Danielle Gavanescu, Master of Public Health student and former PHAA intern
Making the news in Australia, particularly in 2022, have been the significant ongoing issues with accessing affordable oral healthcare across the country.
Consumers and health professionals have shared their stories, and politicians have called for changes to the Medicare system to provide better dental service coverage.
Right now, the average wait on the NSW public dental waiting list is 460 days. Over a year of waiting, while your teeth get worse and the pain doesn’t stop.
That’s not good enough. We’ve got to get dental health into Medicare.
— Adam Bandt (@AdamBandt) April 23, 2022
As noted by Australia’s National Oral Health Plan 2015-2024, the Child Dental Benefits Schedule (CDBS) aims to increase access to affordable oral healthcare, particularly for children from low-income households, who are at greater risk for oral diseases. The scheme can be accessed in either the public or private sector. There are, however, several opportunities to strengthen the CDBS to reduce ongoing access inequalities.
The PHAA Oral Health Policy articulates the need to enhance the CDBS’ effectiveness by
- introducing evidence-based guidelines,
- introducing risk-based preventive dental care pathways, and
- monitoring treatment services and access by high needs groups
Key points for review
At present the CDBS is restricted and can only be billed by a registered dental practitioner. This means that it does not allow for non-dental health professionals to access the program to provide preventive oral healthcare services, for which they may be trained and competent to do so. These professionals may include Aboriginal and Torres Strait Islander health practitioners, general practitioners, nurse practitioners, midwives, and pharmacists.
The need for a stronger focus on prevention
There is little insight into whether the dental services provided under the scheme are providing value to clients or are clinically relevant and appropriate to the clients’ oral health needs. In its current form, the CDBS is at-risk for overservicing treatments including restorative (fillings), endodontic and oral surgery (especially wisdom teeth). Regarding restorative treatments, there is evidence that many are provided when they may be unnecessary, or when alternative non-invasive preventive treatment options are more clinically appropriate.
Three key strategies could address many of the administrative barriers to accessing the dental program:
- Aligning billing requirements to be consistent with the Medicare Benefits Schedule (MBS)
- Reviewing whether a ‘capped’ benefit is required
- Enabling functionality to review client information on previous billing history
The third action would allow us to understand what item codes may be restricted if dental services are provided recently and externally to the public or private practice entity. Consent timelines and validity are particularly challenging for state and territory government school dental programs.
The CDBS was designed to be readily accessible for children under the existing service delivery model in the public or private sector. As a result, the dental program does not specifically address the needs of Aboriginal and Torres Strait Islander children, children with Intellectual Disability, and/or children in rural or remote Australia. In addition, many Aboriginal Community Controlled Organisations who provide oral health services have noted challenges with the administrative processes for claiming. A specific criterion for the inclusion of children from these groups will also help in ensuring they have access to this scheme, beyond the eligibility solely based on the household income means-test.
The PHAA supports the broad directions of the Dental Benefits Act 2008 to increase access to affordable oral healthcare for children in Australia. The key recommendations are:
- To increase the focus of the dental program towards prevention and early intervention
- Review the schedule of dental services to ensure it is aligned with value-based health care in order for the allocation of resources proportionate to children’s oral health needs
- Actively promote the dental program to increase its utilisation by working with stakeholders who work with Aboriginal and Torres Strait Islander children, children with intellectual disability and/or children in rural or remote Australia
To ensure dental program sustainability and promote evidence-based practice, a national standard set of clinical guidelines should be developed to assure appropriate and safe clinical care. These guidelines could then be reviewed for alignment against the World Health Organization Global Oral Health Action Plan. In addition, the CDBS fee-for-service model should gradually transition towards value-based health care, which will support better integration of dental services into primary healthcare.
Image: Nadezhda Moryak/Pexels