Public funding won’t work

Most dentists in New Zealand think cost is a barrier to dental care, but don’t believe moving to a publicly funded dentistry system will address unmet need, a new survey has found.

Most general practice dentists thought ‘‘preventive measures’’ would better address dental issues than a publicly funded system, according to the study published in the March issue of the

But there were significant differences among dentists depending on where they lived, worked and their gender.

For example, just over 59 per cent of general dentists who practised in the major cities thought cost was a barrier for adult patients.

In provincial cities, the percentage rose slightly to 61.4 per cent.

But 83.3 per cent of dentists practising in towns thought cost was a barrier.

Town dentists typically see more patients of low socioeconomic status, according to the Ministry of Health, so it’s ‘‘not surprising’’ they felt this way, wrote the authors, led by Meishan Cheng, who earned a bachelor of dental surgery from the University of Otago in 2019.

Pulling dentistry into the public health system has long been a goal for many. Successive governments have declined to do so and the big health overhaul announced last month did not please those campaigners.

The dentists in this study are the most numerous group in oral healthcare, the authors noted. ‘‘Their views on the issue of publicly funded care are important because they would likely be key players in any initiatives to widen access to care.’’

On the questions of how dentistry should be funded, the survey showed ‘‘nearly twothirds of the responding dentists did not think that low-cost dental care schemes would be effective, and this was higher among male dentists.

‘‘More than 70 per cent of those practising in big cities did not feel that a low-cost dental care scheme would be effective.’’

But practice type influenced dentists’ opinions on this point. ‘‘All the dentists who felt that adult dental care should be fully privately funded were from conventional or corporateowned practices.’’

These people are directly or indirectly responsible for the financial management of their practices. ‘‘As such, cost and profit considerations are more likely to influence their opinions and treatment decisions since

Government-regulated remuneration rates do not match either the level of private fees or the real cost of providing quality care,’’ the authors wrote.

Surveyed dentists were also asked if they supported a mixed scheme, where funding was half public, half private. About 38 per cent supported such a scheme, compared to 37 per cent who preferred a system that was mostly private.

The percentage of dentists who thought their work should be ‘‘fully publicly funded’’ was 2.6 per cent. Fewer than 14 per cent thought dentistry should be ‘‘mostly public funded’’.

The authors compared these results to a similar Canadian study.

‘‘Both studies suggest that upstream preventive measures should be seriously considered when it comes to addressing New Zealand’s oral health burden,’’ they wrote.

About 60 per cent of dentists working in conventional and corporate-owned practices thought cost was a barrier. That number jumped to 100 per cent among those practising in institutions such as public hospitals.

The study was a questionnaire emailed to 800 general practice dentists in 2019. The response rate was 29 per cent, which the authors noted was low and could affect the study’s reliability.