Dental care – the great gap in our subsidised healthcare system

I live in a good place when it comes to health care access. Most things are either heavily subsidised or free. One of the glaring omissions, however, is dental care. It’s a huge gap in our system, one that’s costing us in terms of quality of life, as well as in the economic terms to loved by the government. Poor dental health has been linked to heart disease, diabetes, dementia, and more, things which make people pretty miserable as well as costing our free health system a tidy pile of cash.

Basic dental health care is provided through community-based clinics for children up to age 13, and through private dental practices until age 18. Other than these provisions, special dental services like those for cleft palate are provided free of charge for life, and emergency pain relief and extractions are available for people on low incomes. ACC provides for dental services as a result of injury, and in some lucky places, the DHB funds basic dental services for low-income adults.

What all that means is that dental care for adults is patchy. If you’re in an accident then you’ll be ok (usually – ACC can be a bit odd at times). If you’re in absolute agony the hospital will see you – but only for pain relief and extraction, and you may have to pay a part charge. I’m not sure what the services are like in the DHBs that fund basic adult services, but I assume they’re similar to the providions for under-18s – cleaning, fillings, extractions. It’s not a huge range, but it’s covering the basics, and that’s a huge step up from the nothing offered in other areas.

Dental issues are painful. They impact severely on quality of life. Constant pain makes it hard to eat and hard to concentrate. It puts you on edge and wears away your patience. It’s unpleasant for you, and can make you unpleasant to other people. It’s a pretty big social cost, and one that’s pretty unnecessary. Basic dental health care is as important as good primary health services – it should be part of the primary health care package.

Dental treatment is far too expensive for low-income families. When you’re so poor that taking the kids to the doctor is often out of reach, preventative dental treatment is way out. WINZ offer a dental grant of $300 per year for urgent dental treatment, and this is useful for a dental crisis, when the pain gets so bad that it can’t be endured. It’s just about enough to get a tooth pulled. but it’s well short of what you’ll need to save that tooth with a root canal.

I would think that, given the extra health costs associated with dental ill health, it would be a cost-effective intervention to provide free basic dental care for all low-income adults. Something along the lines of ‘if you have a community services card it’s free’. I would want to extend that to everyone, but in the interests of keeping the bean-counters happy, low-income people are a good start. Less heart disease, fewer diabetes complications, less dementia – these will all save the government money and help fund the programme. Or at least, it would work that way in my ideal world.

I feel very wrong justifying the basic right of free dental care by appealing to other cost savings. We acknowledge that health care is a basic right, why not dental health care? Why is dental care still the preserve of the well-off? New Zealanders deserve better.