Inequalities in the utilisation of the Child Dental Benefits Schedule between Aboriginal* and non-Aboriginal children
Neil Orr A B D , Kylie Gwynne A B , Woosung Sohn C and John Skinner
A
A Poche Centre for Indigenous Health, Edward Ford Building (A27), The University of Sydney, 2006. Email: kylie.gwynne@sydney.edu.au; john.skinner@sydney.edu.au
B The Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, NSW 2109, Australia.
C Sydney Dental School, Westmead Centre for Oral Health, Darcy Road, Westmead, NSW 2145, Australia. Email: woosung.sohn@sydney.edu.au
D Corresponding author. Email: neil.orr@sydney.edu.au
Australian Health Review 45(3) 274-280 https://doi.org/10.1071/AH20028
Submitted: 17 February 2020 Accepted: 16 October 2020 Published: 5 February 2021
Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND
Abstract
Objectives The Child Dental Benefits Schedule (CDBS) is an Australian Government initiative providing basic dental care to children from low-income households. We sought to investigate levels of utilisation of the CDBS among Aboriginal and non-Aboriginal children to determine whether there is equal access to dental services provided through the schedule.
Methods CDBS data were obtained for four financial (July–June) years (from 2013–14 to 2016–17). The data captured all claims made during this period. The data included estimates of usage by Aboriginal status, age group and Dental Benefits groups (administrative categories of related dental procedures).
Results The utilisation of CDBS services was lower for Aboriginal children. However, in 2013–14, although the odds of using the schedule were higher for non-Aboriginal children (odds ratio (OR) 0.89; P < 0.0001) this was reversed in 2015–16 and 2016–17 (OR 1.11 and 1.21 respectively; P < 0.0001 in both years). The odds of Aboriginal children using preventive services was below that of non-Aboriginal children in 2013–14 (OR 0.82), 2014–15 (OR 0.76), 2015–16 (OR 0.83) and 2016–17 (OR 0.90; P < 0.0001) in all years.
Conclusions The data are encouraging with regard to equity because they show that for services overall, Australian Aboriginal and non-Aboriginal children have similar levels of utilisation. However, lower levels of the use of preventive services may indicate future inequalities in oral health among Aboriginal children.
What is known about the topic? The CDBS is an Australian Government initiative aimed at improving access to dental care for children from low-income households, including for Aboriginal people. By facilitating greater access to dental care, the schedule has the potential to help address inequalities in oral health for both Aboriginal and non-Aboriginal children.
What does this paper add? There are no analyses available comparing the utilisation of the CDBS by Aboriginal and non-Aboriginal children. This study compared levels of utilisation of the schedule overall and specifically for preventive services.
What are the implications for practitioners? Greater efforts should be made to address inequalities in the utilisation of the CDBS between Aboriginal and non-Aboriginal children. Although there are some hopeful signs, inequalities remain that may affect the oral health of Aboriginal children. There is also potential to encourage utilisation of the CDBS for greater provision of preventive services, including targeted population oral health initiatives.
References
[1] Ha DH, Roberts-Thomson K, Arrow P, Peres KG, Do LG. Children’s oral health status in Australia, 2012–14. In: Do LG, Spencer AJ, editors. Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide: University of Adelaide Press; 2016. pp. 86–152.[2] Christian B, Blinkhorn AS. A review of dental caries in Australian Aboriginal children: the health inequalities perspective. Rural Remote Health 2012; 12 2032
| 23098560PubMed |
[3] Australian Institute of Health and Welfare (AIHW). Oral health and dental care in Australia. Catalogue no. DEN 231. Canberra: AIHW; 2019. Available at: https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia [verified 21 July 2020].
[4] Australian Medical Association (AMA). AMA report card on Indigenous health. 2019. Available at: https://ama.com.au/sites/default/files/documents/2019_AMA_Report_Card_on_Indigenous_Health_0.pdf [verified 16 December 2020].
[5] Butten K, Johnson NW, Hall KK, Anderson J, Toombs M, King N, O’Grady K‐AF. Risk factors for oral health in young, urban, Aboriginal and Torres Strait Islander children. Aust Dent J 2019; 64 72–81.
| Risk factors for oral health in young, urban, Aboriginal and Torres Strait Islander children.Crossref | GoogleScholarGoogle Scholar | 30375649PubMed |
[6] Williams S, Jamieson L, MacRae A, Gray C. Review of Indigenous oral health. Aust Indigen Health Bull 2011; 11 1–17.
[7] Durey A, McAullay D, Gibson B, Slack-Smith L. Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia. Int J Equity Health 2016; 15 4
| Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia.Crossref | GoogleScholarGoogle Scholar | 26754073PubMed |
[8] Butten K, Johnson NW, Hall KK, Toombs M, King N, O’Grady K‐AF. Impact of oral health on Australian urban Aboriginal and Torres Strait Islander families: a qualitative study. Int J Equity Health 2019; 18 34
| Impact of oral health on Australian urban Aboriginal and Torres Strait Islander families: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 30777079PubMed |
[9] Department of Health. Guide to the Child Dental Benefits Schedule. Version 7. Canberra: Commonwealth of Australia; 2018. Available at: https://www.health.gov.au/internet/main/publishing.nsf/content/42FC28F2797C4A10CA257BF0001A35F6/$File/CDBS%20Guide%20v7%20-%201Jan2018.pdf [verified 4 June 2019].
[10] Services Australia. Child Dental Benefits Schedule. Available at: https://www.servicesaustralia.gov.au/individuals/services/medicare/child-dental-benefits-schedule [verified 5 May 2020].
[11] Department of Health. Report on the second review of the Dental Benefits Act 2008. Canberra: Commonwealth of Australia; 2012.
[12] The Australian Auditor-General. 2015–16 Performance audit: administration of the Child Dental Benefits Schedule. Australian National Audit Office Report No. 12. Canberra: Australian National Audit Office; 2015.
[13] Department of Health. Report on the third review of the Dental Benefits Act 2008. Canberra: Commonwealth of Australia; 2019.
[14] Australian Institute of Health and Welfare (AIHW). Access to health services for Aboriginal and Torres Strait Islander people. Catalogue no. AIHW 46. Canberra: AIHW; 2011.
[15] World Health Organization (WHO). The world health report 2008: primary health care now more than ever. Geneva: WHO; 2008.
[16] Pourat N, Choi MK, Chen X. Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures. J Public Health Dent 2018; 78 203–13.
| Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures.Crossref | GoogleScholarGoogle Scholar | 29405300PubMed |
[17] Department of Health. Voluntary Indigenous Identifier (VII) Framework: A framework for the collection, release, use and publication of VII data (Draft for Consultation). Canberra: Commonwealth of Australia; 2020. Available at: https://apo.org.au/sites/default/files/resource-files/2020-11/apo-nid309291.pdf [verified 18/12/2020]
[18] Australian Dental Association. The Australian Schedule of Dental Services and Glossary. St Leonards, Australian Dental Association; 2017. Available at: https://www.ada.org.au/Dental-Professionals/Publications/Schedule-and-Glossary/The-Australian-Schedule-of-Dental-Services-and-(1)/Australian_Schedule_and_Dental_Glossary_2015_FA2_W.aspx [verified 18 December 2020].
[19] Australian Bureau of Statistics Catalogue No. 3238.0, Estimates and Projections, Aboriginal and Torres Strait Islanders 2001–2026; 2014. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/second+level+view?ReadForm&prodno=3238.0&viewtitle=Estimates%20and%20Projections,%20Aboriginal%20and%20Torres%20Strait%20Islander%20Australians~2001%20to%202026~Previous~30/04/2014&&tabname=Related%20Products&prodno=3238.0&issue=2001%20to%202026&num=&view=& [verified 18 December 2020]
[20] Australian Bureau of Statistics Catalogue No. 3101.0, Australian Demographic Statistics. Estimated Resident Population by Single Year of Age, Australia; 2019. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Jun%202019?OpenDocument [verified 18 December 2020]
[21] Putri DE, Kruger E, Tennant M. Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme. Aust Health Rev 2020; 44 304–9.
| Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme.Crossref | GoogleScholarGoogle Scholar | 31648675PubMed |
[22] National Advisory Committee on Oral Health. Healthy mouths, healthy lives: Australia’s National Oral Health Plan 2004–13. Canberra: The National Advisory Committee on Oral Health; 2004.
[23] Campbell MA, Hunt J, Walker D, Williams R. The oral health care experiences of NSW Aboriginal Community Controlled Health Services. Aust N Z J Public Health 2015; 39 21–5.
| The oral health care experiences of NSW Aboriginal Community Controlled Health Services.Crossref | GoogleScholarGoogle Scholar | 25560833PubMed |
[24] Morgenstern H. Ecologic studies. In: Rothman KJ, Greenland S, editors. Modern epidemiology. 2nd edn. Philadelphia: Lippincott-Raven; 1998. pp. 459–480.
[25] Teng T-HK, Katzenellenbogen JM, Geelhoed E, Gunnell AS, Knuiman M, Sanfilippo FM, Hung J, Mai Q, Vickery A, Thompson SC. Patterns of Medicare-funded primary health and specialist consultation in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease. Int J Equity Health 2018; 17 111
| Patterns of Medicare-funded primary health and specialist consultation in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease.Crossref | GoogleScholarGoogle Scholar |
[26] Schütze H, Jackson Pulver L, Harris M. The uptake of Aboriginal and Torres Strait Islander health assessments fails to improve in some areas. Aust Fam Physician 2016; 45 415–20.
| 27622233PubMed |
[27] Angell B, Laba T-L, Lung T, Brown A, Eades S, Usherwood T, Peiris D, Billot L, Hillis G, Webster R, Tonkin A, Reid C, Molanus B, Rafter N, Cass A, Patel A, Jan S. Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease. Int J Equity Health 2017; 16 108
| Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease.Crossref | GoogleScholarGoogle Scholar | 28645284PubMed |
[28] Department of Prime Minister and Cabinet. Closing the Gap Report 2019. Canberra: Commonwealth of Australia; 2019. Available at: https://www.niaa.gov.au/sites/default/files/reports/closing-the-gap-2019/sites/default/files/ctg-report-20193872.pdf?a=1 [verified 4 June 2019].
