- restricting the program to essential dental services. This still allows for the provision of ‘high end’ level services (crowns, bridges, implants) where basic treatments are insufficient and high–cost items are vital for patient health. Access to ‘high–end’ services could be controlled through an ‘exceptional circumstances’ mechanism, based on advice from an expert group;
- in the short term, introducing a means test to restrict access to concession card holders. As dental workforce capacity increases, eligibility could be scaled up in the medium to long term to include broader groups who suffer from poor access to dental services (e.g. low income non–concession card holders);
- providing for a higher benefit entitlement to reflect the higher cost of treatment outside metropolitan and regional centres and/or to account for increase service costs for certain groups, e.g. denture patients;
- allowing the benefit entitlement to be used in the public or private sector, with schedule benefits set at the cost of providing services in public system; and
- ensuring that any supporting legislation allows for all dental practitioners to provide dental services to the full extent of their scope of practice.
Medicare Teen Dental Plan
Under the individual capped benefit entitlement option proposed for children, (Option 1) the MTDP would continue to operate, albeit with modifications. As a basic benefit entitlement scheme, the MTDP could be used as the vehicle to provide a benefit entitlement that could be expanded to include a broader eligibility base – all children under the age of 18 and not just teenagers – as well as include a broader schedule of benefits for dental treatment – not just preventive checks. The schedule of benefits would be set at the cost of providing services in public system. The benefit entitlement could potentially be increased to reflect the higher cost of treatment outside metropolitan and regional centres. The MTDP would also no longer include a means test, as the option proposes universal access to all children.
Under the public sector approach in Option 2, funding for the MTDP would be bundled into the funding for the states and territories.
However, whether the MTDP continues or is modified, there could be an evaluation of the program’s efficiency, effectiveness and appropriateness in the context of future dental policy directions. The Council is aware that the second review of the Dental Benefits Acts 2008 noted that there should be an evaluation of the program, given the take–up was lower than originally anticipated at only 30 per cent in 2010–11.
Medicare Chronic Disease Dental Scheme
Under a public sector approach for adults as outlined under Option 4, the Government would cease funding services through the CDDS and move to funding services through the states.
If the Government chose to use a benefit entitlement approach as outlined in Option 3, a modified version of the CDDS could be the vehicle for service delivery, resulting in a significant reduction in expenditure. Features of a modified program could include:
There are further matters relating to potential modifications to the CDDS that would benefit from expert consideration for example: how the clinical guidelines could be set; how the ‘exceptional circumstances’ for high–end items could operate; and the scope of chronic diseases included in the scheme.
Private health insurance rebate
The Council recognises the role private health insurance plays in the assisting 11.9 million Australians with financing of health care, including dentistry. The Council was not able to consider private health insurance in any depth. The Council has concluded that further consideration needs to be given to the interactions between the options pursued and private health insurance. This includes consideration of the potential for overlap in public subsidies for dental services and private health insurance. The Council agreed that such consideration could extend to future reforms and incentives for private health insurance as well as other methods of financing dental services.
Other Commonwealth and State dental programs
It is unlikely that there will be any advantage in changing other Commonwealth supported measures or rolling them into broader dental reform in the short term. Such programs are outlined in Chapter Two and include: the Cleft Lip and Cleft Palate Scheme; dental services for the Australian Defence Force, the Army Reserve and eligible veterans; and HELP–supported university courses.States would need to maintain existing resourcing for service delivery through the public sector. However, state investment could be redirected to high need groups depending on the options chosen. For example, if the Commonwealth takes funding responsibility for child dental services, state and territory expenditure in this area could be freed up and directed toward improvements to services for adults. This would be a significant increase in expenditure which could help reduce public waiting times for adults. Further, states would be better placed to use freed up resources for special activities for the child population who are not currently receiving adequate access to services.