Bryce Edwards: Political Roundup - is it time for Labour to introduce public dental care?

The public would surely welcome transformation in this area when Andrew Little carries out his health reforms, writes Bryce Edwards. Photo / 123RF

OPINION:

Dental care is out of the financial reach of a large proportion of our population. At the moment about half of the public put off trips to the dentist due to the burden of paying in a private system.

With the Labour Government currently struggling to enact a programme of transformation, risking the loss of its traditional working-class constituency, perhaps it's time for it to introduce their promised free dental care for adults. Health Minister Andrew Little could fold dental services into the public health system, fixing the historic anomaly in which dentistry has been treated as separate from the rest of the health system.

Such a merger would cost Grant Robertson's Budget a hefty amount, but making dental care universally available would be of immense benefit to poor and ordinary New Zealanders. This could be seen as something of a reward for the hard work in carrying the country through the Covid crisis, and as some sort of partial justice to balance the explosion of inequality that has resulted from Covid policies. It is estimated that about $1 trillion has been transferred to the wealthy in the past two years.

Such a transformative policy would be a true legacy for this government, which must be looking especially attractive now, as the likelihood of Ardern's administration being a two-term government increases. Covid aside, Labour and Jacinda Ardern have nothing much else for the history books.

In fact, making adult dental visits free is Labour Party policy – it was adopted by the party in 2018. Since then, the various ministers of health and the Prime Minister have dragged their feet, seemingly embarrassed by the lack of progress in implementing the policy. At the last election, Ardern said that it would be too expensive, saying "We need to prioritise" blaming the cost of the pandemic.

At the same time, the Government fought to keep the estimated cost of better public dental care secret. There was an attempt to bury a Ministry of Health report which showed that full universal dental care would cost $648 million a year. The report also indicated that if the Government simply extended free dental care for children until the age of 28, the cost would be only $96m.

Instead, Labour promised that, if it was re-elected, emergency dental grants for beneficiaries would be increased from $300 to $1000. Even this has not been implemented.

The health portfolio has shifted from David Clark to Chris Hipkins to Andrew Little, and each new health minister has to make excuses for not fixing a historic anomaly that is causing serious damage to New Zealanders' health.

And the crisis is getting worse. There are continued reports of skyrocketing emergency admissions to hospital of people who can't afford to see the dentist for minor problems that turn into major ones. Last year, more than 6000 people went to hospital emergency departments for problems that should have been fixed earlier by a dentist.

A New Zealand Medical Journal study released last week showed that nearly 1 per cent of emergency department patients turn up because they can't access dental care, and that this is putting a strain on ED resources.

The notion of public dental health has also just received a push with the publication this week of a cover story in the April edition of North & South titled "The Shocking State of Dental Care", by Helen Glenny. You can read an 800-word preview of this online.

This must-read article explains that when New Zealand's public health system was established, lobbyists for the private dental sector successfully pushed the Government to exclude dentistry from the system, so that they could carry on without competition. The compromise was to only fund public dental care for those under the age of 18.

The article argues that: "Dental care in New Zealand is the gaping abyss in our health system." It interviews dental health scholars who say free dental care for children has had a remarkable impact on lowering dental inequality. Prof Jonathan Broadbent at Otago University is quoted saying: "By the age of 26, a few short years after a publicly funded system finishes, [the inequalities] open up, and they open up really wide."

Researchers say there are large returns to be made from government investment in public dental care. For example, according to Glenny's North & South article, the New Zealand Dental Association calculates: "The government could expect $1.60 returned on every dollar spent. This would come from savings to DHBs by reducing oral health issues that have to be treated in hospitals – as well as the tax revenue from increased productivity, given the impact of dental problems on employment."

Meanwhile, a 2018 recent study shows "dental inequality" in New Zealand is worse than in comparable countries such as Australia, Canada and the United States.

So is it time to get rid of the user-pays system, and bring it under the public hospital system? It would certainly be popular. A recent Colmar Brunton survey showed that 64 per cent of the public backs free dental care.

The public are very happy to pay taxes for other parts of the welfare system to be universal – especially other elements of primary health care – and they would surely welcome transformation in this area when Andrew Little carries out his health reforms.

• Dr Bryce Edwards is Political Analyst in Residence at Victoria University of Wellington. He is the director of the Democracy Project.