Follow up of Access to Public Dental Services in Victoria

Tabled: 28 November 2019

Audit overview

This report follows up our performance audit Access to Public Dental Services in Victoria, tabled December 2016.

Performance audits focus on the efficiency, economy, effectiveness and legislative compliance of public sector agencies, and include recommendations to improve the management and delivery of public services.

Each year, we ask agencies to attest to their progress in addressing the recommendations that they accepted. Using these attestations―as well as our assessment of the public interest and materiality of audit topics―we selected Access to Public Dental Services in Victoria to follow up.

This audit examined whether the Department of Health and Human Services (DHHS) and Dental Health Services Victoria (DHSV) have effectively implemented the recommendations we made in that audit and addressed the underlying issues that led to them.

Conclusion

DHHS and DHSV agreed to implement our recommendations by December 2020 and have made some progress in driving preventative care. However, there remains more work to be done. This is in part due to the major reform required to shift public dental services' focus from treatment to a more patient-centred model aimed at prevention, early intervention and improving health outcomes. As a result, adult public dental health patients will continue to wait for improvements to the system. Some actions, such as work on the funding model, could have started earlier.

DHSV applied the principles of value-based healthcare (VBHC) to seven new models of care (MoC) that will help deliver the reform needed. Community dental agencies (CDA) co-designed this work. The first MoC has been piloted in a hospital environment, and DHSV acknowledges that the next step is to test it in CDAs to fully understand issues that may impede implementation. DHSV has not analysed the costs and benefits of shifting to the VBHC MoC as part of the piloting process. With no cost-benefit analysis (CBA), it is difficult to assess whether the VBHC MoC will deliver the expected benefits.

DHHS and DHSV reviewed different funding models that could effectively deliver public dental services. Results from commissioned work due in March 2020 should improve their understanding of CDAs' cost structures and the efficiency of these costs. To optimise patient access with available funding, DHHS needs to know how much it costs CDAs to deliver efficient services.

DHHS and DHSV are working to improve access to care through enhanced waiting list management and CDAs are providing more preventive services. However, further testing with CDAs needs to occur before implementing changes. Until this work is completed, CDAs and patients will only realise limited benefits.

DHHS and DHSV completed work to develop oral health outcome measures. An important next step will be to support CDAs to use the indicators developed to collect better health data on patients accessing their services. Only then can DHHS, DHSV and CDAs show whether patient oral health outcomes are improving.

Assessment of actions to address 2016 audit recommendations

Figure A shows our assessment of the actions taken by DHHS and DHSV to address the 2016 audit recommendations. It uses the following key:

Blue Bubble

Recommendation completed

Teal Bubble

Recommendation in progress

Figure A
Assessment of progress against recommendations

 

A new approach to delivering public dental services (Chapter 2)

1. Identify and pilot MoCs (teal)

DHHS and DHSV partially accepted this recommendation. As part of its shift to more client-centred and value-based services, DHSV is piloting one of seven new MoCs. It needs to work more closely with CDAs to test the new MoCs in their environment. Piloting of MoCs that focus on adult care are likely to be impacted by DHSV's added responsibility for designing, piloting and implementing a new school dental program.

2. Conduct CBA of MoC (teal)

DHSV has not yet completed a CBA. However, in mid-2019 it began a cost analysis of the Royal Dental Hospital of Melbourne's (RDHM) current model and the new VBHC MoC. In a separate project at the RDHM, evidence for the benefits of a VBHC model is being collected as part of piloting the general dental care MoC.

7. Review funding model (teal)

DHSV has reviewed a range of alternative funding models and has engaged consultants to examine how its preferred conceptual model would work in practice.

8. Consideration of loadings in the funding model (teal)

DHHS started a quantitative analysis of the need for loadings in July 2019, after the funding model review. This analysis could have started earlier, as it was not dependent on the funding review's findings.

9. Consistent unit price for public dental services (teal)

A comparative cost analysis of CDAs began in July 2019 and is aiming to identify the efficient cost of public dental services. Implementing consistent pricing is likely to be challenging and will require a phased transition.

 

Access to care during the transition (Chapter 3)

3. Waiting list management (teal)

Both DHHS and DHSV identified strategies to improve waiting list management. A review of patient eligibility and priority access criteria is complete. The tool DHSV developed following the review is still being validated, and further testing of the Bendigo model is required before scaling up.

4. Regional collaboration between CDAs (teal)

DHSV identified examples of regional collaboration with CDAs to address access barriers. A more systematic approach is required to help CDAs identify suitable collaborative approaches for piloting/scaling up programs to test their effectiveness in addressing access barriers and improving oral health outcomes.

5. Oral health promotion (blue)

DHHS and DHSV helped CDAs provide more preventive services, including changes to regulations that allow dental assistants to apply fluoride varnish and provide oral cancer screening and prevention packages. A funding model that provides greater incentives for prevention work will help CDAs take advantage of these initiatives.

 

Measuring and reporting performance (Chapter 4)

6. Oral health data (teal)

DHHS and DHSV worked with an international consortium to develop oral health outcome measures. An important next step will be to involve CDAs in collecting health outcome data to demonstrate whether access to care has improved oral health outcomes.

10. Public reporting on performance of dental health program (teal)

DHHS completed a review of the Statement of Priorities (SoP) key performance indicators (KPI) as part of its review of the State Budget Paper 3: Service Delivery (BP3) KPIs. New measures are included in the SoP. Improving the value of this reporting, including outcome measures, will be an important next step to assess the impact of the dental health program.

11. Public reporting on performance of dental health program (teal)

DHHS developed new BP3 KPIs for public dental services and is continuing to review and trial further measures. As yet, DHHS is still working to identify a set of measures that provide a comprehensive picture of dental service delivery.

Source: VAGO.

Responses to report and recommendations

We have consulted with DHHS and DHSV and considered their views when reaching our audit conclusions. As required by the Audit Act 1994, we gave a draft copy of this report to these agencies and asked for their submissions and comments. We also provided a copy of this report to the Department of Premier and Cabinet.

The full responses are included in Appendix A.

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