Budget Submission. January January 23, 2012 Authored by: Sara Harrup

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1 Budget Submission January 2012 January 23, 2012 Authored by: Sara Harrup

2 BUDGET SUBMISSION January 2012 Introduction The Australian Dental Prosthetists Association Ltd (ADPA Ltd) is the peak professional association for Dental Prosthetists in Australia. We represent over 90% of the 1148 Dental Prosthetists registered in Australia. Dental Prosthetists treat patients requiring removable dental prostheses including full and partial dentures and mouth guards. Dental Prosthetists work independently and do not work under the supervision of dentists. Dental Prosthetists have been active members of the oral health workforce for many years, and provide services for patients accessing benefits from The Department of Veterans Affairs, the Medicare Chronic Diseases Dental Scheme as well as through private billing arrangements supported by private health insurers. Overview ADPA Ltd makes the following recommendations regarding this year s federal budget: 1. The Government support a Medicare funded scheme which replaces the Chronic Disease Dental Scheme. 2. Any federally funded dental scheme be targeted at those Australians who are financially disadvantaged, or are uninsured and require preventative, rehabilitative and non-cosmetic restorative work. 3. Any federally funded dental scheme utilize the full suite of oral health professionals working in Australia (dental prosthetists, dentists, dental hygienists, dental therapists and oral health therapists) with consideration being given to how much overlap in services is provided by each profession. 4. Any federally funded dental scheme employ parity in item number rebates for identical services across professions, to encourage the full participation of all oral health team members. 5. Any federally funded scheme is accompanied by a scheme which supports rural and remote Australians meet the cost of travelling to larger centers to access oral health care. 6. The Government should commission research which addresses the total oral health workforce requirements in Australia and consider the unique contribution that each oral health professional group can make to alleviate the predicted shortfall in ability to meet dental service demand. 7. The Government implements incentives for oral health professionals (inclusive of all disciplines) to practice in rural and remote areas. 8. The Government implements incentives including scholarships for rural and remote students studying in the oral health professions. 1

3 Federally Funded Dental Scheme ADPA Ltd supports the Government s review of the Chronic Disease Dental Scheme and the work of the Advisory Council on Dental Health. Australians are still experiencing significant levels of suboptimum oral health, particularly those with lower incomes, Aboriginal and Torres Strait islanders and those in rural and remote areas. We believe it is essential for the Government to provide supported access to dental care for those who need it most and can ill afford it. In 2010, 5.2 % of Australia s population had no natural teeth and a further 5.3% had an inadequate dentition. Those with lower household incomes, no private health insurance and those in rural and remote areas tended to have higher rates of partial or complete edentulism. Periodontal disease and tooth decay are still prevalent across all age groups. 1 Lack of adequate dentition, either natural or prosthetic, has dramatic effects on the overall health and wellbeing of the population, including: Inadequate nutritional status Altered digestion and absorption of nutrients Oral and jaw pain Gastrointestinal disturbances Poorer general health Poor verbal communication ability Decreased levels of social interaction, self-esteem and self confidence Increased risk of mortality from choking Given that rates of partial and complete edentulism are higher in older age groups, the flow on effects of these issues within a population who are already experiencing some burden of ill health and ageing factors are significant. We note that edentulous adults have much lower rates of private health insurance than those with natural teeth, with only 22.3% having insurance. 2 Whilst the rates of complete tooth loss are predicted to decline over the next twenty years, the rates of partial edentulism will remain stable or increase. Rural and remote patients are likely to experience geographical and economic barriers to accessing 1 Beckwith, Katie; Chrisopoulos, Sergio: Harford, Jane 2011 ) Oral Health and Dental Care in Australia- Key Facts and Figures 2011, Australian Research Centre for Population and Oral Health, University of Adelaide and The Australian Institute of Health and Welfare, Canberra 2 Beckwith, Katie; Chrisopoulos, Sergio: Harford, Jane 2011 ) Oral Health and Dental Care in Australia- Key Facts and Figures 2011, Australian Research Centre for Population and Oral Health, University of Adelaide and The Australian Institute of Health and Welfare, Canberra 2

4 solutions for partial tooth loss. Technologies such as implant dentistry may be out of the reach of many of those who are financially disadvantaged or in rural and remote areas. The provision of partial and full dentures will remain a viable alternative for these people. We believe that any future scheme which replaces the Chronic Disease Dental Scheme should have restricted access based on income and lack of private health insurance. Cosmetic work should be excluded from the scheme and only preventative, rehabilitative and restorative work for improved oral health function should be included. In implementing any scheme, we believe it is vital to take an inclusive approach to the full range of oral health professionals who have the education and experience to support the oral health of Australians. Dentists should continue to undertake the important preventative and advanced restorative work they currently undertake. Dental Prosthetists, Dental Therapists and Oral Health Therapists should take their place in a new scheme with the ability to practice to the full extent of their scope of practice, without unnecessary referrals to dentists. Referrals from one type of oral health professional to another should continue to occur where necessary and appropriate. Dental Hygienists should also be an integral part of any scheme, noting their current requirements to work under the supervision of a dentist. Access to dental care should not be contingent upon a patient seeing a general practitioner first. The truth is that most general practitioners have very little knowledge of oral health in terms of required dental treatment, with the exception of those who are living and working in rural and remote environments. We believe it is important to establish parity in fee amounts for item numbers where more than one profession completes the same type of work. This will encourage optimal practitioner participation in any scheme and lead to less treatment delays for patients. Whilst we support a federally funded scheme for preventative and restorative dental care, we also recognize that due to maldistribution of the oral health workforce, together with workforce shortages, many rural and remote Australians who may be eligible for federally funded treatment would be unable to access it due to the costs incurred when travelling long distances and leaving their communities. Bringing service delivery closer to these Australian s takes years after the initiation of schemes designed to do so, so in the interim period we suggest that a scheme be implemented that supports the travel costs borne by rural and remote Australians in association with any federally funded oral health care. 3

5 Workforce Requirements To date the work undertaken to determine the workforce requirements of the oral health practitioner workforce has relied on arbitrary measures of visits to dentists. The work has failed to take into consideration the range of practitioners that make up the oral health team, including dental prosthetists, dental therapists, oral health therapists, dentists and dental hygienists. It has also failed to examine the changing curricula in training institutions and how this will affect the scopes of practice of these professionals in the future. Recent predictions state that by 2020 there will be a shortfall of about 2 million dental visits which equates to dentists. 3 Whilst there are a range of practicing oral health professionals in Australia it is nonsensical to only consider one of the professions in plugging the current and future gap in services. As dental schools continue to revise their curricula to allow dentists to take on more advanced work, other parts of the curriculum such as removable dental prostheses is minimized and in some cases removed. It logically flows that dental prosthetists are ideally placed to take up any shortfall in the requirements for dentures, but adequate data on the likely numbers needed to do this is not available. We strongly recommend that the Government allocate funding to commission research on the real labour workforce requirements of all members of the oral health team. Rural and Remote Incentives Whilst we commend the Government on the many incentives in place to improve access to primary health care in rural and remote areas, we believe that oral health care as a crucial component of primary health care is overlooked. At present there are very few dental prosthetists working in outer regional, rural and remote areas, with only four present in the Northern Territory. There are few rural and remote students accessing training to become dental prosthetists due to the predominant face to face education modes and the concomitant costs of travelling to metropolitan areas to undertake study. We believe there should be incentives for rural and remote people to study in the oral health professions, by way of scholarships. We also believe incentives should be put in place to encourage existing practitioners to enter private practice in rural and remote areas. 3 Beckwith, Katie; Chrisopoulos, Sergio: Harford, Jane 2011 ) Oral Health and Dental Care in Australia- Key Facts and Figures 2011, Australian Research Centre for Population and Oral Health, University of Adelaide and The Australian Institute of Health and Welfare, Canberra 4

6 References Beckwith, Katie; Chrisopoulos, Sergio: Harford, Jane 2011 ) Oral Health and Dental Care in Australia- Key Facts and Figures 2011, Australian Research Centre for Population and Oral Health, University of Adelaide and The Australian Institute of Health and Welfare, Canberra AIHW DSRU (Australian Institute of Health and Welfare Dental Statistics and Research Unit) Dental Prosthetist Labour Force in Australia (Dental Statistics and Research Series No. 37.) Canberra: AIHW. AIHW DSRU (Australian Institute of Health and Welfare Dental Statistics and Research Unit) Dental Labour Force Projections (Dental Statistics and Research Series No. 43.) Canberra: AIHW. AIHW DSRU (Australian Institute of Health and Welfare Dental Statistics and Research Unit) Projected Demand for Dental Care to 2020 (Dental Statistics and Research Series No. 42.) Canberra: AIHW. Slade GD, Spencer AJ & Roberts-Thomson KF (eds) Australia s dental generations: the National Survey of Adult Oral Health Cat. no. DEN 165. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 34). Teusner DN, Chrisopoulos S & Spencer AJ Projected demand and supply for dental visits in Australia: analysis of the impact of changes in key inputs. Cat. no. DEN 171 (Dental Statistics and Research Series No. 38). Canberra: AIHW. 5

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