant discount.[6] The remaining costs would be paid by consumers although these co-payment amounts are expected to be lower than currently applies.[7] Consumers would then access basic dental services through a private dentist where most of their dentist's fees would be met by the private health plan.

The interim report proposed that the premium paid by Denticare Australia to private health insurers, be 'risk adjusted'.[8] This would mean that a person assessed with a higher dental risk would pay a higher premium than someone assessed as having a lower dental risk. However, this proposal is not repeated in the final report, leaving open the question of what sort of premiums would apply..

Those who decline the private health plan option would have access to basic dental services free of charge through state-based public dental services. These services would receive expanded funding from Denticare Australia, although the level of this expanded funding is not detailed in the final report. Those accessing public dental services may still face delays for treatment, but the NHHRC expects waiting times to be less than is currently the case.

Access to public dental services would not attract a co-payment, even where services are contracted out to private dentists. Nor would public dental services only be restricted to those on concession cards as is currently the case.[9] Anyone opting not to purchase a private dental plan could access public dental services. However, it is not clear how someone who had already purchased a private plan, but who then elects to be treated in a public dental clinic, would be prevented from doing so.

The final report notes that some specialised services such as those provided to people with an intellectual disability may only be available through public dental clinics.[10]

The final report estimates that the cost of the Denticare scheme including the related dental proposals, would be around $5.5 billion annually (this costing includes funding for the proposed dental internship program, expansion of the school dental program and the oral health promotion program). Of this amount, the NHHRC proposes that the government allocation would be $