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Introduction

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

On 1 July 2008, the Australian Government introduced a new scheme of public subsidy for dental visiting for eligible children aged 12–17 years. Under this means-tested scheme, known as the Teen Dental Plan (TDP), a Teen Dental Plan Voucher (TDPV) is automatically posted to all eligible children. Children are eligible for the scheme if at some time in the calendar year they are aged between 12 and 17 years and satisfy the means test for the programme.1 The TDPV entitles the holder to dental check-up and preventive services. These services must include an oral examination. It may also include, if clinically necessary, any of the following services: radiological examination and interpretation; removal of plaque or stain; removal of calculus; topical application of remineralizing agent; dietary advice; oral hygiene instruction; and fissure sealing.2

In 2008, the voucher provided a Medicare benefit of up to $150 towards the cost of an annual preventive dental check. This was indexed to $153.45 for 2009 and $1573 for 2010.

The aim of the TDPV is to provide financial assistance to families to help assess the health of their teenagers’ teeth, and to introduce preventive strategies to encourage lifetime good oral health habits.2

A review of the implementation of the scheme published in 2009 found that uptake of the scheme was likely to be influenced by the availability of service providers and recommended steps to increase awareness of the scheme amongst both potential users and providers.2 This review also noted that current Medicare information did not allow any assessment of actual services received by those teens who used the TDPV to make a dental visit.

Aims

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

The purpose of this Data Watch is to provide an update of patterns of use of TDPVs using information provided through the National Dental Telephone Interview Survey 2010. In particular, this report has three aims: (1) describe teens who (a) received and (b) used TDP vouchers; (2) examine patterns of services received according to TDPV receipt and use; and (3) assess whether access measures for teens change over time in both absolute terms and in relative terms.

Methods

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

The National Dental Telephone Survey 2010 (NDTIS 2010) is the eighth NDTIS in a series that commenced in 1994. The purpose of the survey is to collect data on access to dental care in Australia. The 2010 survey was run from July 2010 to February 2011. In total, interviews were conducted with 6765 adults and 3472 children. In NDTIS 2010, in addition to increasing the number of child respondents over previous NDTISs, additional questions about receipt and use of TDPVs were asked of all respondents aged 12–17 years. In NDTISs proxy interviews are held for all respondents aged under 18 years of age. Therefore, results here reflect answers given by an adult proxy interviewee, usually a parent or guardian.

Comparisons are made for one access to care measure (visited for a check-up in the previous 12 months) and two measures of barriers to dental care (avoided or delayed making a dental visit due to cost and cost prevented recommended dental treatment). Comparisons of the prevalence of these measures in 2010 are made to their prevalences in previous NDTISs, specifically, those conducted in 2002, 2005 and 2008. Details of these surveys can be found elsewhere.4–6

Data were analysed using SAS and SUDAAN and analyses take account of the stratified sampling method used in NDTIS. All results are weighted to the Australian Estimated Resident Population. Differences in voucher receipt and use, visiting, services received and access measures amongst teens within years are reported as differences in proportions. Differences between teens and children aged 5–11 years (younger children) are reported as rate ratios. Statistical significance is determined by non-overlapping 95% confidence intervals in the case of proportions, and by non-inclusion of 1 in the 95% confidence interval for ratios.

Results

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

Interviews were conducted for a total of 1682 children aged 12–17 years (teens) in NDTIS 2010 (Table 1). Slightly more older teens than younger teens were interviewed. A slight majority of the sample was male (53.27%). Approximately 61% of the sample had private dental insurance and almost 16% were covered by a Commonwealth Government concession card. Just over half (51.72%) reported that they had received a TDPV and just over one-quarter (25.95%) had used one. Overall, 81.8% of teens had made a dental visit for any reason in the previous 12 months (95% CI 79.1, 84.2).

Table 1.   Sample description (teens only) age, gender, income, insurance, cardholder (unweighted data)
Parameter NumberPer cent
Age1221612.84
1325214.98
1425315.04
1528817.12
1635320.99
1732019.02
 n = 1682 
GenderMale89653.27
Female78646.73
 n = 1682 
IncomeLowest54132.92
Middle54734.29
Highest50731.79
 n = 1595 
InsuredYes103061.31
No65038.69
 n = 1680 
Concession CardCardholder26815.94
Non-cardholder141384.06
 n = 1681 
Received a voucherYes84351.72
No78748.28
 n = 1630 
Used a voucherYes42425.95
No121074.05
 n = 1634 

Describe the distribution and use of vouchers according to characteristics of interest

There was some evidence of variation in having received and used a voucher by age (Table 2). The differences in receipt of a TDPV by age were not statistically significant. Use was lowest amongst 12-year-olds and highest amongst 15-year-olds. In addition to these two age groups, statistically significant differences are evident for use between 12- and 16-year-olds and between 15- and 17-year-olds. There were no differences evident by gender. The distribution of receipt of TDPV reflects the mean-tested targeting of the programme. Receipt was highest amongst those teens with the lowest household incomes and lowest among those with the highest household incomes. Cardholders and uninsured teens were also more likely than non-cardholders and insured teens to receive a TDPV. The proportion of teens using the vouchers was similar for the lowest and middle income groups, and lowest for the highest income group. There were no statistically significant differences in the proportion of teens in any group who used a TDPV having received one.

Table 2.   Frequencies of receipt and use of teen dental plan vouchers (age, gender, income, insurance, cardholder)
ParameterReceivedUsedUsed if received
%95% CI%95% CI%95% CI
Age
 1249.240.7, 57.818.112.2, 25.938.027.1, 51.9
 1360.653.0, 67.829.622.6, 37.749.739.1, 60.4
 1455.747.3, 63.834.226.5, 42.758.046.9, 68.3
 1561.153.5, 68.237.029.5, 45.159.849.4, 69.4
 1655.648.9, 62.127.922.3, 34.449.740.5, 59.0
 1751.743.9, 59.421.916.2, 29.142.732.0, 54.2
Gender
 Male55.651.2, 59.827.723.8, 32.050.243.9, 56.4
 Female56.351.6, 60.929.124.9, 33.650.844.4, 57.3
Income
 Lowest78.773.5, 83.136.731.4, 42.446.640.3, 53.0
 Middle58.853.5, 63.833.028.1, 38.355.748.4, 62.7
 Highest21.517.2, 26.59.96.9, 14.046.534.7, 58.8
Insured
 Yes42.438.4, 46.522.118.8, 25.851.745.2, 58.1
 No73.769.0, 77.936.731.8, 41.849.743.6, 55.9
Concession Card
 Yes82.875.7, 88.238.431.0, 46.346.738.1, 55.5
 No48.845.5, 52.325.622.6, 29.052.247.4, 57.3

Services received according to TDPV status

The overwhelming majority (95.9%) of teens who made a dental visit reported that they had received at least one check-up in the previous 12 months and a large majority (74.1%) reported that they had received at least one scale and clean service (Table 3). Less than half (44.2%) of teens who had made a dental visit received at least one episode of oral hygiene instruction. Similar proportions reported receiving at least one X-ray (39.9%) or at least one fluoride treatment (36.1%), while a minority (10.4%) reported receiving one or more fissure sealants.

Table 3.   Services received by TDPV receipt and use (teens who made a dental visit in the previous 12 months)
 All teensReceived and used TDPVReceived but did not use TDPVDid not receive TDPV
One or moreOne or moreOne or moreOne or more
%95% CI%95% CI%95% CI%95% CI
Check-up95.994.7, 97.197.696.1, 99.293.990.9, 96.995.693.7, 97.5
Scale and clean74.171.1, 77.179.674.7, 84.567.961.0, 74.973.168.8, 77.6
X-ray39.335.9, 42.736.329.9, 42.741.133.7, 48.640.635.8, 45.4
Fluoride36.132.6, 39.636.129.5, 42.730.523.2, 37.838.833.9, 43.7
Fissure sealant10.48.4, 12.415.611.0, 20.29.35.8, 12.97.24.9, 9.5
Oral hygiene instruction44.240.7, 47.749.142.4, 55.945.738.0, 53.340.135.4, 44.7

Minimal differences in services received were found according to TDPV status. The exception to this is that teens that used a TDPV were more likely to report having one or more fissure sealant treatments than teens that did not received a TDPV (15.6% compared to 7.2%).

Did access measures for teens change in 2010 with the introduction of the Teen Dental Plan?

In NDTIS 2010, 69.9% of teens were reported to have visited in the previous 12 months for a check-up, 16.5% avoided or delayed making a dental visit due to cost and cost prevented recommended dental treatment for 8.7% of teens (Table 4). While this rate of visiting for a check-up was higher in 2010 than in previous years, the differences were not statistically significant for the comparison with 2008. The rate of avoiding or delaying due to cost was higher in 2010 than in 2005 only. In 2010, the rate of cost preventing recommended dental treatment was identical to that for 2008, and the small increase over 2002 and 2005 did not reach statistical significance.

Table 4.   Teens visiting measures 2010 and compared to previous NDTISs
 2002200520082010
%95% CI%95% CI%95% CI%95% CI
  1. Note: ‘Cost prevented recommended treatment’ includes only children who made a dental visit in the previous 12 months.

Teens
 Visited for a check-up56.550.7, 62.163.761.0, 66.462.957.2, 68.369.966.8, 72.8
 Avoided or delayed10.67.4, 14.410.27.9, 13.017.713.6, 22.716.514.1, 19.3
 Cost prevented7.24.4, 11.56.64.8, 9.18.75.8, 13.08.76.9, 10.9
Children aged 5–11
 Visited for a check-up60.755.7, 65.663.859.7, 67.661.555.9, 66.762.558.9, 65.9
 Avoided or delayed9.77.1, 13.27.15.3, 9.413.39.9, 17.712.310.0, 14.9
 Cost prevented recommended treatment2.41.1, 5.13.11.8, 5.25.63.4, 9.03.82.5, 5.5

Did access measures for teens change relative to other school-aged children?

Figure 1 indicates that teens were equally as likely to visit for a check-up as children aged 5–10 years in both 2005 and 2008 (all 95% CIs for these ratios include 1). However in 2010, teens were 12% more likely to visit for a check-up than the younger children (RR 2010 = 1.12 (95% CI 1.04–1.20)). This is due to the increase in teens visiting for a check-up as the proportion of younger children visiting for a check-up did not change between 2008 and 2010 (61.5 and 62.5).

image

Figure 1.  Rate ratios for access and affordability measures (teens vs. 5–11-year-olds).

Download figure to PowerPoint

Teens were equally likely as younger children to have avoided or delayed due to cost in 2002, 2005 and 2008 (confidence intervals all include 1). In 2010 the ratio was similar to these earlier years but in this year it reached statistical significance. However, these data do not support a conclusion of substantial change in 2010 compared to the previous years.

The slightly higher ratio of teens to younger children reporting that cost prevented recommended treatment in 2010 was not significantly different to any other year.

Discussion

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

This study of TDPV receipt and use is based on a sample of 1682 teens and is the first opportunity to examine any impact of the scheme on patterns of dental visiting, services received and financial barriers to dental care for teens. A minor limitation of the data used here is that the questions on receipt and use of a TDPV related to having received or used a TDPV at any time, whereas the questions about visiting, services received and barrier to access related to the previous 12 months. Therefore, some teens classified as having received or used a TDPV may have done so in a previous 12-month period.

Two striking features are evident in the receipt and use of TVPDs. First, that the distribution of receipt of vouchers indicates a fair degree of success in targeting of the programme according to income. The second is the generally low uptake of the vouchers, which sits at around 56% in this sample. The stronger gradient by income for receiving a TDPV than for using it evident in Table 2 is consistent with a previous observation that use of the voucher may be influenced by the availability of providers.2 While few differences in services received were observed by TDVP status, it is striking that two of the most effective methods of clinical caries prevention (fissure sealant and fluoride treatment) were reported as being received by only a minority of teens. The higher rate of fissure sealant services amongst users of the TDPV may reflect the profession’s attempts to support the intent of the scheme. However, it may also reflect the higher risk status of teens who are eligible to receive a TDPV. The data provided here do not support a conclusion that the TDP has had a major impact on teen visiting, as evidenced by the comparisons with teen visiting in previous years and with 5–11-year-olds visiting over time.

Acknowledgements

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

This report was produced by Jane Harford and Xiangqun Ju. NDTIS is supported by the Australian Government Department of Health and Ageing through the Australian Institute of Health and Welfare.

References

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum
  • 1
    Medicare Australia. Medicare teen dental plan 2011. Undated brochure.
  • 2
    Australian Government Department of Health and Ageing. Report on the Review of the Dental Benefits Act 2008. Canberra: Commonwealth of Australia, 2009.
  • 3
    Plibersek T, Roxon N. Over 1 million dental checks have teens flashing pearly whites. Media release. 29 November 2010.
  • 4
    Carter KD, Stewart JF. National Dental Telephone Interview Survey 2002. AIHW cat. no. DEN 128. Adelaide: AIHW Dental Statistics and Research Unit, 2003.
  • 5
    Slade, GD, Roberts-Thomson KF, Sanders AE. Survey aims and methods. In: Slade GD, Spencer AJ, Roberts-Thomson KF, eds. Australia’s dental generations: the National Survey of Adult Oral Health 2004–06. AIHW cat. no. DEN 165. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 34), 2007.
  • 6
    Ellershaw AE, Stewart JF. National Dental Telephone Interview Survey 2010. Technical Report. Adelaide: Australian Research Centre for Population Oral Health (in press).

Addendum

  1. Top of page
  2. Introduction
  3. Aims
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Addendum

Chronic disease and use of dental services in Australia. Aust Dent J 2011;56:336–340.

The September 2011 Data Watch article was produced by A John Spencer and Anne Ellershaw with support from the Australian Institute of Health and Welfare. NDTIS is supported by the Australian Government Department of Health and Ageing.