Dental health services in Australia: the impact of the Chronic Disease Dental Scheme

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A notable omission of Australia’s Medicare program is universal adult dental services. In 2007, Medicare was expanded to cover dental services for those with a chronic condition or complex care needs through the Chronic Disease Dental Scheme (CDDS). This program provided subsidised services through the Medicare Benefits Schedule (MBS). The cost of the CDDS to the Commonwealth Government exceeded initial estimates and there were claims it was misused and it was poorly targeted. It was subsequently closed in 2012. While the CDDS was time-limited, it was an important program as it represented an expansion of public health insurance through Medicare to a select group. There are four empirical studies in this thesis. Studies one to three use quasi-experimental analyses to provide causal insights into the program and study four uses survey data linked to Medicare data to provide insights into a known cohort of CDDS recipients to identify their characteristics. In studies one to three there is no increase in the probability of a dental visit for those who were eligible for the CDDS as compared to those who were not eligible. The analysis into the characteristics of those who received a CDDS service found a positive association between those who were concessional or experiencing financial hardship or with poorer overall dental health status and a CDDS service, suggesting services went to those who could be considered in need. This study also found those living in inner regional and outer regional, rural and remote areas received fewer CDDS benefits. This absence of any increase in the probability of a dental visit are surprising especially given the large budgetary overspend by the Commonwealth Government. The results of the linked data study show that as opposed to criticisms that the CDDS was not targeting those in need, those who were more likely to have received a service could be considered to be in need of subsidised dental services. Further, an overview of the costs of CDDS services show most costs went toward higher cost restorative services, which may be needed to improve dental health status. Overall, the conclusion of this thesis is that the benefit of the CDDS, while not necessarily increasing a dental visit in non-attendees, may have been to allow recipients, particularly those with poorer dental health status and those with financial difficulties or concessional patients, to receive dental benefits that they previously may not have been able to afford.
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