Question: Oral health in New Zealand has been lagging. How do we address the impending crisis?
Our health system is being transformed with the aim of providing health services that are more accessible and equitable for all people in New Zealand. As part of this transformation, perhaps it is the right time to reassess funding streams for GPs and dentists.
Publicly funded hospitalisation rates for oral health increased by 31% from 2007/08 to 2018/19, while the population increased by 17% over the same period. Dental caries is the main reason for hospitalisation, amounting to 58% of all oral health hospitalisations in 2018/19. Hospitalisations for other conditions such as heart disease, which may be linked to unmet oral health need, are not included in these statistics. Most oral health conditions are largely preventable and can be treated in their early stages.
There is a dearth of information comparing the state of dental health internationally. What is available is confined to 12-year-old children – a ‘DMFT (Decayed, Missing due to caries, and Filled Teeth in the permanent teeth.)index’, which describes the extent of dental caries in an individual.
The most recent New Zealand data (2017) shows a DMFT score of 0.7, which is considered a good result and may in part reflect the effects of having fully subsidised dental care for children. Nevertheless, about 1 in 10 have teeth removed due to decay. Those in the most deprived section of the population (quintile 5) are almost twice as likely to lose their teeth as those in the least deprived group.
Opponents to this policy change might argue that it will cost too much and it will take away the autonomy that dentists have traditionally had to set their own fees making up for funding shortfalls from the Government.
Research has shown that removing the cost of the co-payment and making visits to the GP and access to early dental care will save money. It will make living costs easier for whānau but it will also reduce the resources that are needed within our emergency departments and hospitals to care for people with complex health needs that were preventable.
It is now 85 years since the Social Security Act 1938 established our national health system along three distinct pathways: free specialist and hospital care paid for by the Government, subsidised GP care that requires out-of-pocket payments from the individuals using those services and private dental care outside of the public health system. Since then, the numbers reveal significant inequities in access to dental care between Pākehā and Māori New Zealanders.
In 2020, the Ministry of Health estimated that the cost of extending free dental care to adults would tally up to $648 million per annum. The New Zealand Dental Association proposed a stepwise approach to target the most in need first. This came into fruition during Budget 2022 wherein dental grants for low-income families increased from $300 to $1000.
There is consensus across the sector that the issue around oral healthcare in NZ needs to be looked at broadly. A subsidised service however, may not be the silver bullet.