COMMENT

The essential health service that divides Australia

DENTAL DIVIDE: Of the total annual spend on dental care ($9.9 billion in 2015-16), Australians contributed 58 per cent in out-of-pocket costs to the bill. But many Australians are simply priced out of their own dental care and the consequences for our health are grim.
DENTAL DIVIDE: Of the total annual spend on dental care ($9.9 billion in 2015-16), Australians contributed 58 per cent in out-of-pocket costs to the bill. But many Australians are simply priced out of their own dental care and the consequences for our health are grim.

I’m continually surprised by the churn of good news stories that make me feel sick to my stomach. 

In June, a “heartwarming” tale out of South Carolina. A nine-year-old set up a lemonade stand and raised $6000 in three hours.

The kid – Andrew Emery – was raising money to help keep his baby brother Dylan alive. Dylan has Krabbe disease, a rare neurological condition, and the bills were mounting.

“I'm gonna spend it on doctor's bills and stuff, and buy him a teddy bear too,” Andrew told his local newspaper. “I just want to help Dylan. He's my baby brother.”

No doubt a cursory glance across the story was followed with a swoon from a U.S. audience. Brotherly love! Reading it in an Australian context, the land of universal healthcare, it’s hard not to read with some degree of dystopian discomfort.

Universal healthcare is one of the central pillars of Australian society, and political rumours of privatisation, which reached a crescendo in 2016, were met with strong condemnation from the public and opposition government alike.

We cherish our flawed, imperfect health insurance scheme that, for its many issues, still mostly ensures that our bank accounts aren’t determining our used-by date.

Rebates against the cost of medical fees mean that around 80 per cent of GP visits incur no out-of-pocket costs. All Australians can receive treatment in a public hospital without charge, though lengthy wait times in most states leaves much to be desired.

But Medicare largely excludes one essential health service, and the substantial health implications from polarising the rich and the poor are stark. The dental divide. 

Dental is seen largely as a cosmetic concern, but poor oral health is linked to a myriad of health and wellbeing issues. Earlier this year, The Australian Health Policy Collaboration found a staggering 90 per cent of adults have some form of tooth decay, making it Australia’s foremost health issue. 

The consequences go far beyond pain, infection and tooth loss, however.

Poor oral health has been linked to infective carditis, coronary heart disease, stroke, adverse pregnancy outcomes and aspiration pneumonia.

Poor dental health also causes societal barriers. Impairment of appearance and speech from dental disease can inhibit opportunities for education, employment and social interaction. 

Despite these outcomes, general medicine and dentistry remain distinct practices that have never been treated the same way by our policymakers, health care system, public health professionals and health insurance funds.

The ABS recently released the 2017-18 Patient Experiences in Australia study, and dental findings were grim. Nearly one in five people who needed to see a dental professional delayed seeing or did not see one because of the cost. 

When it comes to accessing essential dental services, there was a staggering 21 per cent difference between the rich and the poor – 61 per cent of Australians living in a higher socioeconomic areas access regular dentistry, versus just 40 per cent of those living in disadvantaged areas. 

What also became clear from ABS’ study was a new divide – young versus old. One in five people aged 15 to 34 were more likely to delay or not see a dental professional due to cost, compared to one in 10 Australians aged 65 years and over. This could be in part due to the age-based cut off, where 25 years old marks the dependency threshold on parents’ private health insurance. 

Private health insurance (held by just over half of the population) does provide some dental cover – but leaves you substantially out-of-pocket when it comes to unexpected dental work. Despite health insurance companies’ primary care role in keeping Australians away from acute care, limited dental rebates are standard.

Nearly one in five people who needed to see a dental professional delayed seeing or did not see one because of the cost.

The entire situation is exacerbated by the dentistry industry’s unregulated fee structure when it comes to defining dental services – often in the thousands of dollars.

Those who cannot afford private health insurance face wait times exceeding a year in multiple states in the chronically under-resourced public system, in which time their dental health continues to deteriorate.

While over a third of Australians are eligible for public dental care, current funding for oral health services only allows for around 20 per cent of the eligible group to receive treatment.

Adding full dental to Medicare feels like a pipe dream, but there are more realistic things that could ease the pressure.

Emergency dental services within hospital emergency departments on weekends is one idea.

Abolishing the taxpayer subsidy for private health insurance and using the savings to fund dental care is another. Recent polling found 48 per cent of Australians agree.

Some forecasts suggest this could deliver as much as $12 billion, which could help fund a program that provides basic dental care to all.

An Australian smile should not be an indicator of socio-economic status. It’s time to fill this gaping hole. 

Emma Elsworthy is a Fairfax journalist.