A Progressive Dental Health Policy for All New Zealanders
Hon Jim Anderton
Member of Parliament for Wigram
22 June 2011 Media statement
A PROGRESSIVE DENTAL HEALTH POLICY FOR ALL NEW ZEALANDERS
Today Progressive leader Jim Anderton launched a policy to promote free dental health care for all New Zealanders.
• 44% of all New Zealanders do not receive any form of dental care. Obesity and diabetes are increasing and both are linked to an increase in dental health problems.
• The number of New Zealanders over 65 years of age who still have some or all their natural teeth is rapidly increasing. Dental problems amongst this group are complex and costly. Because 70% of those over 65 years of age only have NZ Superannuation as their main or only source of income, regular dental care is simply unaffordable.
• While free dental care is theoretically available in New Zealand from birth to 18 years of age, in practice only 50% of young NZers receive treatment because of availability of services, cost or understanding how to access them.
• A very worrying statistic is the 2,668 children (and rising) under 5 years of age who require dental procedures at our public hospitals each year, including the removal of teeth under general anaesthetic.
• District Health Boards provide access to dental health services for children up to year 8 (age 13) of their schooling through the school dental service – a combination of school mobile clinics followed by dental services for adolescents from age 13 up to the 18th birthday with services at agreed fee levels. (A service introduced by Hon Annette King). The goal is to achieve and maintain an 85% access rate compared to around 50% at present.
Available data on dental disease suggest that:
• Māori and Pacific children are less likely to be cavity-free by 5 years of age.
• Māori and Pacific children experience more dental cavities by 5 years of age
• Water fluoridation has a significant and positive preventative effect on dental decay.
• In general, drinks containing high amounts of sugar (including fruit juices, milk shakes and fizzy drinks) are not only associated with an increased risk of cavities, but also with weight and obesity problems.
• To a large extent, dental problems result from what we eat and drink. There are three major problems:- dental cavities, gum disease and gum erosion. Our diet encourages the development of tooth decay. Sugar and refined carbohydrates which we consume are the key culprits in this regard.
• People who are overweight tend to have worse dental problems. The 2009 Social Report found that 1.13 million New Zealanders were overweight. Greater consumption of sugar-sweetened drinks is associated with weight gains and obesity and is a serious risk factor for dental decay.
• According to Diabetes NZ, about 270,000 New Zealanders suffer from Type 2 diabetes, whilst another 90,000 cases go undiagnosed. The incidence is increasing rapidly and around 500 young NZers aged between 10-18 years also have Type 2 diabetes.
• From 2011 to 2030 the baby-boom generation will retire and because most of them have kept their natural teeth, even though heavily restored, many will get serious decay from tooth crowns and exposed tooth roots. Clearly this means that many elderly NZers will need expensive dental treatment, in many cases well beyond what they had to spend on dental care in their younger years and well beyond their ability to pay.
This policy proposal advocates free dental care should be extended over time, and on an incremental basis, to all New Zealanders. First to the most vulnerable groups; pregnant women, those aged 65 years and over followed by those aged between 18 and 28, then those 28 years to 50, followed by those between 50 and 65 years old.
These steps should be supported by education, publicity and the fluoridation of all drinking water (following, and if supported, by a parliamentary select committee enquiry).
There should also be a bonding scheme for dentists and dental hygienists who are prepared to work in rural/provincial areas where dental professionals are in short supply in return for writing off student debt over a 3-5 year period of service.
Good oral health should also be reinstated as a priority goal for the public health system, together with the reinstatement of the requirement that school lunch shops/cafeterias provide only healthy food.
Considering the three trends: Obesity – Diabetes - and Dental Deterioration – it seems clear that there will be an increasing need for dental care, especially for people on low incomes, including a growing number of elderly citizens.
Put simply, bad teeth are likely to compromise the overall health of large numbers of New Zealanders and add significant cost to an already stretched public health system.
Prevention should therefore be the thrust of good dental health policy, and ensuring that all people have access to high quality, affordable dental care will have a powerful preventative effect.
Prevention should be aided by four new policies:
I. Providing Free Dental Services so
that dental decay can be arrested and other health problems
which may arise from a lack of dental care can be avoided
and general health costs reduced.
II. Bonding of Dentists working in Provincial and Rural areas
III. A Parliamentary Inquiry into the need (or otherwise) for Fluoridation as part of a National Dental Health Strategy
Current fluoridation policy in NZ is that local authorities decide whether or not drinking water should be fluoridated. Children using fluoridated water have a lower rate of tooth decay (over 30% less) than those whose water is not fluoridated (All Australian States have fluoridated water supply under a Federal Dental Health Policy Framework. 80% of Australians have access to fluoridated water compared to 60% of New Zealanders. As late as March 2008, the Queensland State Parliament overwhelmingly passed legislation allowing for the completion of fluoridation supplies for the whole state, which currently only has 54% fluoridation compared to:
92% in New South Wales
78% in Victoria
90% in South Australia
92% in Western Australia
83% in Tasmania
70% in Northern Territory
100% Australian Capital Territory
IV. Publicity - In order to make free dental
care as effective as possible, the government should fund
advertising across all media to show the importance of
care. Doctors, Plunkett rooms and schools should be provided with educational material to encourage proper dental hygiene.
THE COST OF A UNIVERSAL FREE DENTAL CARE SYSTEM
The current cost of free dental care to those under 18 is approximately $120 million per year. The estimated cost of introducing free dental care to those over 18 years of age (based on 2002-2003 data) would be an additional $542 million bringing the total cost of universal dental care to an estimated $670 million.
However, allowing for inflation, the cost of more expensive equipment and more people accessing dental services, we should allow for a cost of around $1 billion.
FINANCING THE PROPOSED
Accepting that the cost of extending free dental care to all could be around $1 billion a year at current prices, the required funding could come from a levy on income, similar to ACC levies, a reduction in the $17.8 billion tax cuts given to the most affluent New Zealanders by the National-led government over 4 years (average $4.4 billion per year), a levy on sugary soft drinks (such as we have on tobacco or alcohol) because of their contribution to the forthcoming diabetes epidemic, or a mix of all these possible sources of funds.
The extension of the Volunteer Bonding Scheme (VBS) to dentist and dental hygienists will also require funds. In the absence of details about shortages of such professional services in rural areas and provincial centres with serious shortages that cannot, at this time, be costed.
However, the current Voluntary Bonding Scheme costing around $7.5 million p.a for over 500 doctors, midwives and nurses, indicates that such a scheme for improved dental services, should be able to be accommodated within the $800-$1000 million estimated to obtain a free dental service.
This plan could be implemented over a period of between 5-10 years so that the funding, administration and resources required could be accommodated more efficiently.
The current Dental Agreement will continue to apply, but will also be amended to cover the incremental extension to other groups. There will need to be an agreed fee structure.
The introduction of State Funding should make private insurance cover redundant. This should be reflected in a reduction in premiums charged by insurers for general health insurance if this includes cover for dental care – a saving for existing policy holders.
Dentists will remain in charge of their own practices and professional procedures. They will not become Government employees.
Negotiations with the dental profession will be conducted to agree on an administrative system which would be required, over time, to introduce the free dental system.
Because of my retirement from politics this year, I am handing this policy programme to the NZ Labour Party as the vehicle through which I hope these issues, concerns and initiatives can be progressed.