Medicare legislation lacks teeth

IN FEWER than three months’ time, Aussies will be at the ballot booths putting ticks in boxes to decide which political party has the chance to continue falling short on putting in place the type of legislation that most of us both want and need. It’s the perfect time to approach potential governments for pre-election commitments. Who knows, one day they may even listen! But seriously, if it’s affecting millions of voters and is reasonable and affordable, they might be reasonably receptive. The issue I’m flagging here is about sensible dental services for everyone, but mainly for seniors.

The medical research establishment continually publishes articles about bacteria from untreated – and usually undiagnosed – dental infections that cause medical complications, and which cost many times more to treat medically than dentally:

• The Australian Bureau of Statistics (ABS) reports that the medical risk increases with age, and seniors are obviously the highest medical-risk group.
• The Australian Institute of Health and Welfare (AIHW, 2006) reports seven million have a chronic disease or a disability, and three million require care – again, most are seniors.
• AIHW reports those least likely to seek dental care are those with chronic disease, and 50% of hospital admissions are for treatment of chronic disease, which are amenable to prevention – again, seniors.
• Worldwide, dental statistics tell the same story, and it’s that older people have the worst oral health of all age groups.

These facts tell a story which must be obvious to everyone – if you exclude oral health from the medical management of high-medical-risk groups, you’ll be wasting money and precious resources. Treating dental infection in high-medical-risk patients is essential healthcare, and medically necessary, and covered by Medicare ­– but not necessary dental care. This is a very important distinction and legislation should be amended accordingly.

The US introduced Medicare dental in 1998 along these lines. Medicare there pays for diagnosis and treatment of dental infections in specific medical conditions, but does not pay for restoring teeth. This preventive intervention costs far less than restorative dentistry, and saves many times more than the cost of treatment. If this arrangement actually saves money for all concerned, why hasn’t Australia adopted the same approach?

Medicare in Australia currently excludes all dental services.

Dental services are a problem for government because 80% (10,500) of Australian dentists work in the private sector, are self-regulated, provide 90% of the dental services, and they are outside of health care. So governments have to negotiate terms with dentists.

In 2004, Tony Abbott first introduced a Medicare dental program. It was very sound health policy, but it had limited uptake. It lacked co-ordination, was poorly paid, involved reams of paperwork, and was unfamiliar territory for patients, doctors, dentists and Medicare staff.

In 2007, it was radically amended and really took off. Then Labor committed to closing it later in 2007, but only succeeded in July 2012. It had cost a lot, but it benefited more than a million people, improved their quality of life and their health care, and saved many times more than it cost. But it did not address those who most needed ‘medically necessary’ dental services or those in care. This must be high on the agenda of the incoming government.

The following recommendations are all achievable and affordable:

• Amend Medicare legislation to include ‘medically necessary’ dental care.
• Legislate it as healthcare and cover the 12 major diseases (National Health Priority Areas).
• Ensure Medicare pays for a professional oral and dental examination in these 12 NHPAs, and such examinations should be required to be included as part the medical examination, reporting X-ray, and clinical evidence of dental infection and the cost of treating it.
• Once authorised by Medicare, doctors should advise dentists to proceed with treatment.
• Develop an outreach preventive oral health capability within mental health, disability, aged care, and HACC (Commonwealth Home and Community Care program), to improve oral health and general health-care outcomes.

Action Plan

There needs to be a logical approach to integrating such a scheme, something along the lines of:

1. Oral care management in aged care be legislated as health care (NOT personal care)
2. Dental examination by health-care dentist and reported to GP
3. Advise GP of dental infection
4. GP referral to private dentist to treat dental infection and be paid for by Medicare
5. Oral care in aged care is specialised nursing, requiring time and resources
6. Resources are treated as medical supplies and paid for by Medicare.

Such intervention would provide better care, save money, and benefit both patients and health-care staff.

Health-care dentists would possess a Bachelor of Oral Health, and be trained specifically for health care, NOT clinical dentistry. They would be trained in the Health Sciences stream because they would be working within a multidisciplinary environment, NOT isolated outside as traditionally trained dentists. Bachelors of Oral Health are dentally qualified and could be dental hygienists or therapists or graduates from outside traditional dentistry. Their role in health care would be to integrate with medicine, nursing, and all the other health disciplines, in a preventive health capacity. They would NOT be doing any dental treatment. They would primarily be educators, consultants, and facilitators.

Both Kevin and Tony need to chew on this!