Background: Australia’s Chronic Disease Dental Scheme (CDDS) was a significant yet controversial health policy. It facilitated the first Medicare-funded private dental treatment, with patient eligibility into CDDS determined by General Medical Practitioners (GP). CDDS was subjected to intense political and media coverage for its rapid uptake and cost blow-outs, prior to its cessation on December 2012. In 2014, the new Child Dental Benefits Schedule, a scheme similar in design to CDDS, is to be introduced despite very little research into the policy process of its predecessor.
Aim: To explore patient and health practitioner experiences of the CDDS by examining their experiences regarding access, treatment provided and received, administrative requirements and financial dealings.
Methods: A qualitative research study conducted in metropolitan Brisbane and Sydney and Queensland’s Sunshine Coast Region. Thirty-two participants partook in twenty-four semi-structured interviews and two focus group sessions. Participants included patients, dentists, dental prosthetists, GPs, a dental technician, dental specialist and dental hygienist. The focus groups and interviews explored the diversity in participant experiences regarding the overarching study aim. It explored participant understanding of the knowledge underpinning CDDS and issues related to patient’s gaining and GPs providing access to the scheme. It explored health practitioners’ financial and administrative experiences, including billing practices and dealings with Medicare and the Medicare Compliance Program.
Findings: Practitioners and patients had very little understanding of the knowledge underpinning the CDDS. Patients, through social networks, became aware of their ability to access the CDDS and pressured GPs into providing referrals. GPs reported the lack of knowledge coupled with poor entry guidelines caused subjective and therefore unnecessary CDDS referral provision. All practitioners related being poorly educated about the scheme and its requirements, from inception. This situation was exacerbated by reduced collaborative efforts that reverberated through governmental bodies such as Medicare and professional representative bodies, through to the efforts between individual health practitioners. Medicare’s Compliance Program was seen to unfairly target dental practitioners for what was considered minor oversights in clinically unnecessary paperwork requirements. Additionally, bulk-billing CDDS patients resulted in dental practitioners reporting overall business losses. Despite such observations of the scheme, the CDDS funded vital dental services to people. Patients reported psychosocial and overall health benefits as a result of the treatment received through the scheme, although not all oral health needs were met through the scheme.
Conclusion: This study identified the worthiness and therefore need for qualitative research method use in examining dental policy process. It highlights the effects of involving participants from diverse backgrounds, to help understand complex schemes such as the CDDS. It provides valuable insights into the effects of multidisciplinary involvement of health professionals when attempting to address chronic illness at multiple levels. Thus examining dentistry, not as an isolated area of health, but as part of an intricate and important component seated within the paradigms of poor general health and its broader determinants.