Fed Up To The Back Teeth
Sydney Morning Herald
Wednesday February 16, 2005
Short of bottomless spending, no state can guarantee all its citizens will grow up with perfect Hollywood smiles. But as Ross King, head of the Australian Dental Council, says, the least people should expect is a healthy mouth for life. The advent of fluoride in public water supplies and advances in modern dentistry mean no person growing up today need ever loose any teeth apart from milk teeth - something undreamt of even a generation ago.
Yet a Herald investigation has exposed the unevenness of access to quality dentistry in NSW. There are only about 240 public dentists for more than 2.5 million health care card holders, children and the elderly. This compares with more than 3000 private dentists to treat the rest of the population. The poor and the vulnerable are now having to wait for up to eight years to get treatment through a run-down public system. People are pulling their teeth out with pliers. Children are in pain. Leaders in dentistry have been screaming about the situation for years, but no one has listened. The state and federal governments bear responsibility. The federal Treasurer, Peter Costello, abolished the Commonwealth Dental Health Program in January 1997. The program had provided the states with an extra $100 million each year. The Carr Government was particularly mean-spirited about filling the gap left by the federal withdrawal. While some other states went about rebuilding public dental programs, NSW fell further behind. Meanwhile we have the ridiculous situation that has wealthier people receiving higher public subsidies for dental treatment than those on lower incomes. This is because the Federal Government's private insurance rebates exceed the state's spending per person on public care. Little wonder that private practices are skewed to wealthier areas. The challenge therefore is to get more dentists into the public system without penalising dentists who are understandably anxious to get to the riches of private practice. After all, dentists spend up to seven years in unpaid training while at the same time exposing themselves to some of the highest tuition fees. Medical doctors, who undergo a similar arduous regime, at least get paid for some of their training period when they join hospitals as interns. The public system needs bold, innovative approaches to keeping at least some newly qualified dentists in public practice for at least a while. If that means finding a lot more cash, then so be it, although more money alone is rarely ever a durable solution for health shortcomings because demand will always be excited by extra supply and therefore always exceed it. We might need to look at ways, for instance, of subsidising HECS costs in return for set tenure of post-training service in public practice. While this runs contrary to the HECS principle that professions with the highest incomes will be charged the highest tuition fees, this has to be considered alongside the reality that poor dental hygiene, even more than poor general health, is concentrated among the poor, who have no realistic opportunity of being able to afford dental insurance coverage.
© 2005 Sydney Morning Herald