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Australia's dental care inequality needs a check-up


The cost of dental care deters many from seeking treatment, with long-term impact on personal health. Barbara Pocock argues that expanding Medicare to cover dentistry will improve public health and equality.

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After a big weekend featuring our annual chocolate binge, it is worth sparing a thought for our state’s teeth – and how we can keep them in better repair.

There is nothing quite like the grip of toothache. Few of us get through life without experiencing it – or those moments of tense anxiety as we await the dentist’s estimate of the cost of a procedure. 

Sadly many South Australians defer dental care because they cannot afford it. This is often a false economy and no protection against pain: dental care postponed is usually pain deferred. But the cost of dental care means that many put off preventative dentist visits and defer treatment.

It is an accident of history rather than sensible policy design that care of our teeth is left out of Medicare. In 1974 as Gough Whitlam established Medicare he wanted to avoid the costs of dental care. He got us to Medicare, but his compromise in leaving out our teeth has left a long shadow.

This means that despite being a wealthy country, Australia has considerably less public dental health coverage than many comparable countries. And this coverage varies widely according to your income and where you live. The lower your income and the further from a city, the worse your dental care. It is a double whammy for many First Nations Australians.

Tooth decay and gum disease affect general health, depress nutritional intake, create inflammation and increase the risk of heart disease

Around two million Australians avoided or delayed visiting the dentist in the past year because of the cost, despite needing care: only 48% of us visited the dentist in the past year compared to 74% of those in the UK. 

About one in five said they did not obtain the treatment recommended by their dentist because of its expense. This reflects the fact that out-of-pocket dental costs fall on Australians much more heavily than other health costs, even when we have private health insurance: we pay around 58% of dental care costs compared to 11% of primary care costs like GP visits and 12% of prescription costs.

Poorer people are especially likely to put off dental check-ups and procedures: 27.9% of low-income adults who needed to go to the dentist skipped or delayed treatment in the past year compared to 8.5% of high income adults. Women are more likely to face financial barriers and skip the dentist than men, and a third of First Nations Australians skip or delay dentist visits because of cost.

For too many Australians, a visit to the dentist is an unaffordable luxury and for others the waiting time for public services is very, very long – driving them to seek emergency health treatment or pain relief from a GP.

The wait for public dental patients in South Australia is almost 15 months, and it costs up to $274 for a check-up – more than the entire one-off ‘cost of living’ payment included for pensioners in the Morrison Government’s recent budget. For a country that congratulates itself on an egalitarian ethos, this is no proud record.

Unfortunately, the problem of dental care is likely to get worse as our population ages, given that older people are more vulnerable to dental problems.

We pay a big price for the absence of a fair, national dental care system both personally and in our national accounts. Millions of Australians suffer from toothache and/or gum disease. These are not mere cosmetic or economic problems: they shape our health, create disability and can kill us.

While we don’t add it up officially, failure to take preventative action and delaying treatment increases our national health bill. Tooth decay and gum disease affect general health, depress nutritional intake, create inflammation and increase the risk of heart disease.

Dental problems can also contribute to social isolation and depression. It is estimated that 750,000 GP consultations and 67,000 hospital admissions annually relate to dental problems. The Australian Dental Association estimates we could avoid costs of $818 million a year through better oral health care.

Sadly, despite the last 30 years of almost continuous economic growth, we have not ‘put the mouth into Medicare’ as some medical experts have long recommended – an investment that would have narrowed inequality, reduced cost of living pressures, alleviated dental pain and reduced our public health bill. 

We took a step in this direction in 2012 when the Greens, in balance of power, successfully negotiated with the Gillard Labor Government to implement dental care for children with a payment of up to $1000 over two years per child.

It is time to bring everyone’s teeth into Medicare. This week the Greens announced our proposal to provide free dental care to everyone. Under this proposal, everyone entitled to Medicare would be able to get Medicare-funded dental care and orthodontic treatment as well as oral surgeries, periodontics and prosthodontics. 

This policy would benefit over a million South Australians.

Is there support for putting dental care into Medicare? There is widespread support for this policy. Last week a poll by uComms commissioned by the South Australian Greens asked 1054 randomly selected South Australians whether it is time for that to change. More than 87% of those polled were in favour – 71% in strong support. Support was consistent across age, gender and most notably, voting intentions. 

Politics is about choice. The Morrison government this year chose to spend $11.6 billion subsidising fossil fuels that create long term health hazards for our planet. By comparison, funding dental under Medicare would cost $7.6 billion a year, creating a fairer system that would end a lot of unnecessary physical and economic pain.

This Parliamentary Budget Office estimate of the cost does not take account of offsetting savings through better health care, fewer hospital admissions, or lower costs to individuals through lower private health insurance costs.

A scheme like this would create increased demand for dental services, and for dental professionals. However, it would significantly improve the health of many, especially those living on low incomes or outside cities, women, and First Nations Australians. It would narrow the inequality arising from differences in access to dental services.

Wait times for care will not disappear, and dental decay arising from too many chocolates over Easter will not go away. But it is time that Australia looked to build on its Medicare base-line, and help those millions of Australians for whom a toothache is a serious financial and health crisis. 

If the Greens achieve balance of power in the federal election on 21 May, we aim to get dental into Medicare so it is free for all, not just those who can afford it. It is well overdue.

Barbara Pocock AM is Emeritus Professor in the Business School at the University of South Australia and the lead Greens Senate candidate for South Australia.

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