OF all the several bold ideas contained in the interim report from the federal Government's National Health and Hospitals Reform Commission, released this week, the plan for a universal dental scheme is the one that has, perhaps, captured the public's imagination the most.
Over the past two years the nation has been bombarded with horror stories of pensioners nursing mouths filled with rotting teeth which they can't afford to get fixed, and of others lingering for months, even years, on waiting lists for public treatment.
There is wide support for some sort of re-think. But the NHHRC's proposal has not been greeted with open arms on all sides.
Famously, the Australian Dental Association -- the nation's peak group for private dentists -- attacked the plan almost immediately as "impractical, nonsensical, (and) overly simplistic" and declared it "flies in the face of much of the deliberations that have taken place on this issue over the past decade".
Responses from individual dentists have been more moderate, although still widely diverging. Tony Burges, a dentist in Sydney's inner-west suburb of Drummoyne, says the NHHRC's proposal is "a reasonable suggestion" but the "devil will be in the detail".
The ADA made a number of specific criticisms, including the claim that the costs of the scheme would be "crippling" and unaffordable, potentially costing over $11 billion.
However, a modelling report prepared by consulting firm PricewaterhouseCoopers at the NHHRC's request, and published this week, makes clear that based on certain assumptions about claiming patterns, the extra cost to government would be just $3.9billion a year. This amount would be more than covered by the proposed 0.75 percentage point increase in the Medicare levy.
But it turns out this affordability comes at a price.
The PwC report outlined three variations of what specific dental services the proposed Denticare scheme might cover, ranging from a fuller coverage to lesser. But none is truly comprehensive.
All exclude root canal treatments, crowns and bridges, periodontic care (involving cases of advanced gum inflammation leading to bone loss) and orthodontic treatments (including braces).
Crowns and bridges have been blamed for the soaring costs of the Howard government's Medicare-based dental scheme, which the Labor government has so far failed to scrap due to opposition in the Senate.
The existing Medicare scheme pays $2150 in Medicare rebates for private dental treatment per year, provided the patient is referred to the dentist by a GP who has assessed them as having a potentially life-threatening chronic condition that is being exacerbated by their dental problems. An analysis of spending in the Medicare scheme last year showed patients enrolled in it were making claims for crowns and bridges at a higher rate than would be seen in the normal dental patient population: about 7.4 per cent of total Medicare treatments, on a per-tooth basis.
However, the affordability means that basic dental treatment, which would be covered by any of the foreseen Denticare options, would be much more equitable.
At present, individuals going to private dentists spend an average of 0.79 per cent of their income on out-of-pocket charges to private dentists, an amount that rises to 0.96 per cent of taxable income once the cost of private health insurance premiums for dental cover are added in. Together this accounts for 78 per cent of total expenditure on dental services.
Under Denticare, individual funding of dental services would shrink to an average of 0.37 per cent of taxable income, equivalent to 29 per cent of spending on dental services.
The Denticare scheme, funded by the increased Medicare levy, would allow patients to choose cover under private insurance plans, in which case Denticare would pay the premium and the policy would cover 85 per cent of the fees, leaving the patient to pick up the remaining 15 per cent.
Other patients who wished to avoid the 15 per cent gap could elect to be covered under the public system, where treatment would be totally free, with the downside of some waiting.
Patients opting for private treatment would no longer need to pay separately for dental premiums. Overall, the average proportion of income spent on dental would rise from 1.24 per cent at present to 1.3 per cent under Denticare, with the increase due to the expansion of programs such as school dental and oral health promotion.
But this conceals the fact that according to PwC, equity -- meaning access for the poorest -- would be substantially increased under the proposal.
According to the modelling, taxpayers with annual household income of up to $25,218 currently pay just under 2 per cent of their taxable income on dental costs, or $11.25 per taxpayer per week.
This would fall to $8.94, just under 1.5 per cent of taxable income, under Denticare.
Those in households with annual income between $25,219 and $44,286 would be better off by 74 cents per taxpayer per week, and taxpayers in households with income between $44,287 and $67,129 would be $1.15 better off per week.
Taxpayers in households with income over $67,130 would be paying more under Denticare ($1.37 per taxpayer per week more, rising to $2.74 per week for income over $108,277).
Yet there are many assumptions in the Denticare modelling, and unexpected changes in consumer behaviour could have a significant effect on the impact of any scheme, should one be approved by the federal government.
For example, it's not easy to predict how many more dental services will be provided as a consequence of making dentistry more affordable for the less well-off. Also, about 35 per cent of people who visit the dentist do not at present have private dental cover, even though they visit a private dentist. How their needs will be met if they continue to eschew the private option, and rely instead on the public Denticare scheme, is not totally clear.
Burges feels that Denticare will come unstuck in the details.
"My personal view has always been that private dentists are probably best placed to treat most people in the population," he says.
"The NHHRC has budgeted about $4.5billion (for Denticare) ... but it could easily blow out and be very expensive to run. I think there's real potential for any universal scheme to blow out and be very expensive, and that might lead the government to cut costs."
