What workforces deliver oral health services?
Australia’s oral health workforce is comprised of a broad mix of care providers and support workers providing services to consumers through the public and private sectors. The following registered1 and unregistered occupations provide oral health services in Australia.
Dentists – which includes general dentists and dental specialists
Oral health therapists
A detailed description of oral health workforce roles is provided in Appendix D.
Health Mouths, Healthy Lives – Australia’s National Oral Health Plan 2004 – 2013 guided efforts to improve oral health in Australia. This plan was supported by Commonwealth, State and Territory Health Ministers, and aimed to ‘improve health and wellbeing across the Australian population by improving oral health status and reducing the burden of oral disease’. The Plan identified workforce development as an action area, calling for consistent national planning across all states and territories and an understanding of the appropriate aggregate number and mix of oral health professionals. Additionally, it identified the following as specific action areas: children and adolescents, older people, low income and socially disadvantaged people, Aboriginal and Torres Strait Islander peoples, those with special needs and people living in rural and remote areas.
With the current plan reaching the end of its lifespan, the Standing Council on Health, through the Australian Health Ministers’ Advisory Council, has tasked the National Oral Health Plan Monitoring Group to develop a new national plan for the period 2014-2023. This is currently underway, and is expected to be signed off in 2014.
In 2009, the National Health and Hospitals Reform Commission (NHHRC) report A healthier future for all Australians identified improved access to dental healthcare as a priority under the reform goal to tackle ‘major access and equity issues that affect health outcomes for people now’. Recommendations from this report included a new universal scheme for access to basic dental services, internships for graduating dentists and oral health professionals to provide broader clinical experience and training, as well as to expand the public dental workforce, and the national expansion of preschool and school dental programmes.
In 2011, the National Advisory Council on Dental Health was established to provide strategic, independent advice on dental health issues. This informed the development of new dental measures in the 2012-13 Budget and the measures announced in August 2012 by the then Minister for Health (outlined in the Mid-Year Economic and Fiscal Outlook 2012-13).
In the 2012-13 Budget, $344 million was allocated to the NPA on Treating More Public Dental Patients. The programme runs over three years from 2012-13 until 2014-15 and has a national target to treat an additional 400,000 public dental patients.
The Government also committed to the NPA on Adult Public Dental Services, which will provide public dental services to adult public dental patients, as announced in August 2012 by the then Minister for Health (outlined in the Mid-Year Economic and Fiscal Outlook 2012-13). The Child Dental Benefits Schedule was implemented from 1 January 2014.
How does HWA assess oral health workforce requirements?
This section presents HWA’s workforce planning projections for the total oral health workforce. Firstly, summary information on the projection methodology and planning scenarios used to generate the results is presented, along with an outline of the workforces included in the oral health projections. This is followed by the workforce planning projection results.
Workforce planning methodology
Workforce projections require two components – estimating future workforce supply and estimating future demand for the workforce.
A detailed discussion of the methodology used in AFHW – Oral Health is contained in the HWA publication Health Workforce 2025 – Oral Health, Supply and Demand Methodology13. This is followed by a brief summary of the methodology used to generate the oral health workforce planning projections.
Projecting future workforce supply
AFHW – Oral Health used a dynamic stock and flow model to estimate future workforce supply at national level in Australia. The four key inputs in the dynamic stock and flow model were:
Workforce stock (in five-year age and gender cohorts)
Domestic new entrants
Migration (permanent and temporary)
Net exits, which included all permanent and temporary flows out of the workforce.
In the stock and flow method, the number and characteristics of the current workforce (stock) are identified, along with the sources and number of workforce inflows and outflows. Trends or influences impacting on the stock and flows are also identified, including the effect of people ageing.
To project future workforce supply, the initial workforce stock is moved forward based on expected inflows and outflows, allowing for the impact of identified trends and influences on the stock. This is an iterative calculation for each year over the projection period, and provides for a more realistic representation of labour market dynamics.
Projecting future workforce demand
Demand projections employed the utilisation method – which measures expressed demand – and are based on utilisation patterns as they currently exist for population five-year age and gender cohorts. Any potential unmet need is not accounted for in the demand projections.
Utilisation data was matched against age and gender cohorts, and once mapped, was projected against future demographic structures.
For the total population, the expressed demand rate for the comparison scenario was calculated based on the growth in the number of visits between 1994 and 2010, using data from the ARCPOH NDTIS. This was calculated to be 2.55 per cent. It should be noted that in calculating this rate, demand attributable to the CDDS (which closed from 1 December 2012) was, as much as possible, removed from the calculation. This was done to provide a more realistic representation of future workforce demand, and this approach was supported by HWA’s Oral Health Clinical Advisory Group and Project Advisory Group.
Using the methods above, it is possible to project the relationship of supply and demand in future periods.
The methods used to produce the workforce planning projections rely on two key inputs:
The set of assumptions about future conditions
The data from which the model’s parameters inputs and starting position are derived.
The assumptions underpinning the workforce projections are outlined in Appendix E.
In terms of data, as HWA is conducting national workforce planning, national datasets are used. For workforce supply, reliable, national datasets exist that are used to establish the existing workforce and workforce inflows.
The National Health Workforce Dataset (which combines data from the annual registration process, together with data from a workforce survey completed at the time of registration) provides extensive, reliable, national information on the number and characteristics of the registered oral health workforces, forming a strong basis for the workforce projections.
For workforce inflows, Department of Immigration and Border Protection visa grant data is used, while for graduates, Australasian Council of Dental Schools data (for dentists), and Department of Education and National Centre for Vocational Education Research (for oral health therapists, dental hygienists and dental therapists) provide national data for use in the workforce projections. The use of Australian Health Practitioner Regulation Authority student registration information will also be investigated as a potential future national data source on graduate numbers.
The primary limitation on the supply side for the workforce planning projections is that the unregistered component of the oral health workforce (dental assistants and dental technicians) is not included. For these two workforces, the Australian Bureau of Statistics Census of Population and Housing (the Census) is the only data source available. From the Census, the number and characteristics of people who self-report as dental assistants and dental technicians can be identified. However for workforce planning purposes, limitations with Census data include that information is self-reported, responses provided depend on an individual’s understanding and interpretation of the questions asked, and of particular importance, it is only conducted every five years. While this is useful for identifying long-term workforce trends, the information is quickly out-of-date for workforce planning purposes. Therefore, for these two workforces, there was no systematic collection of workforce data able to be used to establish workforce supply.
Limitations also exist in the availability of reliable, national datasets to measure workforce demand. Following are the primary options available, and a brief outline of their limitations.
Information from the Commonwealth Government (collected by Medicare and the Department of Veterans Affairs) and State and Territory departments. This covers services provided under Commonwealth funded schemes and by states and territories, which only account for a small percentage of all oral health services provided.
Private Health Insurance Administration Council (PHIAC) data. While this covers private sector services (where the majority of dental services are provided), there are coverage concerns in that it is only those services able to be claimed through private health insurance. Additionally, for detailed workforce planning by practitioner type, information is not readily available on which practitioner type provided which service.
Information from individual insurance funds. This information could identify the practitioner type providing services, however access to data is not readily available. Additionally, as for PHIAC, there are coverage concerns, as this only covers those people who hold extras cover and claim dental through their private health insurance.
ARCPOH NDTIS. The NDTIS is the only source to provide information on private and public services accessed on a consistent, national basis.. However the NDTIS is a sample survey designed to produce population level estimates for the most common dental services received only (that is, information on all dental services received is not collected). Therefore for some specific sub-populations of interest, there are an insufficient number of records to provide stable estimates for service use, and there is also the likelihood that the total count of services is conservative. Additionally, for detailed workforce planning by practitioner type, information is not readily available on which practitioner type provided which service.
In considering data availability and associated limitations of each data source, HWA decided to use the ARCPOH NDTIS for measuring workforce demand in this workforce planning exercise. This was on the basis that it is the only available source that provides a consistent, national measure on dental services received and dental visits in the private and public sectors, with time-series information also readily available.
While the limitations highlighted above do need to be considered when interpreting the workforce planning projection results, having used the best available data, HWA is confident in the workforce planning projections presented in this publication, and in the findings resulting from those projections for the overall oral health workforce. Given questions raised by some stakeholders regarding the accuracy of attributing oral health activity to specific practitioners, care should be taken in the interpretation of the results for individual professions (with these results contained in AFHW – Oral Health – Detailed).
Appendix F contains the list of data sources used in generating the oral health workforce planning projections.
Scenario modelling is used to demonstrate the impact of potential policy options on future workforce supply and demand. 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 impact of these scenarios is measured by comparing their workforce projection results with the comparison scenario – a technical construct where current trends are assumed to continue into the future. The comparison scenario is not a prediction of the future; it is based on utilisation patterns as they currently exist; and should be interpreted as a ‘do nothing’ scenario, which assumes known policy settings are held constant as their future levels cannot be predicted. This allows an assessment of the effects of other changes, which may impact the workforce.
Seven alternative scenarios were developed for AFHW – Oral Health. It is important to note the scenarios are not predictions of what will happen over the period to 2025 – each provides an estimate of a likely outcome given the set of conditions upon which it is based.
Medium self-sufficiency – showing the impact of reducing net international migration and international students graduating from Australian dental programmes.
Productivity – showing the impact of a five per cent productivity gain over the projection period.
Low demand – showing the impact of a reduction in demand for the oral health services.
High demand – showing the impact of an increase in demand for oral health services.
Undersupply – showing the impact on the workforce planning projections of a commencing workforce supply gap, that is, workforce demand exceeds workforce supply.
Oversupply – showing the impact on the workforce planning projections of a commencing workforce supply excess, that is, workforce supply exceeds workforce demand.
Graduate reduction – showing the impact of a reduction in the number of graduates (both domestic and international) from Australian dental programmes.
Details of how the scenarios were constructed are provided in Appendix E.