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Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Conundrums in merging public policy into private dentistry: experiences from Australia’s recent past

Raymond Lam A B , Estie Kruger A and Marc Tennant A
+ Author Affiliations
- Author Affiliations

A International Research Collaborative – Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.

B Corresponding author. Email: rlraymondlam@gmail.com

Australian Health Review 39(2) 169-174 https://doi.org/10.1071/AH14038
Submitted: 16 April 2014  Accepted: 22 October 2014   Published: 17 December 2014

Abstract

Oral disease continues to be a major problem in Australia impacting quality of life, the economy and broader health system. Although the understanding of caries and periodontal disease has improved along with increased government support, oral diseases continue to be the most prevalent among all health conditions. This is despite unprecedented levels of funding in the Chronic Disease Dental Scheme and the Teen Dental Plan. Access to primary care dentistry in the private sector, where the majority of dental services are provided, remains a critical issue. Under the current system of dentistry, it cannot be assumed that the practice of dentistry represents a prioritised approach to combat disease patterns based on scientific evidence in primary health and prevention. Drawing on data in relation to these two programs, the present study highlights issues impacting dental service provision. This includes issues such as access and affordability to dental care, sustainability of policy and its unintended consequences, private practice pressures and the impact of remuneration on treatment. This paper argues that without structural reform there will continue to be barriers in implementing policies capable of improving oral health.

What is known about the topic? The burden of oral diseases remains high and there continue to be problems in accessing and affording dental treatment.

What does this paper add? This paper highlights factors impacting dental service provision and offers potential solutions to improve access to primary care dentistry.

What are the implications for practitioners? A consideration of these factors may assist policy makers and governments in formulating effective policies.


References

[1]  Australian Institute of Health and Welfare (AIHW). Australia’s health 2000. AIHW catalogue no. 19. Canberra: AIHW; 2000.

[2]  Marshall M, Spencer A. Accessing oral health care in Australia. Med J Aust 2006; 185 59–60.

[3]  Harford JE, Ellershaw A, Spencer A. Trends in access to dental care among Australian adults 1994–2008. Dental statistics and research series no. 55. Catalogue no. DEN 204. Canberra: Australian Institute of Health and Welfare; 2011.

[4]  National Health and Hospitals Reform Commission (NHHRC). A healthier future for all Australians, final report. Canberra: NHHRC; 2004.

[5]  Verma S, Chambers I. Dental emergencies presenting to a general hospital emergency department in Hobart, Australia. Aust Dent J 2014; 59 329–33.
Dental emergencies presenting to a general hospital emergency department in Hobart, Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2cfgslCnug%3D%3D&md5=a307d476b3c4439408c595a1b4f3704bCAS | 24913020PubMed |

[6]  National Advisory Committee on Oral Health. Healthy mouths, healthy lives: Australia’s national oral health plan 2004–2013. Adelaide: South Australian Department of Health; 2004.

[7]  Department of Human Services. MBS statistics. Available at: http://www.medicareaustralia.gov.au/provider/medicare/mbs.jsp#N1003F [verified 12 January 2013].

[8]  Hobdell M, Petersen P, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J 2003; 53 285–8.
Global goals for oral health 2020.Crossref | GoogleScholarGoogle Scholar | 14560802PubMed |

[9]  Lunnay B, McIntyre E. Factsheet: primary health care matters. Primary Health Care and Research Information Service; 2014. Availabe at: http://www.phcris.org.au/publications/catalogue.php?elibid=8371 [verified May 2014].

[10]  Department of Health and Aging. Primary health care reform in Australia: report to support Australia’s first national primary health care strategy. Canberra: Department of Health and Aging; 2009. Available at: http://www.mmgpn.org.au/media/download_gallery/COAG%202011%20Communique%20re%20Health%20Reform.pdf [verified November 2014].

[11]  Biggs A. Medicare: background brief. Canberra: Parliament of Australia. Available at: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/medicare [verified May 2014].

[12]  Abbott T. MedicarePlus [media release]. Canberra: Parliament of Australia; 2004.

[13]  Biggs A. Overview of Commonwealth involvement in funding dental care. Research paper no. 1, 2008–2009. Canberra: Parliament of Australia; 2009.

[14]  Loe H, Theilade E, Börglum Jensen S. Experimental gingivitis in man. J Periodontol 1965; 36 177–87.
Experimental gingivitis in man.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaF2M7gtFGgtw%3D%3D&md5=5b3aded7140f5ed829e4f260db071666CAS | 14296927PubMed |

[15]  Mount GJ. A new paradigm for operative dentistry. Aust Dent J 2007; 52 264–70.
A new paradigm for operative dentistry.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c7gvVaisQ%3D%3D&md5=fd4092cba64fd92b3de22ff2c6761142CAS | 18265680PubMed |

[16]  Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 1997; 76 1587–95.
Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DyaK2sXmtVCjtr0%3D&md5=48570cfa4508bcd939ffb4df7eb70729CAS | 9294493PubMed |

[17]  Walsh L. A system for total environmental management (STEM) for the oral cavity, and its application to dental caries control. Int Dent SA Aust Edi 2008; 3 34–48.

[18]  Selwitz R, Ismail A, Pitts N. Dental caries. Lancet 2007; 369 51–9.
Dental caries.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXit12itA%3D%3D&md5=6735e132cc3dbca114c23c4d4578ce38CAS | 17208642PubMed |

[19]  Lucarotti P, Burke F. Analysis of an administrative database of indirect restorations over 11 years. J Dent 2009; 37 4–11.
Analysis of an administrative database of indirect restorations over 11 years.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1M%2FgtVKiuw%3D%3D&md5=456c14ad3421ed99c81b075b21017a1dCAS | 18550255PubMed |

[20]  Lewis J. The road to oral health policy innovation in Australia. 2007. Available at: http://www.australianreview.net/digest/2007/election/lewis.html [verified 11 November 2014].

[21]  Australian Institute of Health and Welfare (AIHW), Harford JE, Islam S. Adult oral health and dental visiting in Australia: results from the National Dental Telephone Interview Survey 2010. Catalogue no. DEN 227. Canberra: AIHW; 2013.

[22]  Marshall M, Spencer A. Accessing oral health care in Australia. Med J Aust 2006; 185 59–60.

[23]  Gurbuxani A, Kruger E, Tennant M. Geographic redistribution of practice location of graduate dentists: a six year retrospective analysis. Aust Dent J 2012; 57 85–9.
Geographic redistribution of practice location of graduate dentists: a six year retrospective analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC383mslOksQ%3D%3D&md5=0d3e3efae8ad7fcccb802ea3f6acdbbdCAS | 22369563PubMed |

[24]  Spencer A. What options do we have for organising, providing and funding better public dental care? Sydney: Australian Health Policy Institute; 2001.

[25]  Crawley MD. Patients wait up to decade to see dentist in Wide Bay. Fraser Coast Chronicle. Courier Mail, 22 November 2012. Available at: http://www.frasercoastchronicle.com.au/news/patients-wait-up-to-a-decade-to-see-dentist/1631755/ [verified November 2014].

[26]  Australian Research Centre for Population Oral Health Dental specialists in Australia. Aust Dent J 2010; 55 96–100.
Dental specialists in Australia.Crossref | GoogleScholarGoogle Scholar | 20415919PubMed |

[27]  Lam R, Kruger E, Tennant M. Role of the Chronic Dental Disease Scheme in enhanced primary care: allied health or allied outlier? Aust J Primary Health 2012; 19 228–35.
Role of the Chronic Dental Disease Scheme in enhanced primary care: allied health or allied outlier?Crossref | GoogleScholarGoogle Scholar |

[28]  Hochberg M, Tielsch J, Munoz B, Bandeen-Roche K, West S, Schein O. Prevalence of symptoms of dry mouth and their relationship to saliva production in community dwelling elderly: the SEE project. Salisbury Eye Evaluation. J Rheumatol 1998; 25 486–91.
| 1:STN:280:DyaK1c7ns12ntQ%3D%3D&md5=ec308b36dde38af1d54d172d4e1f4d68CAS | 9517768PubMed |

[29]  John C, Skinner A, Wright C. Utlisation of the Medicare Teen Dental Plan in NSW, 2008–2010. N S W Public Health Bull 2012; 23 5–11.

[30]  Australian Research Centre for Population Oral Health Teen dental plan voucher use. Aust Dent J 2011; 56 437–40.
Teen dental plan voucher use.Crossref | GoogleScholarGoogle Scholar | 22133235PubMed |

[31]  Brocklehurst P, Price J, Glenny A, Tickle M, Birch S, Mertz E, Gryten J. The effect of different methods of remuneration on the behaviour of primary care dentists. Cochrane Database Syst Rev 2013; 11 CD009853.pub2

[32]  Fischer J, Marchant T. Owners’ insights into private practice dentistry in New South Wales and the Australian Capital Territory. Aust Dent J 2010; 55 423–9.
Owners’ insights into private practice dentistry in New South Wales and the Australian Capital Territory.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M%2FitFOhtQ%3D%3D&md5=87f59aaad5b03f388d3da1cd261079f3CAS | 21133942PubMed |

[33]  Christensen G.. Dentistry’s mission and the high fee practice. J Am Dental Assoc 1999; 130 115
Dentistry’s mission and the high fee practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7hslKrtw%3D%3D&md5=d2a33c4919d147b841b522bed22283f0CAS |

[34]  Christensen G. When is a full-crown restoration indicated? J Am Dent Assoc 2007; 138 101–3.
When is a full-crown restoration indicated?Crossref | GoogleScholarGoogle Scholar | 17197409PubMed |

[35]  Department of Veterans Affairs. Fee schedule of dental services for dentists and dental specialists. Canberra: Department of Veterans Affairs, Australian Government; 2014.

[36]  Reissmann D, Schierz O, Szentpetery A, John M. Improved perceived general health is observed with prosthodontic treatment. J Dent 2011; 39 326–31.
Improved perceived general health is observed with prosthodontic treatment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M3ptl2qsw%3D%3D&md5=4046e6d37f0a82ecb088fef731d59678CAS | 21315132PubMed |

[37]  Radford J. Abstracts in brief. Br Dent J 2011; 211 373

[38]  Australian Dental Association. The Australian schedule of dental services and glossary. 10th edn. St Leonards, NSW: Australian Dental Association; 2013.

[39]  Birch S. The identification of supplier-inducement in a fixed price system of health care provision: the case of dentistry in the United Kingdom. J Health Econ 1988; 7 129–50.
The identification of supplier-inducement in a fixed price system of health care provision: the case of dentistry in the United Kingdom.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1czjt1Cltw%3D%3D&md5=ad8af79ee86e55b9c66ebb1b663e1dcaCAS | 10288955PubMed |

[40]  Australian Dental Association. Dental fees survey Australia 2013. St Leonards, NSW: Australian Dental Association Press; 2014.

[41]  Lam R, Kruger E, Tennant M. JERM model of care: an in-principle model for dental health policy. Aust J Primary Health 2013; 20 311–15.
JERM model of care: an in-principle model for dental health policy.Crossref | GoogleScholarGoogle Scholar |

[42]  Renshaw J. After the first 125 years of the BDJ where might clinical dentistry be heading? Br Dent J 2005; 199 331–7.
After the first 125 years of the BDJ where might clinical dentistry be heading?Crossref | GoogleScholarGoogle Scholar | 16184104PubMed |

[43]  Hefford M, Crampton P, Foley J. Reducing health disparities through primary care reforms: the New Zealand experiment. Health Policy 2005; 72 9–23.
Reducing health disparities through primary care reforms: the New Zealand experiment.Crossref | GoogleScholarGoogle Scholar | 15760695PubMed |