National Advisory Council On Dental Health

Oral health has a direct impact on the general health, hence, it is important that all Canadians have adequate access to dental care services. Over the years successive Governments have reduced financial support to programs delivering dental care to most vulnerable populations. As a result, many low income families and other vulnerable groups have been unable to access dental care. There is further escalation in the disparities in oral health care among Canadians, as the number of Canadians losing dental care benefits continues to increase. Also, higher oral health care costs can be expected in the near future due to shortage of health care professionals.

The healthcare system in Australia is complex involving many funders and healthcare providers. In 2011 to 2012 the health expenditure in Australia was estimated to have been $140.2 billion, which made up 9.5 percent of gross domestic product in that year (AIHW, 2013). Responsibilities are split between different levels of government, and between the government and non-government sectors. With non-government sources funding for about 30 percent of the total health expenditure each year (AIHW, 2013). Australians make their contribution to their healthcare system through taxes, including the Medicare levy, and through private financing such as private health insurance. Private health insurance in Australia is a voluntary facility for private funding of hospital care and ancillaries. Insurance funds may cover the costs of treatment for private patients in private or public hospitals and can include some services that Medicare does not cover. The Australian governments fund for almost 70 percent of the health expenditure each year (AIHW, 2013). The federal government contributes to approximately two-thirds, while State, Territory and local governments together contribute for the other one-third (AIWH, 2013). As a generalization the Australian government is primarily responsible for the funding of healthcare, through health insurance arrangements and direct payments to the state and territories, while state and territories are primarily responsible

As the number of older Americans continue to rise, along with dental practitioners who are entering retirement, it would benefit this under-served population for the dental profession to develop new models of mid- level care. To expand training as well as additional licensing for dental hygienists, along with more training for other health care professionals would be a great beginning towards improved access to care (Overview of oral health,

However, Department of Health, Australian Government in 2016 reported that the scheme had been underutilised, which there was a possibility of underpromotion. From the patient’s view, even though the actual fee was paid by the Government through CDBS, people usually aware of the gap between the benefit coverage and the actual fee (DeVoe et al. 2008). It is known that the gap exists in the payment. For example, the difference for the same services between the benefit for the 10 most utilised services and the national average dental charges for 10 privately insured services, the gap is up to 27 dollars (Private Health Insurance Ombudsman, Australian Government 2014). Moreover, in Australia, children utilised more private services than the public one, since private practitioners provide most dental services. The dentist in the private setting is also free to set their own fee and charges the patient directly (Department of Health, Australian Government 2015; Department of Health 2014; Chrisopoulos, S & Harford JE, 2013). Hence, these conditions may affect some groups of people that does not have sufficient financial resource to afford appropriate dental

While most of the patients I interacted with were seeking non-dental care, I met patients who were seeking care to health conditions that stem from their oral health such as oral abscesses, which our team was unable to treat except for prescribing antibiotics or painkillers. I encountered similar situations when I shadowed physicians in the emergency room of hospitals, observing a variety of craniofacial disorders originating from a preventable tooth decay. From these observations, I learned that patients often did not receive treatment that addressed the root of their problems: their oral health. As the result, I learned that many physicians saw the same patient repeatedly for problems that would otherwise be easily prevented through proper preventive dental care. Determining to address the unmet needs for accessible preventive dental care, I decided to pursue a career in dentistry so that I can provide a positive and meaningful impact to the underserved community on their oral health and ultimately their overall

The provision of dental treatment in Australia is a topic that ignites a wide range of opinions and emotions among the various stakeholders involved. Much of dentistry in Australia is provided in the private setting, some estimates suggesting 83%1. Australians fund up to 60% of dental care via out of pocket payments1,2. Only a relatively small amount of dental care is provided in the public sector to patients who are often disadvantaged in regards to their oral health1. It is estimated that a large amount of the population is unable to access dental care due to finances; however the capacity of the public sector to provide dental care is limited. With limited funding and resources, the public sector is unable to provide dental care for all Australians and a large proportion of people are on long wait lists, some estimates of 650,0002.

Hundreds of years ago, the dental profession and the medical profession was perceived as two separate entities, however, this bifurcated health system has created an epidemic in oral disease with our aging population (Nagro, 2016). Dentistry should be more closely integrated with medicine and the health care system, however, organized dentistry has fought to stay a monopoly. They have protested regarding dental personnel being independent, even in the advancement of serving more rural areas, just as they repelled being part of Medicare. Finally, there are a few states that have alternative choices for a dental hygienist to travel to people who can’t get to a traditional dental office. Some of these states include Minnesota, Colorado, Oregon,

All level government including local, state, territory and the Australian Government, provides public health services. While, health services in private sector are available in private hospitals, medical practices and pharmacies (Australian Institute of Health and Welfare 2014). Furthermore, the detail of oral health system in Australia is described based on type of health care, funding and oral health workforce.

Oral health in Australia is a concern. The impact of poor dental health can instigate ulcers, gingivitis, gum disease and damage one’s overall health. Tooth decay is extensive among Australian adults, and tooth aches are a considerable amount of hospital admission for children (Parliament of Australia, 2013). Two in three children aged 14 years have deteriorated permanent teeth, while three in ten adults receive no treatment at all. Adults living in rural Australia are 1.7 times more likely to have no teeth than those in major cities. 14 percent of children and 37 percent of adults avoid or delaying seeing a dentist due to costs (Australian Institude of Health and Welfare, 2012). The advantages of installing a dental program within

Lack of access to dental health services and providers also affects utilization rates within the adult Medicaid population (Licata & Paradise, 2012; Davis., Deinard &, Maïga, 2010; MacDougall, 2016; Hinton & Paradise 2016; PEW Center on the

Unlike the previous studies mentioned here, this study by Decker & Lipton (2015) looked more on adults who are covered by the Medicaid. Two key findings were revealed in this study—first of all, an increase of the likelihood of dental care visit is evidenced by those who have Medicaid coverage and second, there is also a reduction of the likelihood of untreated dental caries. It is also concluded that Medicaid is essential in promoting dental care and that it is strongly suggested that it should be expanded to further benefit a wider population of

accept Medicaid and this might result in higher utilization in particular wards over others. We did not have information about parental marital status and other private insurance, which could be used for dental services and not reflect in Medicaid billing data. Also, there could be a potential bias due to delayed reporting of the data which might not be included in the dataset when we received it. Also, Centre for Medicaid Services (CMS) uses the information from these datasets and presents it by financial year whereas this analysis was done by calendar year, which may not match with the generally available information. Also, the composition of Medicaid population might not be a true representation of over-all population. People having private dental insurance might have a different utilization pattern for assigned dental home and preventive dental services. We also feel that the information of ward might not be an accurate representation of utilization since people may seek services from a provider in different wards than the one in which they reside. Having data about unique providers, along with unique patient might make a robust database to get more accurate information. Last but not the least, we restricted our definition preventive dental services to a combination of examination and fluoride application, which is not the same as followed by

While the private sector provides excellent quality of oral health care for its patients, many vulnerable groups have difficulty with access.2 It is also these vulnerable groups who demonstrate extremely high levels of oral health disease. According to a 2014 report issued by the Canadian Academy of Health Services (CAHS), the following represent Canada’s most vulnerable groups: individuals with low incomes; younger age children living in low-income families; individuals working without dental insurance; elderly populations with low incomes and/or living in institutions; aboriginal people, immigrants/refugees; people with disabilities; and, populations living in rural/remote communities.2 The CAHS authors report that increasingly and in light of challenging economic times, families from lower-middle income strata are also demonstrating difficulty with accessing oral health care (this is partially attributable to an increasing tendency toward part-time employment rather than full-time employment with benefits).

It appears to backs this notion by the lack of unified healthcare, fewer fee based dental clinics versus health clinics, lack of supportive legislation and fewer people with dental coverage versus healthcare coverage (Fingar, et al., 2015). Much to my dismay, dental care is a major health disparity. Three quarters of my career has been spent in the emergency department (ED). During these years, we continue to see patients with dental issues. Admittedly, their main reason for seeking care from the ED is that they lack dental insurance. Under the Emergency Medical Treatment and Labor Act (EMTALA), these patients cannot be turned away from the ED due to their lack of ability to pay. Daily we treat patients with mouth pain related to dental caries, mouth abscesses and fractured teeth. Patients have told me that they are saving to have the tooth pull which can cost at least $100. I have had several crowns placed in my mouth and I can attest that this procedure costs approximately $500 with decent insurance and triple this amount without insurance. The general reason for my concern, is that, dental infections can lead to other serious health problems such has respiratory infections, heart value disease or brain abscesses (Li, Kolltveit, Tronstad, & Olsen, 2000). I witnessed my 32 year old female patient die after surgery for removal of an infected brain abscess. The day prior, she confessed that it was related to dental

Although many Americans have good oral hygiene due to fluoride and making everyday good decisions, others do not have any access at all to oral health care. Over the years, dentists have been trying to demonstrate the importance of oral care. (“Access to Dental Care”) From commercials to campaigns, dentists will continue to demonstrate to their patients as well as to the people who don't have insurance the importance of oral health care. They will teach them preventative care and some techniques on how to prevent from getting any diseases.