Under Medicare, all Australians have access to free health care. If you have a medical emergency, you can go to a hospital and receive treatment at no personal cost. But if you have a dental emergency—sudden, intense pain from a cavity, infection, or broken tooth—you may be on your own to foot the bill. Medicare doesn’t cover dental work, which means an emergency can leave you in both physical and financial pain. The Australian Dental Association (ADA)—the peak national body of the dental profession — says that “Good oral health is a basic human right”. So why then isn’t dental work covered by Medicare?
The reason boils down to politics and money (surprise, surprise!). A brief history lesson: Prime Minister Gough Whitlam introduced Medicare, then known as Medibank, to Australia in 1974. Whitlam intended Medicare to include free, universal dental. But, facing opposition from the medical and dental professions, he pivoted to fight one battle at a time. He’d introduce free medical care first, and dental later. But later never came. Fifty years have passed and Australia still doesn’t have a nationwide free dental scheme. Instead, we have a fractured, arbitrary arrangement based on wealth, or lack of it. It’s full of holes, and government red tape is barely holding it together. Let’s break it down.
What’s currently covered by Medicare?
The Australian Government pays for some essential dental services for eligible children and low-income adults. The Child Dental Benefit Scheme provides up to $1000 in treatment every two years for children between the ages of two and 17. This doesn’t cover orthodontics, cosmetic dentistry, or dental procedures performed in a hospital, and children are only eligible if their families are receiving a government benefit.
Adults who receive government benefits or concessions are also eligible for free dental care. But the kicker is the waitlists. They vary across states but are always high. According to the Sydney Morning Herald, in December 2021 almost 100 000 people in NSW were waiting to receive public treatment. The waiting period? 15 months. Covid only made things worse. In the 2018-19 financial year, the public system provided 625 000 dental services to adults. In 2021-22, that number dwindled to 204 000.
What about Private Health Insurance?
Some Australians pay for private health insurance. However, most providers draw a line between general and dental health. This means that dental insurance is usually classified as an “extra”. If you want it, your policy will cost more. But even with dental insurance, most procedures aren’t fully covered. On top of paying your policy, you usually have to fork over around half the treatment cost, with the insurance provider covering the other half.
Lastly, there’s a portion of Australians who don’t qualify for public dental help, and don’t have, or can’t afford, private insurance. If they want to see a dentist, they have to pay 100% of the bill.
It’s messy, right? Especially in an emergency. Say you have an infected tooth and suspect you need a root canal treatment. You’re in blinding pain, and you need to see a dentist, now! If you’re eligible for public dental, it won’t cost you, but getting an appointment may take some time. If you have private insurance, you’ll have to pay roughly half the cost, and you may also have to wait, as many policies have waiting periods for major dental work. And if you don’t qualify for public help or have insurance? You’ll be paying between $900 and $3400, which is the average cost of a root canal treatment. But how can the price vary so much? Well, that’s a good question and brings me to our next topic: the Wild West of dental pricing.
Dental: An Unregulated Industry
Quite literally, it’s lawless. Unlike general medicine, dentistry fees aren’t regulated by the government. There’s no standard pricing schedule like there is for doctors. This is why costs vary so widely from dentist to dentist (and why the average price of a root canal is difficult to pinpoint). Dentists determine their fees according to factors such as their location and what treatment methods they use. Like any other commercial enterprise, they are free to charge what they want. This isn’t to say that all dentists are over-charging. But the lack of defined pricing standards for such an essential health service is baffling, and confusing for consumers. Like the battle Whitlam fought against doctors over the introduction of Medicare, many dentists oppose reform. They don’t want regulated fees, and argue that Medicare-funded dental care would result in dentists being forced to work in stressful conditions and poor workmanship. And yet, it’s reported that Australia has an over-supply of dentists based on population.
So where has this got us? Nowhere good. In July 2022, the Australian Dental Association released their annual Consumer Survey results. They showed that many Australians are avoiding or delaying seeing a dentist. Only 13% of respondents had been to the dentist in the past 12 months. Twenty-six per cent hadn’t been in over five years, and 40% hadn’t been for two to five years.
According to the Sydney Morning Herald, 67% of respondents in the ADA survey said they had delayed dental treatment in the past 12 months for problems such as suspected cavities, cracked teeth or bleeding gums. Fifty-four per cent of these people said they did so because they couldn’t afford it. The ADA itself said that in the past 10 years the proportion of people delaying treatment had increased by 50%.
Even worse was our lack of good oral hygiene habits. Seventy-seven per cent of respondents said they rarely, or never, flossed. Nineteen per cent brushed only once, or less, per day, and 30% of these people said they didn’t brush regularly because of pain. Another 66% of respondents said they were unaware that poor oral health can affect their general health. Delaying or avoiding necessary dental care can have an enormous impact on a person’s physical well-being, appearance, confidence and quality of life.
Who’s fighting to add dental care to Medicare?
It’s a hot mess, and for an affluent country like Australia, an alarming one. But there are things we can do as a nation and individuals to change these trends. In the past few years, more organisations have been calling for dental reform in Australia. So far, the Greens are leading the charge, pushing universal access to free dental care. In 2019, the Grattan Institute released its Filling the Gap report. It painted a grim picture of Australia’s oral health and called for the introduction of nationwide Medicare-funded dental care. This would be of tremendous benefit to all Australians, and hopefully, it happens. But if it does, it’ll be a slow transition.
What can you do?
Take care of your teeth! To quote AirSmile founder Dr Heath Fraser: “prevention is the cheapest and best dental care”. Delaying or avoiding a trip to the dentist is likely to backfire on you at some point, and end up costing a lot more. The best thing you can do is brush and floss daily, cut down on or avoid sugar, and see a dentist regularly. This is where AirSmile can help. If the pricing of dental treatments is equivalent to the Wild West, then AirSmile is the lone cowboy riding into town, determined to shake things up. Our goal is to make it easier for Australians to access dental treatment, and to bring some transparency to the industry. AirSmile helps you navigate dental care like you would any other purchase – with research and price comparisons. We help consumers figure out what treatments they need and provide quotes from multiple dentists so they can choose one that’s right for them and within their budget. All Australians should be able to make informed decisions about their dental care so that they can stop delaying dental problems and start preventing them.