Universal Dental Health Scheme

Transcription

1 Universal Dental Health Scheme Country: Australia Partner Institute: Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney Survey no: (13) 2009 Author(s): Gallego, Gisselle Health Policy Issues: System Organisation/ Integration, Funding / Pooling, Access Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change 1. Abstract As part of an overhaul of the current healthcare system, a proposal has been released to introduce a AUS$4 billion universal dental scheme. The proposed scheme to be called?denticare? would be funded through a taxpayer levy and would provide access to preventative and restorative care and dentures. 2. Purpose of health policy or idea In Australia dental services are provided in both public and private sectors. Public dental services, which are the responsibility of the States, have traditionally been directed towards children and low income adults and their capacity is limited. (Brennan 2008) Around 650,000 adults are on public dental waiting lists, with a two year average waiting time. (National Health and Hospitals Reform Commission 2009) The Commission report recommends the creation of a Denticare scheme funded by an increase in the Medicare levy of 0.75% of taxable income. Under the Denticare proposal Australians will have to opt to "become a member of a dental health plan (with a private health insurer) or to use public dental services". In other words Denticare would pay the insurance premiums fees, but patients will get reimbursed 85% of the fees, incurring in a 15% out-of-pocket cost. Those who want to avoid the 15% gap payment could elect to be covered under the public dental system, where treatment could be totally free but with a waiting time. The proposed reform also recommends (National Health and Hospitals Reform Commission 2009): The introduction of a one year internship scheme prior to full registration, for oral health practitioners (dentists, dental therapists and dental hygienists). This means that newly graduated practitioners will not be able to work without supervision as soon as they graduate but must spend one year in either a public or private practice being supervised in their work by an experienced practitioner. The National expansion of the pre-school and school dental programs. That additional funding is made available for improved oral health promotion. Main objectives - 1 -

2 To establish a universal dental scheme that provides access to preventative and restorative dental care and dentures, regardless of a person's ability to pay. Type of incentives Financial Groups affected Goverment, Dentists, Taxpayers 3. Characteristics of this policy Degree of Innovation traditional innovative Degree of Controversy consensual highly controversial Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral The ratings above indicate that this proposal is rather traditional. Other countries such as the United Kingdom have already implemented Universal dental schemes. However, increased taxes that go into a general revenue pool and that would give everyone the option of taking private dental insurance (people already have this choice without the proposed extra levy increase) make the proposal highly controversial. The transferability from Australia to other systems seems unlikely. 4. Political and economic background In early 2008 the National Labor Government appointed the National Health and Hospital Reform Commission (NHHRC) (also see the report Reforming the Australian Health System (13)2009). The commission is looking at the long-term health needs of the nation and has identified dental services as a priority area. Denticare is only one of 116 proposed medical reforms contained in the interim report. It is expected that the final plan will be delivered to Canberra mid Shortly before the 2007 federal election the previous Liberal Government initiated a Medical Dental Scheme, for chronically ill patients (see Health Monitor report Access to dental care in Australia: a bit more (10) 2007). The current government has unsuccessfully attempted to stop this scheme in federal parliament. The current government considers that before a national dental care system is introduced the current medical dental scheme has to disappear. But political parties such as the Greens do no support the initiative because "it would leave Australia with only the promise of a full national dental plan at some time in the future and with no publicly funded dental care at all in the meantime". (Cresswell and Ryan 2009) - 2 -

3 5. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Origins of health policy idea Since the establishment of Medicare in the early 1980, this is the first time there is an open discussion about a national dental healthcare system. As previously described Denticare is one of the recommendations of the National Health and Hospital Reform Commission (NHHRC). The proposed Denticare reform differs from the existing Medicare funding arrangements. Medicare covers medical services by acting as an insurer, and medical services covered by Medicare cannot be covered by private insurance. There is no opting out as everyone is covered by Medicare. Under Denticare everyone will be eligible for the public insurance scheme. But individuals can choose to retain their private insurance cover, in which case Denticare will provide a risk adjusted payment to the insurer with individuals able to increase their cover. This is a managed competition model, and quite different to the existing relationship between insurers and the government funding. Initiators of idea/main actors Government Providers Private Sector or Industry Opinion Leaders Approach of idea The approach of the idea is described as: renewed: Stakeholder positions The Australian Dental Association (ADA-peak group for private dentists) described "Denticare" as too complex, inefficient and impractical. Dr. Neil Hewson (president of the ADA) commented that that the Government should focus on the delivery of health care to those who needed it the most, 35% of the community who cannot afford proper dental care. Dr. Hewson also warned that Denticare could nearly double the cost of dentistry. (Australian Dental Association 2009) However the ADA supports the proposed one year internship scheme for dentists prior to full registration. Interns will be required to practice in the public sector or in rural and remote areas. It also supported the initiative of improved health promotion. The Association for the promotion of oral health described the initiative as a two tier system "where federal funding would be simply given to the private system". Professor John Spencer who has studied the dental industry for more than two decades is in favour of Denticare. He considers that the Denticare proposal could lead to national standards of care being established with an emphasis on preventative rather than emergency treatments. (ABC 2009) The chief executive of NIB (a private health insurance) described "Denticare" as "inefficient and lacking competition" The nationalisation of dental services was described a "disaster" Actors and positions Description of actors and their positions Government - 3 -

4 Commonwealth very supportive strongly opposed Providers Australian Dental Association very supportive strongly opposed Private Sector or Industry Private health insurers very supportive strongly opposed Opinion Leaders Academics very supportive strongly opposed Actors and influence Description of actors and their influence Government Commonwealth very strong none Providers Australian Dental Association very strong none Private Sector or Industry Private health insurers very strong none Opinion Leaders Academics very strong none Positions and Influences at a glance - 4 -

5 Adoption and implementation Public consultation is now closed for the interim report. It is expected that the final plan will be delivered to Canberra mid It is important to note that the Commission has an advisory role. Therefore the Government is not compelled to implement the recommendations provided by the NHHRC. However it is expected that the Government will respond to this once the final report is released. 6. Expected outcome In its interim report the commission asserts that introducing "Denticare" will improve oral health and equitable access to dental care. The final report is expected to be release in mid June The Government would need to respond to the final recommendations. However Health Minister Nicola Roxon commented "They (the commission) have put forward a fairly radical proposal, obviously the way of delivering the services, and a tax, an extra levy attached to it, it is a fairly ambitious proposal." (Australian Associated Press 2009) Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable Cost Efficiency very low very high The proposed measures are unlikely to deliver quality dental care. It is also unlikely that the proposed changes will result in a more equitable/efficient system. 7. References Sources of Information 1. Brennan DS. Oral health of adults in the public dental sector. Dental statistics and research series no. 47. Cat. no. DEN 192. Canberra: Australian Institute of Health and Welfare National Health and Hospitals Reform Commission. A healthier future for all Australians: Interim report December 2008 Canberra Commonwealth of Australia Cresswell A, Ryan S. Greens poke holes in Rudd's dental scheme. In: The Australian. Sydney: The Australian Australian Dental Association. Media Release: National Health and Hospitals Commission Interim Report. In: Australian Dental Association ABC Online. Universal dental scheme wins qualified support. Transcript of PM news story. In: ABC Australian Associated Press. Dental plan "needs Medicare levy raise". In: Livenews.com.au Reform formerly reported in Access to dental care in Australia Access to dental care in Australia: a bit more - 5 -

6 Author/s and/or contributors to this survey Gallego, Gisselle Suggested citation for this online article Gallego, Gisselle. "Universal Dental Health Scheme". Health Policy Monitor, April Available at -