The Association between State Funding and Utilization of Dental Services: A Case for A Universal Dental Scheme

The aim of this study is to investigate the association between State funding towards dental services and the frequency of dental visits among concession card holders. Based on nationally representative data collected from the Australian National Health Survey, probit regression showed that individuals residing in the State of Tasmania were less likely to visit the dentist relative to residents from the State of Victoria, but no other Australian State showed a consistently significant relation. Variation in the funding of dental services provided by Australian States amplifies inequity among concession card holders and provides support for a universal dental scheme. INTRODUCTION Oral health is an integral component of general health (Brennan and Singh 2011; Gift and Atchison 1995; Petersen 2003; Spencer and Ellershaw 2011). Indeed, the success of general health care interventions can be compromised by a failure to deal with oral health issues (Australian Health Ministers' Advisory Council Sterring Committee for National Planning for Oral Health 2001; Rutkauskas 2000). In Australia the total number of Potentially Preventable Hospitalisations (PPHs) related to dental conditions was 2.8 separations per 1,000 population in 2009–10 (S. Chrisopoulos et al. 2011). Poor dental health influences diet which in turn impacts on health outcomes. An infected mouth delays and excludes patients from surgery. Missing teeth reduce the probability of getting a job or rental accommodation. And yet most dental disease is preventable. By adopting preventative measures such as the introduction of water fluoridation across most States and Territories and the inclusion of fluoride in tooth-paste, Australia has been rather successful in improving oral health at the population health level (Wright and List 2012). The Australian Commonwealth government, however, has been less successful in reducing inequalities in access to dental services (Harford and Spencer 2004; Wright and List 2012). The transference of the Commonwealth Government’s School Dental Program and later the Commonwealth Dental Health Program in late 1996 to the state and territory governments meant that no individual State or Territory had sufficient resources to reduce inequality in access to dental services through the promotion of universal access (Wright and List 2012). Across the States, considerable differences now exist in publicly funded dental health expenditure per capita (AIHW 2006, 2011), giving rise to variations in the availability and utilization of dental services (Vecchio 2008) (Australian Research Centre for Population Oral Health 2003). Ironically, although the Commonwealth plays a national leadership role in providing general health services, the same does not apply to oral health (Harford and Spencer 2004). Despite Australia’s universal health coverage, most dental care in Australia is provided through the private sector (ARCPOH et al. 2010). State/territory public dental programs for adults limit eligibility to those who have a health care card or pensioner health care card. In Australia, a concession card is issued to social security pensioners and other eligible individuals who receive government assistance. Concession cardholders have access to Australian Government health concessions such as cheaper health care services and less expensive medicines, and also receive help with the cost of living. Various State / territory and local governments and some private providers may offer additional health, household, transport, education and recreation concessions to concession card holders (Australian Government Department of Social Services 2014). The Commonwealth makes an indirect contribution to these services through the dental component of the 30% rebate on private health insurance. (Harford and Spencer 2004). The consequence of the Commonwealth’s subsidization of oral health towards private health insurance for middle and high income earners has been the diversion of resources away from preventive strategies and clinical services for disadvantaged Australians. Public funding for dental care favours the financially and orally better off at the expense of disadvantaged and orally unhealthy Australians (Harford and Spencer 2004). This has led to an inequitable and inefficient health care system (Harford and Spencer 2004). i hospital separations where the principal diagnosis of the hospitalisation is thought to be avoidable if timely and adequate non-hospital care had been provided S. Chrisopoulos, K. Beckwith, and Je. Harford, 'Oral Health and Dental Care in Australia: Key Facts and Figures 2011. Cat. No. Den 214 ', (Canberra: AIHW, 2011).