The Medicare dental scheme has caused a huge increase in the number of dental care complaints in Victoria in the last year, according to the annual report of the Office of the Health Services Commissioner.

Commissioner Beth Wilson reports that misunderstandings about how much dental care costs are to blame for the 43% increase in complaints.

Wilson said:  “There is a lot of misunderstanding around how much dental care costs … and a lack of proper informed financial consent.”

But the underlying problem would seem to be a strong need for dental treatment, and under-funding by federal Government, meaning that the limited provision for dental treatment under Medicare is struggling to cope.

The Medicare chronic disease dental scheme was introduced in November 2007 and is available for people with chronic conditions and complex-care needs.

Complex-care needs must be present for at least six months and can include conditions such as asthma, cancer, cardiovascular illness, diabetes mellitus, arthritis, mental illness, musculoskeletal conditions and stroke, according to a release by Medicare Australia. The patient must also already be receiving treatment from their GP and at least two other health care providers. The scheme is limited to concession card holders, reducing the eligibility to 34% of the adult population.

Despite two attempts in 2008 by the government to end the scheme, patients are still eligible to receive up to $4250 worth of dental work over two calendar years if all requirements are met.

But according to the Health Services Commission report, typical complaints include patients who have used up their Medicare entitlements but still need more dental work done. In one case study in the report, a woman was referred by her doctor to the dentist after years of neglect because she had not been able to afford dental care.

She had severe gum disease, and also needed crowns and dentures. The first part of treatment — for gum disease — used up all her benefits, and she was informed she would have to wait another year before becoming eligible for more treatment under the program.

In another case, a patient travelled for more than half an hour to their dental surgeon, only to be turned away because of an administrative issue. The transport was subsidised, and the Medicare money was used up on that.

Under the Medicare dental scheme, rebates cannot be claimed for dental treatment provided by public dental clinics or where the patient is an in-patient in a hospital.

In Australia, 86% of dentists work in the private sector, where they alone determine location, hours worked and fees charged.

There has been controversy over the scheme with The Age reporting 11 fraudulent dental providers claiming more than $7 million in work not actually provided, and a further 250 dentists yet to be investigated.

It is unclear what percentages of the claims being investigated are fraudulent until figures are released from the Medicare Australia taskforce.

The Health Services Commission is still undergoing a further analysis into the increase of dental complaints identified in its annual report.

The federal president of the Australian Dental Association, Dr Neil Hewson, told Crikey: “The ADA has been lobbying the government for quite some time to put more funding into the dental system.

“Decay, gum disease and oral cancer are almost entirely preventable; we’d like to see the government spend more on oral education.”

The federal Labor Government has also stated that its planned Commonwealth Dental Health Program will not be implemented “until we can abolish this scheme”.

In 2007 the costs of the scheme were estimated to be $377 million over four years. However, these quickly blew out. In 2009 alone claims by dentists exceeded $484 million.

Peter Fray

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