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Introduce a Scheme to Subsidise Primary Dental Care
- Isobel Tyquin
- May 21
- 5 min read
Updated: Jun 18
Author: Isobel Tyquin | Publish date: 21/05/2024
Problem Identification:
In Australia, many adults cannot afford to access primary dental care.
While the Child Dental Benefits Schedule covers part or the full cost of some basic dental services for eligible children, 77% of Australians, particularly adults, are not eligible for public dental care.
In 2021, almost 4 million people (32% of Australians who needed dental care) skipped or delayed getting dental care at least once. Reportedly, about half of the time, people skipped or delayed care because of the cost. People aged 25 to 44 were the most likely to do this. This is known to lead to untreated oral health issues and broader health complications. The inability to afford primary dental care is also known to create inequities in health outcomes, disproportionately affecting individuals on low incomes and those in more at-risk communities.
Context:
Primary dental care refers to a variety of dental services ranging from preventative care, such as cleanings and x-rays, to surgical interventions such as root canals, extractions and even dentures. However, primary dental care typically excludes orthodontic and cosmetic care.
Oral health problems are known to be widespread among Australian adults, with certain issues such as toothache becoming more common. The Grattan Institute have stated that without regular checkups, people's oral health is more likely to degrade to the point where more extensive and expensive treatment is required. In 2022-23, an estimated 84,000 hospital admissions for dental conditions could have been prevented with earlier treatment.
Dental care is funded very differently from most other types of health care, with patients paying for most care themselves. In contrast, patients play only a minor role in funding most major areas of health spending, such as hospitals and primary care. The Grattan Institute have highlighted that there is ‘no compelling medical or economic reason to have a universal health care system for the rest of the body but not the mouth’.
In almost all jurisdictions, for those eligible for public dental care, there can be wait times of over a year for a first appointment. These long wait times have been found to be bad for patients, whose oral health problems can deteriorate while they are waiting. It has also been found to be bad for governments, who end up paying more as the cost of delivering this care is much higher than it would have been if the care were delivered months or years earlier.
The 2019 report ‘Filling the Gap’ from the Grattan Institute proposed a scheme to expand subsidies for primary dental care to all eligible Australians. They have said this ‘universal’ scheme could cover the same population as Medicare to access primary dental care. They proposed that the scheme be initially based on a ‘fee for service’ model, where fees are similar to those currently set under the Child Dental Benefits Scheme. However, over time they have suggested that this evolve into a blended payment model, in which dental practices are remunerated based on both the service provided and the oral health outcomes of the patients. They have suggested that the scheme be rolled out in 4 phases over 10 years. They have said this could remove out-of-pocket costs, help to avoid preventable hospital admissions and help to eliminate the financial barriers to accessing primary dental care.
A November 2023 recommendation from the Select Committee into the Provision of and Access to Dental Services in Australia mirrored the Grattan Institute’s proposal, advising the government to work towards achieving ‘universal access to dental and oral healthcare... over time, in stages.’
There is international precedent for subsidising dental care for adults. Greenland provides dental treatment free of charge to permanent residents.
Solution Identification:
Establish a scheme to subsidise primary dental care, as recommended by the 'Filling the Gap’ report by the Grattan Institute.
This could provide access to dental care for the millions of Australian adults who cannot currently access care due to costs.
Advice:
The Minister for Health should establish a scheme to subsidise primary dental care for adults at the next opportunity.
Public Support:
Where to go to learn more:
Human Perspective:
Tanya is a single mother working to support herself and her eight-year-old son, Eli. For months, she’s been living with persistent tooth pain, but the cost of seeing a dentist has kept her from seeking treatment. She’s not eligible for public dental care, and even if she were, the waitlist in her area is over a year long. Over time, the pain has made it harder to eat, sleep, and focus at work, forcing her to turn down shifts and stretch already tight finances. Eventually, the infection worsened to the point where she ended up in the emergency department. The visit was costly and distressing, and completely avoidable with earlier care. While Tanya was in the hospital, Eli stayed with a neighbour, confused and worried, unsure why his mum was suddenly gone. What began as an untreated dental issue spiralled into a serious health episode that disrupted both of their lives, because Tanya couldn’t access basic dental care. To protect the anonymity of those involved, this is a fictionalised account drawn from an amalgamation of real-life stories, experiences, and testimonials gathered during the research process for this brief. Any resemblance to actual individuals is purely coincidental.
Conflict of interest/acknowledgment statement:
N/a
Support
If your organisation would like to add your support to this paper or suggest amendments, please email Info@foreaustralia.com.
Reference list:
Australian Bureau of Statistics. (2024). Patient Experiences. ABS. https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release.
Australian Institute of Health and Welfare. (2024). Oral health and dental care in Australia. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia
Australian Institute of Health and Welfare. (2018). A discussion of public dental waiting times information in Australia: 2013–14 to 2016–17. http://aihw.gov.au/getmedia/df234a9a-5c47-4483-9cf7-15ce162d3461/aihw-den-230.pdf?v=20230605171952&inline=true
Breadon, P., & Fox, L. (2023). A growing cavity: Why expanding dental coverage is increasingly urgent. Grattan Institute. https://grattan.edu.au/wp-content/uploads/2023/06/A-growing-cavity-why-expanding-dental-coverage-is-increasingly-urgent.pdf
Duckett, S., Cowgill, M., & Swerissen, H. (2019). Filling the gap: A universal dental scheme for Australia. Grattan Institute. https://grattan.edu.au/wp-content/uploads/2019/03/915-Filling-the-gap-A-universal-dental-scheme-for-Australia.pdf
Nordic Institute of Health and Welfare. (2024). Dental care. https://nhwstat.org/health/organization-health-services/health-care-user-charges/dental-care
Nordic Cooperation. (n.d.) Visiting the Dentist in Greenland. Retrieved January 23, 2025, from https://www.norden.org/en/info-norden/visiting-dentist-greenland
Select Committee into the Provision of and Access to Dental Services in Australia. (2023). A system in decay: a review into dental services in Australia, final report. Parliament of Australia. https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000078/toc_pdf/AsystemindecayareviewintodentalservicesinAustralia.pdf
Services Australia. (2024). Child Dental Benefits Schedule. https://www.servicesaustralia.gov.au/child-dental-benefits-schedule
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