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Aboriginal oral health care: double the services, half the cost

28 September 2017
Public Aboriginal oral health care models compared

The latest Closing The Gap report reveals Australia's failure to meet Aboriginal and Torres Strait Islander health targets. Could a system engaging local communities inspire more effective ways to deliver much needed services?

A young girl brushing the teeth of a stuffed toy.

A Boggabillia Central School student shows how to brush your teeth. Credit ABC News.

Aboriginal Australians have significantly higher rates of dental disease than the wider Australian population.  It is an issue compounded for people in rural and remote areas with less access to public dental services, and is linked to higher risk of other chronic health conditions.

Recognising the high need for public oral health services targeting Aboriginal communities, governments have invested in several service delivery models using distinctive approaches.

A comparison of two models that provide public oral health services specifically for Aboriginal patients has found a significant difference in costs and outputs, with implications for future policy and funding decisions.

Young Aboriginal students holding up an artwork showing healthy and unhealthy foods

Toomelah school students during an oral health lesson. 

Published in the Australian Dental Journal , the research was conducted by the University of Sydney’s Poche Centre for Indigenous HealthCentre of Translational Data Science and faculties of Health Sciences and Dentistry, with the Armajun Aboriginal Health Service in Inverell, NSW.

The cost and output of Model A, the major oral health service for Aboriginal people in rural NSW delivered by the state government, was compared with Model B, a collaboration between the Poche Centre and Armajun.

Dental weighted activity units (DWAUs) are the national measure of productivity in publicly funded oral health services. The NSW government applies this measure to local health districts and grant programs. During 2014 and 2015 the government set the NSW price per DWAU at $589.

Over the same two-year period, Model A cost $ $1,800 per DWAU and Model B cost $370 per DWAU.

Model A delivered just over 1,600 DWAUs with total funding of over $3.6m, and Model B delivered over 3,000 DWAUs with total funding of just over $1.4m. 

Summary of funding and DWAU for models A and B for the period of 1 January 2014 to 31 December 2015

 

Model A

Model B

Benchmark

Total funding

$3,683,643.50

$1,418,150.00

 

Total DWAU delivered

1,608.19

3,072.16

 

Cost/DWAU (based on 80 percent of allocated funding as per funding formula)

$1,832.44

$369.29

$589.00

“Following the troubling lack of progress presented in the latest Closing The Gap report, our model provides a valuable example of another way of doing things,” said lead author Dr Kylie Gwynne, a research affiliate of the Poche Centre.

“The Poche Centre is committed to pursuing evidence-based approaches to health care, and we thank the NSW Centre for Oral Health Strategy for supporting this study by providing DWAU data for analysis.” 

A student having their teeth checked by a health worker.

A child receiving an oral health check. 

The main difference between the two models is the centralised versus localised coordination.

Model A delivers services across the state from a city-centre clinic, as well as dentists operating on a fly-in fly-out basis at host clinics across NSW.  It provides blocks of oral health care to communities and draws on the infrastructure and community links of the host Aboriginal Community Controlled Health Service.

In contrast, Model B delivers services almost entirely in local communities, employing local Aboriginal staff wherever possible. Initially operating in three communities, the service expanded in the first year to include nine Aboriginal communities in central northern NSW with local community partnerships and accountability. It is staffed almost equally by dentists and oral health therapists, and new graduate clinicians live near and work across communities using fixed and portable equipment in multiple locations including clinics, schools, health care settings and other community locations.

“Fly-in fly-out services are more expensive than local services, yet we still provide so many dental and allied health services in this way,” Debbie McCowen, Chief Executive Officer of the Armajun Aboriginal Health Service, said. 

This research tells an important story about community engagement, and the benefit of employing locally and building local capacity.
Debbie McCowen, CEO Armajun Aboriginal Health Service

According to the authors, the results raise important questions around how such services should be delivered in the future.

“Good public policy evaluates and adjusts service models over time as circumstances and needs change," said Dr Gwynne.

“There’s growing recognition the fly-in fly-out model is no longer appropriate as workforce shortages are addressed and rural and remote health services are better able to recruit and retain oral health clinicians.

“Yet, while the state government has committed to changing its approach, the federal government just recently increased its funding for fly-in-fly-out dentistry.

With limited resources and oral health outcomes in Aboriginal communities still poor, we must focus on service delivery models that are proven to be effective and efficient.
Dr Kylie Gwynne, research affiliate of the Poche Centre for Indigenous Health at the University of Sydney

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