Summary

Research regarding variation in dental health within the adult community has highlighted manifest social inequalities in dental health status and access to basic dental care in the Australian adult population.  The formative document on adult dental health, A research database on dental care in Australia (AIHW Dental Statistics and Research Unit, 1993), identified three principal themes of interest, including the need to convert care provided to health care card holders from:

  • emergency to basic dental care;
  • extraction to restoration;
  • treatment to prevention.

Accordingly, the Commonwealth Dental Health Program (CDHP) aims to reduce geographic and financial barriers that are at present preventing adult card holders and their dependants receiving timely and appropriate dental care.

The AIHW Dental Statistics and Research Unit (DSRU) is evaluating the Program to assess its effectiveness in altering the profile of health and access to care of the eligible card holder population relative to the broader community.

A hierarchy of surveys was designed to collect information:  from the whole community via a national telephone survey (including a survey of satisfaction with care received); from eligible persons who actually received care;  and about services provided to recipients during their courses of care.

Annual repeats of these surveys will track the oral health, access to care, and satisfaction with care of recipients of care under the C!JHP relative to the broader community.

This report summarises key findings of detailed technical reports from the above surveys in one accessible document.  The tables and figures have been selected with specific regard to the terms of reference for the evaluation of the CDHP.  Following are the key findings of the surveys presented with the relevant terms of reference.

Access and availability

  • Perceived need for treatment was higher amongst card holders, compared with non-card holders (27.7% vs 20.6%), including the need for extraction, where there was a greater than two-fold variation (7.3% vs 3.6%).
  • Significantly fewer card holders were able to cite a check-up as their usual reason for visiting a dentist compared to non-card holders (40.9% vs   52.5%).

Barriers

  • Cost of dental care was related to both avoiding or delaying care, and in preventing the receipt of recommended or wanted treatment.

Use of services

  • Card holders were more likely than non-card holders to have last visited a dentist more than 5 years ago.
  • Rural dwellers were less likely than urban dwellers to cite a check-up as the reason for their last visit to a dentist.
  • There was substantial variation between States and Territories in the percentage of public patients receiving emergency rather than routine care, and in the average number of services received.

Health status

  • Rural dwellers were greatly disadvantaged in oral health status, with 53.6 per cent of the 65 years and older group having no natural teeth, compared with 35.4 per cent of urban dwellers of the same age.
  • Card holders were more likely than non-card holders to have no natural teeth, with this trend being more evident in older age groups and in rural areas.
  • There was substantial variation between States and Territories in the percentage of persons with no natural teeth, with the differences being most striking for persons aged 45-54 years where the range varied from 20.1 per cent in Tasmania to 4.3 per cent in the Australian Capital Territory.
  • The pattern of disadvantage for card holders noted for the loss of all teeth was reflected in the average number of missing teeth, where card holders reported greater numbers of missing teeth than non-card holders.
  • Rural dwellers reported greater numbers of missing teeth compared to urban dwellers.
  • The patterns of total tooth loss between States and Territories was also reflected in the average numbers of missing teeth, and Tasma':nians reported more missing teeth than other locations.
  • Card holders were more likely than non-card holders to report avoiding certain foods due to problems with their teeth, mouth, or dentures in the past 12 months.

Appropriateness of care

  • Consistent with observed variation in health status, card holders were more likely to report having received extractions than non-card holders.
  • Persons visiting for a problem rather than for a check-up were more likely to receive extractions.
  • Non-card holders were more likely than card holders to have received a filling at the last visit
  • A clear inverse relationship existed between receiving fillings or extractions, particularly for those presenting with problems.
  • Insured card holders were substantially less likely to have received an extraction at their last visit
  • Consistent with reported findings, the recorded percentage of public sector services that were extractions was high at 14.6 per cent.
  • There was wide variation between States and Territories in the percentage of services made up of extractions.
  • Emergency care was associated with high rates of extraction.
  • Persons in rural areas received high rates of extractions.
  • A multivariate model predicts higher extraction rates for younger persons, males, Aboriginals, rural dwellers, and those receiving emergency care.
  • Private patients were, in general, more satisfied with their care than public patients, particularly in waiting time and choice of dentist.
  • Insured card holders were less likely to offer comments of dissatisfaction than non-insured card holders, particularly in waiting time and cost.

Together these findings indicate that the population eligible for public dental care is at a clear disadvantage in terms of access to care and the treatment received, and in oral health as a consequence.  Moreover; the variations.in satisfaction between public and private patients and between insured and non-insured public patients highlights several of the perceived difficulties in obtaining timely and appropriate care within the public sector. These findings provide a clear basis for assessing the progress of the CDHP towards its objectives.