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OPINION: The problem of poor oral health lurked like an unwanted guest during this election campaign. Fancy dental policy was to be part of Labor’s reelection speech, before that other brighter health crisis got in the way.
But cavities don’t fill in on their own just because everyone is worried about a bigger problem. During the press leaders’ debate, Dr. Arun Natarajan, the Canterbury DHB pediatric dentistry clinical leader, told Labor and national leaders that each year 8,000 children must undergo dental extractions that require general anesthesia, at a cost of $ 4000 for each operation. or $ 32 million a year.
This weekend, Three’s The Hui found that people in the Northland town of Kaikohe were in so much pain that they were removing their teeth with pliers.
Like many public policy problems, health straddles the moral line between personal responsibility and the genetic or dispositional lottery. Oh, to be born with a supernatural enthusiasm for tooth brushing and a revulsion for sweets!
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Any solution should not give up hope for a change in behavior (less sugar, more brushing), but should focus on providing care to those who need it.
National’s election policy of bringing kids toothbrushes and getting them brushed was a good start: ambulance, cliff, and all that.
But the problem is bigger than that. And designing a health system, as we have learned this year, is about figuring out how to manage when things go wrong, as is inevitable.
Decentralization makes it difficult to calculate how much money is spent on oral health, but in 2018 our 20 DHBs spent $ 197.2 million on oral health. Of that, community oral health services cost $ 98.4 million, adolescent dental care $ 42.17 million, hospital dental care $ 49.68 million and emergency dental services for low-income individuals cost $ 7 ,45 millions.
It is not a small amount of money, but it is nothing sweet within the total health budget, which came to just $ 17 billion that year (now over $ 20 billion).
So how much could we spend on dentistry if a drunken finance minister decided to tax our path to better oral health?
The answer is not much. The Stats NZ national accounts for 2018 (these are the figures we use to calculate GDP) place the dental services industry at between 0.2 and 0.5 percent of GDP, or around $ 600 million to $ 1.5 billion.
Chris Skelton / Stuff
New Zealand faces a growing dental crisis.
That number should be handled with a little care, but it is in addition to the $ 1.5 billion the Dental Association believes is spent on private dental care, and Stats NZ’s other business survey, the Annual Business Survey, said that dental services had revenues of $ 990m last year, right in the middle of that range.
If we wanted to effectively nationalize the private costs of dental care, we would essentially have roughly 2,000 private dental companies in the country billing Grant Robertson for roughly $ 1.5 billion a year.
That, of course, is not what we would like to do. The $ 1.5 billion figure likely includes a fair amount of cosmetic dental care, which the smiling dwellers of our leafier suburbs can continue to pay for themselves, thank you very much.
But it doesn’t include the increased demand for services you would see if dental care were free. More people would see their dentist, increasing the cost to the Crown.
For starters, health chiefs could try something like a free annual checkup, plus the basic procedures (fillings, wisdom teeth, the whole ghastly gallery) for all fillings without the fancy state-backed dental services.
It would be possible to test the resources of the scheme, using something like a community services card.
Better yet, you could base the system on a partial subsidy, like the system we use for GPs. Everyone would pay, but less than now. Price signals remind us that all resources are in short supply, and in the case of dental care, they remind us that it might be a good idea to pick up a toothbrush every now and then. The problem with today’s dental regimen is that you can’t tell the difference between a price signal and a cost barrier.
It is expensive, but not prohibitive. A $ 600 million to $ 1.5 billion package pushes the ceiling on what is politically and fiscally possible. The draft Labor tax plan set the government’s operational appropriations of $ 2.6 billion for the next four years. The dental plan would consume more than half of that, leaving very little room for more Budget sweeteners (although given the oral health issue, sweeteners are likely out anyway).
At that point, a government would have to consider opportunity costs. You could throw in $ 1 billion in dental care, or you could see what Pharmac could get out of pharmaceutical companies on a budget twice what it is now.
Or, let’s say you wanted to have your cake and eat it too (don’t tell your dentist), there’s always the option of earning a little extra income. If the cannabis referendum passes, the economics agency BERL estimates that the state could get $ 640 million a year in excise taxes and $ 180 million a year in additional GST, more than enough to at least try to reform funded dental care. For the state.
