Australian Dental Journal
The official journal of the Australian Dental Association
Australian Dental Journal 2014; 59: 268–272
DATA WATCH
doi: 10.1111/adj.12181
Financial burden of dental care among Australian children* Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.
INTRODUCTION While the oral health of children in Australia improved in the latter part of the twentieth century, there has been no decrease in the proportion of children reporting financial barriers and hardship associated with use of dental services over the past 20 years.1 In Australia, the cost of dental care falls largely on the individual. As a result, financial burden reflects both the direct and indirect cost of dental services to the individual, the disposable income of a household and the number of persons dependent on that income.2 Subsidized dental care is available to children in all states and territories, although eligibility, coverage and co-payment arrangements vary across jurisdictions. Nevertheless, only 27% of children who made a dental visit in 2010 did so at a public provider.1 On 1 January 2014, the Australian Government’s new dental scheme, Child Dental Benefits Schedule (CDBS), was launched. CDBS will allow children to access Medicare rebates for selected services, capped at $1000 over a two-year period. The scheme replaces the Medicare Teen Dental Plan, which provided eligible teens with vouchers for private dental care (to the value of one preventive dental check per year). This initiative does not replace the publicly funded services provided by the states and territories. Children must be aged between 2 and 17 years to receive benefits under the new scheme. They must also be eligible for Medicare benefits, and be part of a family that receives Family Tax Benefit Part A (i.e. a payment that helps with the cost of raising children) or other selected government assistance payments, e.g. Parenting Payment (i.e. income support for parents or guardians to help with the cost of raising children). However, there are some limitations to the CDBS. This scheme aims to cover basic dental services. Cosmetic and orthodontic services are not covered, while certain other services, such as intravenous sedation during dental treatment, can only be claimed once in a 12-month period.3 In light of the introduction of the CDBS, this article reports on the experience of two financial barriers to *This article is a solicited opinion piece and did not undergo peer review. 268
dental care and one financial hardship relating to dental visiting and treatment among Australian children. The two experiences related to barriers to care are having avoided or delayed making a dental visit due to cost and having had cost prevent a recommended dental treatment. The hardship experience related to having experienced a large financial burden due to the cost of dental care. The aim of this paper is to describe the characteristics of those children who currently experience any financial barriers or hardship and identify those groups who could potentially benefit from this additional government support. METHODS Data source Data presented in this report were sourced from the National Dental Telephone Interview Survey (NDTIS) 2010. The target population for NDTIS 2010 was Australian residents aged two years and over in all states and territories. To select a representative sample of residents a two-stage stratified sampling design was implemented. In the first stage a random sample of households was selected from the Electronic White Pages (EWP). To access the latest version of the EWP, the Australian Institute of Health and Welfare Dental Statistics and Research Unit (AIHW DSRU) requested the Australian Electoral Commission (AEC) extract a sample of Australian adults aged 18 years and over from the electoral roll. These data were matched against the Sensis® MacroMatch database to append a residential telephone number. Matched records that returned either a landline or mobile telephone number formed the basis of the sample frame for the 2010 NDTIS. In the second stage, the sample frame was stratified by state and region, where region was defined as metropolitan or non-metropolitan. Households were randomly selected from each stratum using the inbuilt features of the WinCati software programme (WinCati 4.2 Sawtooth Technologies, Inc.) and contacted by telephone. © 2014 Australian Dental Association
Financial burden of dental care among Australian children If telephone contact was made with a household, the interviewer established whether the telephone number served a residential dwelling. If the household was inscope of the survey an adult aged 18 years or older usually resident in the household was randomly selected for interview. Once an interview was completed with the target adult, if there were children aged 2–17 years usually residing in the household, one child was randomly selected to participate in the survey, with a parent answering the questions on behalf of the child. Data were weighted to account for the different probabilities of selection to reflect the 2009 estimated resident population.4 Sample A total of 6765 adults and 3472 children were interviewed and asked a range of questions relating to their oral health, access to dental care, dental treatment received and affordability of dental care. This article presents findings from the 3472 child interviews. Data items Financial barriers and hardship To assess whether respondents had avoided or delayed visiting a dental professional due to cost, respondents to NDTIS were asked ‘During the last 12 months, have you avoided or delayed visiting a dental professional because of the cost?’. The response categories were ‘yes’ and ‘no’. Respondents who responded ‘yes’ are reported as having avoided or delayed making a dental visit due to cost. To assess whether cost had prevented recommended dental treatment respondents to NDTIS who had made a dental visit in the previous 12 months were asked ‘Has the cost prevented you from having any dental treatment that was recommended by a dental professional at a visit during the last 12 months?’. The response categories were ‘yes’ and ‘no’. Respondents who responded ‘yes’ are reported as having had cost prevent a recommended treatment. To assess whether respondents had experienced a large financial burden from dental visits, respondents to NDTIS who had made a dental visit in the previous 12 months were asked ‘In the last 12 months, how much of a financial burden have dental visits been for you?’. The response categories were ‘none’, ‘hardly any’, ‘a little’ and ‘a large burden’. The responses are reported as ‘experienced a large burden’ and ‘did not experience a large burden’. Respondents who nominated ‘a large burden’ are reported as having experienced a large financial burden from dental costs. If respondents reported either avoiding or delaying visiting a dentist because of cost or cost prevented © 2014 Australian Dental Association
them from having recommended dental treatment or dental visits were a large financial burden in the previous 12 months, they were regarded as having experienced any financial barriers or hardship in the previous 12 months. Child characteristics Experience of the two barriers and one financial barrier are reported by the following child sociodemographic characteristics: gender (male, female), age (2–5 years, 5–11 years, 2–17 years), geographic location (Major cities, Inner regional, Outer regional, Remote/Very remote), annual household income (less than $30 000, $30 000–
The official journal of the Australian Dental Association
Australian Dental Journal 2014; 59: 268–272
DATA WATCH
doi: 10.1111/adj.12181
Financial burden of dental care among Australian children* Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.
INTRODUCTION While the oral health of children in Australia improved in the latter part of the twentieth century, there has been no decrease in the proportion of children reporting financial barriers and hardship associated with use of dental services over the past 20 years.1 In Australia, the cost of dental care falls largely on the individual. As a result, financial burden reflects both the direct and indirect cost of dental services to the individual, the disposable income of a household and the number of persons dependent on that income.2 Subsidized dental care is available to children in all states and territories, although eligibility, coverage and co-payment arrangements vary across jurisdictions. Nevertheless, only 27% of children who made a dental visit in 2010 did so at a public provider.1 On 1 January 2014, the Australian Government’s new dental scheme, Child Dental Benefits Schedule (CDBS), was launched. CDBS will allow children to access Medicare rebates for selected services, capped at $1000 over a two-year period. The scheme replaces the Medicare Teen Dental Plan, which provided eligible teens with vouchers for private dental care (to the value of one preventive dental check per year). This initiative does not replace the publicly funded services provided by the states and territories. Children must be aged between 2 and 17 years to receive benefits under the new scheme. They must also be eligible for Medicare benefits, and be part of a family that receives Family Tax Benefit Part A (i.e. a payment that helps with the cost of raising children) or other selected government assistance payments, e.g. Parenting Payment (i.e. income support for parents or guardians to help with the cost of raising children). However, there are some limitations to the CDBS. This scheme aims to cover basic dental services. Cosmetic and orthodontic services are not covered, while certain other services, such as intravenous sedation during dental treatment, can only be claimed once in a 12-month period.3 In light of the introduction of the CDBS, this article reports on the experience of two financial barriers to *This article is a solicited opinion piece and did not undergo peer review. 268
dental care and one financial hardship relating to dental visiting and treatment among Australian children. The two experiences related to barriers to care are having avoided or delayed making a dental visit due to cost and having had cost prevent a recommended dental treatment. The hardship experience related to having experienced a large financial burden due to the cost of dental care. The aim of this paper is to describe the characteristics of those children who currently experience any financial barriers or hardship and identify those groups who could potentially benefit from this additional government support. METHODS Data source Data presented in this report were sourced from the National Dental Telephone Interview Survey (NDTIS) 2010. The target population for NDTIS 2010 was Australian residents aged two years and over in all states and territories. To select a representative sample of residents a two-stage stratified sampling design was implemented. In the first stage a random sample of households was selected from the Electronic White Pages (EWP). To access the latest version of the EWP, the Australian Institute of Health and Welfare Dental Statistics and Research Unit (AIHW DSRU) requested the Australian Electoral Commission (AEC) extract a sample of Australian adults aged 18 years and over from the electoral roll. These data were matched against the Sensis® MacroMatch database to append a residential telephone number. Matched records that returned either a landline or mobile telephone number formed the basis of the sample frame for the 2010 NDTIS. In the second stage, the sample frame was stratified by state and region, where region was defined as metropolitan or non-metropolitan. Households were randomly selected from each stratum using the inbuilt features of the WinCati software programme (WinCati 4.2 Sawtooth Technologies, Inc.) and contacted by telephone. © 2014 Australian Dental Association
Financial burden of dental care among Australian children If telephone contact was made with a household, the interviewer established whether the telephone number served a residential dwelling. If the household was inscope of the survey an adult aged 18 years or older usually resident in the household was randomly selected for interview. Once an interview was completed with the target adult, if there were children aged 2–17 years usually residing in the household, one child was randomly selected to participate in the survey, with a parent answering the questions on behalf of the child. Data were weighted to account for the different probabilities of selection to reflect the 2009 estimated resident population.4 Sample A total of 6765 adults and 3472 children were interviewed and asked a range of questions relating to their oral health, access to dental care, dental treatment received and affordability of dental care. This article presents findings from the 3472 child interviews. Data items Financial barriers and hardship To assess whether respondents had avoided or delayed visiting a dental professional due to cost, respondents to NDTIS were asked ‘During the last 12 months, have you avoided or delayed visiting a dental professional because of the cost?’. The response categories were ‘yes’ and ‘no’. Respondents who responded ‘yes’ are reported as having avoided or delayed making a dental visit due to cost. To assess whether cost had prevented recommended dental treatment respondents to NDTIS who had made a dental visit in the previous 12 months were asked ‘Has the cost prevented you from having any dental treatment that was recommended by a dental professional at a visit during the last 12 months?’. The response categories were ‘yes’ and ‘no’. Respondents who responded ‘yes’ are reported as having had cost prevent a recommended treatment. To assess whether respondents had experienced a large financial burden from dental visits, respondents to NDTIS who had made a dental visit in the previous 12 months were asked ‘In the last 12 months, how much of a financial burden have dental visits been for you?’. The response categories were ‘none’, ‘hardly any’, ‘a little’ and ‘a large burden’. The responses are reported as ‘experienced a large burden’ and ‘did not experience a large burden’. Respondents who nominated ‘a large burden’ are reported as having experienced a large financial burden from dental costs. If respondents reported either avoiding or delaying visiting a dentist because of cost or cost prevented © 2014 Australian Dental Association
them from having recommended dental treatment or dental visits were a large financial burden in the previous 12 months, they were regarded as having experienced any financial barriers or hardship in the previous 12 months. Child characteristics Experience of the two barriers and one financial barrier are reported by the following child sociodemographic characteristics: gender (male, female), age (2–5 years, 5–11 years, 2–17 years), geographic location (Major cities, Inner regional, Outer regional, Remote/Very remote), annual household income (less than $30 000, $30 000–
