What would it cost to give everyone free checkups at the dentist?

A universal dental scheme for Australians would cost the Commonwealth about $12 billion a year, while subsidising a capped amount of preventative dental work would amount to less than $3 billion, according to a range of dental reform options handed to the federal government.

The Parliamentary Budget Office has costed eight potential ways of expanding Medicare to improve Australians’ access to dentistry as part of a Senate inquiry that late last year called on the federal government to fix the country’s two-tiered dental system.

Capped or uncapped: the parliamentary budget office has costed eight ways to subsidise dental care in Australia.Credit: iStock

The Greens-led inquiry – which included two Labor and two Coalition senators – recommended the government work with states and territories to achieve universal dental access in stages, either by expanding Medicare or introducing a similar scheme for essential oral health care that started with priority groups.

Federal Health Minister Mark Butler will be required to respond to the findings after Parliament returns this year.

There were eight ways identified to expand Medicare subsidies for dental services: four systems, with a capped and uncapped version of each with predicted annual costs.

In the capped systems, the rebates would be modelled off the Child Dental Benefits Schedule, which is offered to families on income support. It offers an indexed rebate, currently $1095, over two calendar years for basic dental services. In the others, rebates would not be limited.

The first reform option was for a universal dental scheme available to all Medicare cardholders, under which they would be eligible for services ranging from check-ups and cleans to fillings, root canals and extractions.

A capped version of that universal scheme would cost the federal government more than $8.3 billion after five years, when the scheme would be fully realised, while the uncapped version – the most expensive of the options – would cost about $11.6 billion.

The second option was a means-tested system. The same range of dental services would be subsidised, but only for healthcare cardholders, pensioners and people on government income support. Limiting rebates under that scheme would cost almost $3 billion, while an uncapped means-tested scheme would cost about $4 billion.

The third system would be a seniors dental care scheme, which would offer coverage to people who hold Commonwealth seniors health cards, pensioner concession cards, and those over 65 with a healthcare card. The capped version of the scheme would cost about $1.7 billion; the uncapped about $2 billion.

The final option – a preventative scheme – would apply to all Medicare cardholders but only cover diagnostic and preventative dental services. Capping the rebate in this system would cost the government about $2.7 billion, while uncapped it would cost about $3.8 billion.

The budget office said all its costings assumed the scheme would be gradually phased in over five years.

At that point, it estimated that 85 per cent of Australians would use Medicare-subsidised dental services – a statistic that mirrors costings of similar schemes in Canada, and a significant uptick as roughly half of Australians say they see a dentist only once a year under the current system.

The projection draws on Australian data and assumes some people still won’t go to the dentist because they don’t think it’s important, have logistical or physical barriers, or hate going.

Any of the reform options would be a major change to the way Australians access dental services and a huge new expense for the government. Currently, people are paying an average of $230 for a standard check-up and clean at the dentist in a system that leaves consumers responsible for the bulk of dental costs.

Of the $11.1 billion spent on dental in Australia in the 2020-21 financial year, almost 60 per cent ($6.5 billion) was paid for directly by consumers, compared to an OECD average of 17 per cent.

Private health insurers covered 20 per cent ($2.2 billion) while the federal government ($1.4 billion) and state and territory governments ($950 million) made up the rest.

Most of the federal government’s contributions go to private health rebates ($775 million), followed by the children’s dental benefits scheme ($337 million), while the states fund public dental services for people with healthcare or concession cards that have a median wait time of 189 days.

By comparison, Medicare and the National Disability Insurance Scheme – two of the Commonwealth’s fastest-growing budget expenses – cost $31 billion and $37 billion last financial year, respectively.

The Senate inquiry’s final report described a two-tiered system for oral health and dental care.

“Around half of Australians have acceptable oral and dental health, and adequate access to services, and the other half do not,” it said.

“Evidence to the inquiry revealed a private dental system that is unaffordable for many, and a public dental system under severe strain. These problems have been known for decades, but responses have been ad hoc or piecemeal.”

The United Kingdom’s National Health Service offers a variety of reimbursements for dental services, while Canada is introducing a dental care safety net under which uninsured Canadians with a household income of less than $A80,000 will receive full coverage.

A spokeswoman for Butler said the government is considering the final Senate report and preparing a response to its recommendations.

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