What would happen if we increased services to populations identified for specific action?
The sections above clearly show dental visiting patterns for those populations identified for specific action for improving oral health are generally lower than that of the total population. HWA’s overall oral health workforce planning results show extra capacity exists within the workforce. Additionally, evidence exists to suggest dental visiting patterns influence oral health outcomes. For example, individuals who visit regularly are more likely (than those who do not) to report that their oral health has a positive effect on their quality of life43, and adults who usually made a dental visit once a year or more have fewer missing teeth on average (five) than those who usually visited once every two years (six) or less than once every two years (seven).44 Therefore, it can be assumed that if the number of oral health services accessed by those identified populations increased, this would result in improved oral health.
Recognising that a sustainable health workforce is about services being provided where they are most needed to prevent poorer health outcomes (as well as having the right number of oral health professionals providing services), HWA has examined the impact on the workforce planning projections of increasing workforce demand, to represent increased services accessed by those identified populations.
In this section, information and caveats relating to how this was conducted is presented first, followed by the workforce planning projection results.
There is no change in the workforce supply projections contained in this analysis from those presented in the comparison scenario earlier in this publication. This is because the analysis of those populations identified for specific action only focuses on changing utilisation rates, which are then transferred into expressed demand measures. Therefore only workforce demand is affected.
Projecting workforce demand
Demand projections for the oral health workforce employed the utilisation method – which measures expressed demand, and is based on utilisation patterns as they currently exist for population five-year age and gender cohorts (with any potential unmet need not accounted for).
The information above clearly shows expressed demand rates for each population identified for specific action vary substantially, and is generally lower, than that of the total population.
The purpose of Australia’s National Oral Health Plan 2004 – 2013 was to improve health and wellbeing across the Australian population by improving oral health status and reducing the burden of oral disease, with specific action areas identified.
For the purpose of this workforce planning projection exercise, and recognising a link exists between oral health and dental visiting patterns, it is assumed that increasing the number of oral health services accessed per member of the population will result in improved oral health. Therefore, this was the basis upon which the alternative scenarios for each of the identified populations were developed.
For those identified populations, the alternative expressed demand scenario was calculated as equivalent to 25 per cent of the number of services provided to the existing identified population. This was then added to the total oral health workforce demand in the comparison scenario, to generate an alternative expressed demand.
Please note, this was not conducted for children, people with special needs and Aboriginal and Torres Strait Islander people due to data limitations.
In interpreting the following workforce planning exercise, the following caveats must be noted:
The use of 25 per cent in the alternative scenario (increasing expressed demand by an amount equivalent to 25 per cent of the number of services provided to the existing population of interest) is an arbitrary figure. It is not based on specific advice, it does not represent, and should not be interpreted as, policy advice or a recommendation on an appropriate level of oral health services for the populations identified for specific action.
Double counting is likely to occur across the identified populations. For example, someone may be in the older people cohort, and live in a rural and remote area that also falls in ISRAD quintiles 1 or 2. Due to data constraints, this double counting was not able to be accounted for, and the magnitude of its impact on the workforce planning projections is unknown. Any double counting would have the effect of overstating the modelled increase in workforce demand.
Given these caveats, this workforce planning projection is for illustrative purposes only – to show the potential workforce impact of increasing the number of oral health services accessed for the populations of interest.
Figure 10 presents the results of the alternative expressed demand scenario for those aged 65 years and over. It can clearly be seen that a 25 per cent increase in services results in workforce supply and demand being almost in balance in 2015, after which the increase in demand can be managed within the existing projected workforce supply.
Figure : Oral health workforce, workforce supply and revised demand for those aged 65 years and over, 2012 to 2025
Figure 11 shows the alternative expressed demand scenario for those with low income and social disadvantage, represented by IRSAD areas 1 and 2. It can be seen that the projected workforce supply has the capacity to cater for the additional demand created by a 25 per cent increase in services.
Figure : Oral health workforce, workforce supply and revised demand for low socioeconomic and at social disadvantage, 2012 to 2025
Figure 12 presents the alternative expressed demand scenario for population by remoteness area. Demand was increased for all RAs outside of major cities (which were clearly shown to access fewer oral health services per member of population than the total population, refer Figure 9), except remote and very remote areas. While Figure 5 shows those in remote and very remote areas also access fewer oral health services per member of the population, a number of programmes already exist which are designed to improve access to oral health services for this population, for example the James Cook University rural outreach programme, the Royal Flying Doctor Service TOOTH programme in New South Wales, and Mobile Dental Care in Victoria. The decision was therefore made to only show an increase in demand for services for those in inner regional and outer regional areas only.
It can be seen that apart from 2015 where the demand marginally exceeds supply, the additional demand created by a 25 per cent increase in services can be managed by the projected workforce supply.
Figure : Oral health workforce, workforce supply and revised demand by selected remoteness areas, 2012 to 2025
Aggregate population of interest workforce planning projection results
The results of the alternative scenarios for older people, those with low income and at social disadvantage, and people living in non-metropolitan areas are able to be added to the total population comparison scenario workforce projections, as they are all calculated using the same data source (the ARCPOH NDTIS).
Figure 13 presents the results of this aggregation, which shows a targeted increase in services to those selected populations identified for specific action to improve oral health outcomes. It can clearly be seen that, after a short period of demand exceeding supply (from 2015 to 2019), the additional demand created by increasing services the identified populations can be managed within the existing projected workforce – without a need to introduce new entrants (through domestic education or immigration, beyond what is already included in the projections).
Figure : Oral health workforce, workforce supply and aggregate revised demand, 2012 to 2025
The revised aggregate demand shown in Figure 13, which results in workforce demand exceeding supply in the short-term, assumes that the full amount of additional demand (services accessed) is experienced immediately.
The additional demand created by increasing services to populations of interest could be managed within the existing workforce through an incremental increase in services. Figure 14 shows workforce demand modelled on an incremental increase in services (of five per cent per annum) in the short-term (from 2015 to 2019). This results in that additional demand being managed within the projected workforce supply. From 2019, the full additional demand created by increasing services to the selected populations of interest can be managed within the existing projected workforce.
Figure : Oral health workforce, workforce supply and incremental aggregate revised demand projections, 2012 to 2025