Why are teeth left out of public healthcare?

Tens of millions of dollars are being paid out in dental grants each quarter – and advocates say the total cost of excluding dental care from the public health system is more than the government would have to pay to fund it.

Dental care is generally only publicly funded for people who are under 18.

Ministry of Social Development data shows that in the March quarter of last year, just under 30,000 dental grants were issued, worth a total of $22.2 million.

Of those, 9330 were recoverable.

The quarter before, there were 28,398 worth $21.098m. In the three months before that, there were 33,045 worth $24,853.

Through 2023, there were similar numbers granted and a total of $90.199m issued in grants for the 12 months.

Dental grants of up to $1000 are available to people on low incomes and with limited assets each year. This does not have to be paid back. Grants above this amount may need to be repaid.

In a recent report, Citizens Advice Bureau said its clients were worried about the cost of dental treatment.

“Clients are finding that dental treatment needs to be deemed as immediate and essential treatment to receive an emergency Work and Income grant. People who are struggling with eating or speaking due to long-term dental issues cannot find funds to cover the dentures required after tooth extraction. Dentists are not willing to remove a client’s teeth if there is no possibility of dentures being purchased.

“Clients are looking at different options, such as creating a dental plan with the dental care provider, going to their local hospital emergency department, arranging food parcels while they pay off dental bills, withdrawing KiwiSaver funds, and seeking help from budgeting services. When clients get recoverable assistance, their benefit is reduced to pay it back, which often leaves them without enough money for basic living costs.”

It said one client had been referred to it by Work and Income because he could not pay for dentures.

“They can only offer an advance which he would need to repay, but as he cannot afford the $60 per week that he would require to do this, they have declined his application…Miles has been required to take medicine for many years causing the issues with his teeth. Despite this medical treatment being needed due to an accident, ACC will not help Miles as they do not cover an injury that is a normal side effect of medical treatment. Work and Income policy states that an emergency grant covers only immediate and essential dental treatment and does not include dentures.”

Data from the NZ Dental Association in 2023 showed that the cost of procedures had risen substantially over the previous three years, in some cases by more than 20 percent.

Green MP Ricardo Menéndez-March said people were getting into debt to get “basic healthcare”. “Leaving people with rotten teeth and pain in their mouth.”

“While the previous government did increase the amount that people could get before they would get into debt, what we are seeing on the list is still a large amount of people requiring ongoing assistance from Work and Income for basic healthcare, which takes us back to our core call, which is that dental care should be put into the public healthcare system, something that the Greens have been campaigning on for several years.”

He said the current system meant the government was effectively subsidising private healthcare.

He said over the years there had been an increase in the need for assistance with dental care.

‘A significant gap’

Hana Pilkinton-Ching, spokesperson for the Dental for All campaign, said it was a bigger problem than many people realised.

“It’s a significant gap that leads to a lot of other issues in healthcare but also economically for the country.”

She said the income cutoff for grants was low and they had to be used for urgent and immediate treatments.

“If someone is eligible and they are under the income limit and the savings limit and they’re able to afford the private dental appointments to get the quote because they go to WINZ, once they’re in that position they can only access immediate relief such as extraction. It’s not an effective model to encourage people to access basic preventive care that would prevent them getting into that situation in the first place.”

She said people sometimes ended up in emergency department and inpatient care because of dental infections.

“It’s costing us more as a country for people to not access dental care than it would to make it free for people.”

The New Zealand Health Survey found more than 40 percent of adults had unmet need for dental care because of the cost.

Ministry of Social Development group general manager of client service delivery Graham Allpress said the ministry knew people were finding the cost of living difficult.

“In December 2022, the support eligible people can get for dental treatment through a Special Needs Grant (SNG) was increased significantly from $300 to $1000. At the same time, the requirement for dental need to be considered an emergency was also removed. Instead, the dental treatment would need to be considered immediate and essential to qualify for this support.

“These two changes have meant that thousands more people every year are eligible for financial support to help cover their dental costs. This doesn’t need to be paid back…While treatments such as dentures are not included in this criteria, we may still be able to help pay for it with an advance payment of up to six weeks for a person’s benefit. This is interest-free and needs to be paid back.

“When someone applies for an advance payment of benefit, we are required to consider their existing debt with us and whether they will be able to live with the reduced income as a result of the advance payment. We will also need to consider whether the repayments will allow a person to pay off their debt within 24 months. We set repayments at a manageable level; this is generally no more than $40 per week for a person receiving an advance payment of benefit. When a client is in hardship, we will consider reducing these repayments.”

He said people who were not receiving a benefit might be able to get assistance to help cover essential or emergency costs and this would need to be paid back.

“We have met with the Citizens Advice Bureau and listened to their concerns. We’re happy to look into any example where someone was declined support and explain our decision.”

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