Workforce planning projections conducted by HWA, and based on current utilisation patterns, indicate that extra capacity exists within the oral health workforce.
However a particular problem in assessing the balance between workforce supply and service demand in the dental sector is assessing the underlying level of demand.
Australia's broader health system is underpinned by universal access to public hospitals and Medicare funded services. While there are some problems with access to medical services in some geographical areas, it is reasonable to assume that the level provided is close to the level of demand, and this assumption can underpin estimates of demand for medical services and the workforce supply. By contrast, dental care is largely privately based and funded principally by individuals and to a lesser extent, private health insurance funds and government.
Many people who are unable to access private dental care largely rely on the public system, although some low income earners without concession cards will be ineligible for these services. The Report of the National Advisory Council on Dental Health highlighted the significant barriers for public patients where limited funding constrained access and led to significant waiting times for general treatment. These long waiting times may discourage some people from seeking care, with the result that they do not appear on waiting lists. As a result, it is not valid to assume that workforce supply and underlying demand for services are currently in equilibrium.
Research from the AIHW provides some insight into the potential level of unmet demand. Low income households are more likely to avoid dental care due to cost, have poor visiting patterns and access care less often than high income households. Survey results for different age groups show that between 20 and 37 per cent of people (depending on age) avoided or delayed dental care due to cost2.
Some 11.9 per cent of people aged 15 years and over (or over 2.1 million people) had not visited a dental practitioner in the last 2 years, and a further 8.2 per cent (estimated at around 1.5 million people) had not made a visit to a dental practitioner in the last 5 years3. In other words, almost one fifth of adults visit a dentist less often than necessary for optimum dental care.
In addition, there is a maldistribution of dentists across geographical areas, with most dentists employed in Major Cities (79.7% of all employed dentists), while only 0.9% were employed in Remote/Very remote areas4.
It is therefore important to note that where the report refers to a “supply in excess of demand” it is a reference to supply exceeding the current demand, not unmet demand.
Key points of the Report
Good oral health is an integral part of good general health, and is essential in being able to participate in daily activities without limitation.
States and territories provide most public dental services, however private practitioners provide most dental services in Australia.
The private sector is the only place non-concession card holding adults, and those ineligible for other Commonwealth programmes can access dental care; and these services need to be funded by individuals and families.
Demand for oral healthcare services is expected to grow for reasons including population growth, an ageing population, increased tooth retention, consumer expectations and changing dental service offerings.
Seven alternative workforce planning projection scenarios were developed, examining changes in demand, immigration, the number of graduates, productivity, an existing workforce supply in excess of demand, and existing workforce demand in excess of supply. All scenarios presented the same result – that across the projection period the supply of the oral health workforce is projected to exceed demand.
Differences exist in access to oral health services. Certain populations were identified for specific action in the National Oral Health Plan 2004 – 2013. These were children and adolescents, older people, low income and socially disadvantaged people, people with special needs, Aboriginal and Torres Strait Islander people, and people living in rural and remote areas.
Linkages exist between oral health and dental visiting patterns, with adults who usually made a dental visit at least once a year having fewer missing teeth on average than those who visit less frequently, and individuals who visit regularly more likely to report that their oral health has a positive effect on their quality of life.
It can be assumed if the number of oral health services accessed by those identified populations increased, this would result in improved oral health.
Workforce planning analysis, where expressed demand levels were increased by an arbitrary amount (to reflect potential existing unmet need) for the populations of interest, still results in the supply of the oral health workforce exceeding demand.
This analysis indicates there is scope to effect change and support better oral health outcomes for populations of interest, within the scope of the projected new entrants to the workforce (through domestic education or immigration).
Workforce planning projections were also conducted for dentists (including dental specialists), oral health practitioners (comprised of dental hygienists, dental therapists and oral health practitioners) and dental prosthetists, however it should be noted data limitations exist in assigning demand to individual workforces.
Australia’s Future Health Workforce (AFHW) provide medium to long-term national workforce planning projections for different professions and sectors. Workforce planning projections identify potential gaps between the future supply of, and demand for, the workforce in scope under a range of scenarios. A scenario represents a particular vision of future healthcare delivery, and in the health workforce context, scenarios are often developed to reflect potential government policy decisions, higher education/training sector activities, employer practices, trends within the existing health workforce and trends within service demand.
The identification of potential workforce gaps through workforce planning projections provides government, professional bodies, employers, and higher education and training providers the opportunity to develop and implement plans to minimise such gaps. Such plans can involve workforce reform, changes to training intakes or pathways, changes to immigration levels, or a combination of all factors. It is this step that is essential in the delivery of a sustainable health workforce.
AFHW focuses on workforce planning at the national level. It is at this level that questions of aggregate supply and demand can be separated from issues of allocation and distribution – the principal aim being to ensure an appropriate pool of professionals is available to meet aggregate demand in Australia.