Dental Asia November/December 2023

UNDER THE SPOTLIGHT
problem, plus you need the political will to
make it happen.”
AN ORAL HEALTH CRISIS
In New Zealand, dental care is fully
subsidised by the state for all children
ages 0-18 through the Community Oral
Health Service and through private
practices utilising the Combined Dental
Agreement (CDA). Funding becomes
private after these ages except for some
community sections such as special
needs patients and hospital inpatients
oral cancer treatments.
The policy proffered by the NZDA in
dealing with the crisis since before
the pandemic and global inflationary
pressures was to raise the age cutoff for
state-subsidised dentistry to age 25.
“Across the board, evidence shows a big
drop off in accessing treatment after
age 18. We find that people in the young
adult age group are not accessing dental
treatment, not having routine care, and
is the highest proportion age group that
requires acute hospital treatment for
dental disease that could have been
prevented,” Dr Johnston said.
She felt that targeting this demographic
would be effective as it would provide
early diagnosis and treatment for
preventable diseases.
“Through your life, it is hard to change
your oral health status. People who have
poor oral health at age 20 are likely to
have poor oral health at age 50 and at
age 70 because dental diseases are
cumulative. If you have made it to age 25
with a minimal amount of dentistry, you
have had good preventative programmes
established and a much better chance of
maintaining good oral health through the
rest of your life,” she added.
In addition to increasing the coverage
for dental care, being heard and seen
in the parliament is just as important.
“Our department has gotten smaller
and smaller. Now we have one national
clinical director of oral health who works
three days a week, who is the oral health
voice in the Ministry of Health in New
Zealand,” Dr Johnston said.
The system of district health boards
was abolished about a year before as
the preceding government initiated a
“complete overhaul” of the health system
by establishing a co-governance model
with Health New Zealand and the Māori
Health Authority. Dr Johnston described
the current system for oral health as
being “diluted” through the whole health
system.
“At the moment, the current system that
they have reestablished has oral health
split into public health, community
service and surgical service. Within
the Ministry of Health in the past 10-15
years, there has been a significant
decrease in the voice of oral health,”
Dr Johnston said. “We are really keen
to try and get a bigger workforce at
the national government level, and
to have a better voice and better
presence in the central government.”
A recent success in NZDA advocacy
was the increase in non-recoverable
payment for patients on benefit from
NZ$300 to $1,000 per year, under the
Emergency Dental Needs Grant from
the Ministry of Social Development.
However, Dr Johnston stressed that a
“significant uplift in funding” was first
needed before more workload can be
expected to be put on the dental table.
She was referring to the strain put
on the operation of dental practices
by the CDA funding model, which
many dentists view as a “community
service”.
“The CDA is basically a capitation
system with a minimal fee-for-service
added on, where the funding is about
50% of what our private patients pay.
But because we want to keep patients
in our practice and keep them healthy,
most of us in our communities are
treating patients and expect to barely
cover the treatment cost. We need
to have that system revised and the
funding brought into line,” she said.
MAKING A CHANGE
In the NZDA’s fight to resolve the
crisis, Dr Johnston noted that it
requires a “combination” of drivers
beyond legislation, including
community partners and public
mindsets, to implement preventative
strategies that would alleviate
pressure on the public oral health
system.
Dr Johnston believes funding is needed before practitioners can manage an increase in work capacity
(Image: NZ Herald)
“It is ideal if you can get good
preventative strategies that help to
prevent disease. The cost is limited
for the government, so they are the
winners if we can get less disease out
there. It also has benefits throughout
every age group, where they can
be influenced and hopefully helped
across the board. My personal view is
DENTAL ASIA NOVEMBER / DECEMBER 2023 19