4. Access to Care
4.1 Universal Health Coverage and Oral Health Care
The New Zealand Dental Association position is:
That it supports the FDI World Dental Federation in the goal of equal access to oral health services for all populations.
The Association advocates to address barriers to access to oral healthcare and promotes the universal health coverage (UHC) as providing an opportunity for oral health services to become more integrated into the wider healthcare system, and to be more accessible and responsive to the oral healthcare needs of the population.
Universal health coverage (UHC) is described by the World Health Organization as meaning all people have access to quality health services when and where they need them, without financial hardship. UHC encompasses the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation and palliative care.
Universal health coverage does not suggest free coverage for all health interventions, regardless of cost, as this is not sustainable. It is more than an issue of health financing, but it must also consider delivery systems, workforce, facilities, information and communication systems, technology, quality assurance and governance. It should encompass more than a minimum package of care and aspire to progressive improvements and include population-based services, including community water fluoridation and reductions in dietary sugars.
4.2 Child and Adolescent Oral Health Services
The New Zealand Dental Association position is:
That all New Zealand children and adolescents are entitled to high quality oral health care including diagnosis, prevention and treatment services to maintain their dental health.
That it is very concerned by the declining rates of access to publicly funded dental care and the persistent inequities in the oral health of children and adolescents.
That children, adolescents and young adults at particular risk of dental caries should receive targeted preventive dental care and appropriate treatment services to maintain their oral health and aid in the reduction of inequalities in oral health.
That it considers there may be a need for redesigning services to ensure they can be freely and appropriately accessed by those most in need.
That it supports Māori determining the design, delivery and monitoring of their health services to support achieving equitable health outcomes.
That it supports maintaining the right of families to access private dental care.
While child and adolescent oral health services are publicly-funded and free at point of access, there is increasing concern about the sustainability of these services and their ability to deliver timely services in New Zealand.
Between 2017 and 2021, the number of children aged between 0 and 12-13 years overdue for care increased from 118,518 to 321,680 and represented an increase from 15% to 41% of children. These children were predominantly enrolled with the Community Oral Health Services of Health New Zealand | Te Whatu Ora. Data reported for 2023 indicates that the number of children overdue for care had improved to 191,120, but also suggests that the number enrolled may also have fallen substantially, meaning that the number overdue was less representative of an overall lack of access to care. In the Auckland region, 50% of children remained overdue for care in 2023.
Adolescents from Year 9 until their 18th birthday predominantly receive care from contracting dentists in private practice through funding from Health New Zealand | Te Whatu Ora. In 2023, 137,505 adolescents were seen by contracting dentists, representing 73% of the estimated eligible adolescent population. A further 2,854 adolescents were seen by providers with alternative funding mechanisms (e.g., Hauora Māori providers). Approximately 71% of adolescents accessed oral health services annually from 2016 to 2019.
Historically, New Zealand children and adolescents have had better of access to dental care than adults. However, significant concerns are developing that access rates for children and young people, although free at point of care, have fallen substantially since 2019.
There are concerns that historical data may have under-represented the rates of access by Māori, Pacific and Asian children and adolescents as result of inaccurate systems to capture and report ethnicity. Timely access to oral health care, and accurate data recording, are essential parts of maintaining high-quality healthcare.
In addition, as described in Section 2 of this Roadmap report, there are persisting inequities in the levels of dental decay, and other oral diseases. The Association is concerned that for many years the focus in New Zealand has been on horizontal equity, that is everyone receiving the same type of care. This is built from the assumption of everyone having the same needs. The Association considers it is timely to consider the issues of vertical equity in our delivery of child and adolescent oral health services. Vertical equity considers the basis of need and that different groups have differing health needs, and that some require more health care. It has also been described as proportionate universalism by Professor Michael Marmot in his exploration of health inequalities in England.
The Association is concerned by the rates of access to funded dental care and by the persisting inequities in oral health. It considers there may be a need for targeting of funding and services, to ensure they can be freely accessed by those most in need. Redesigning services should maintain the right of families to access private dental care. Redesign must consider the responsibilities that Te Tiriti o Waitangi confers on the Crown in the context of universal public funding for publicly-funded child and adolescent services. The Association supports Māori determining the design, delivery and monitoring of their health services, to support achieving equitable health outcomes. This should include the funding and delivery of culturally appropriate health services where appropriate.
Children, adolescents and young adults at greatest risk of dental caries should receive preventive dental care and appropriate treatment services to maintain their oral health and to aid in the reduction of inequalities in oral health.
4.3 Adult Access to Care
The New Zealand Dental Association position is:
That all New Zealanders have the right to good oral health.
That it is concerned about accessibility of oral health care, and in particular the affordability of health care for adults.
That it will continue to advocate for actions consistent with the access to care plan outlined in the New Zealand Dental Association 2019 paper.
Funding of dental care for young adults.
Designing and testing dental service models that are appropriate for communities and for high-need population groups
Develop and implement adult oral health care programmes that meet the needs of local communities and high-need population groups.
That it supports Māori determining the design, delivery and monitoring of their health services to support achieving equitable health outcomes.
That pharmacy charges to patients for prescriptions issued by a dentist should be the same as those for prescriptions issued by a medical practitioner in primary care.
That patients attending a dentist should have access to funded laboratory services for histology and routine blood tests on the same basis as primary care.
The New Zealand Dental Association believes that adult dental care must be considered a health service and recognised as a human right. There is no sensible reason for oral health issues not being considered as part of general health and as part of health services.
However, the 2023/24 New Zealand Health Survey reported that of New Zealanders in the highest quintile of deprivation (NZ Dep 5) only 36% visited a dentist in the past 12 months, 72% only attend a dentist for a problem and 52% had avoided dental care in the past 12 months due to cost. In contrast, for adults in the same category 74% had seen a GP in the last 12 months and only 18% avoided a GP visit due to cost.
The UK King’s Fund reported in 2023 that in a comparison study of 9 countries New Zealand had the second highest rate of people on lower incomes skipping dental care, after the United States.
Figure 2: People on low incomes in New Zealand are more likely to skip dental check-ups than skip medical care or have trouble paying medical bills, than in comparator countries except the United States (King’s Fund 2023).
Anandavica S. How does the NHS compare to the health systems of other countries? The King’s Fund June 2023. Available at https://www.kingsfund.org.uk/insight-and-analysis/reports/nhs-compare-health-care-systems-other-countries. (Accessed on 25 June 2025)Consequently, health providers in our Emergency Departments and in primary care regularly report that people attend with dental problems. However, there is little they can do beyond pain relief and management of overt infections. Attendance at these services creates an additional burden on already stretched services and imposes additional costs and delays in accessing appropriate care. In the worst situations these delays lead to people being admitted to hospital with serious infections. The length of stay in hospital can range from 1-2 nights, to a hospital stay greater than 7 nights, according to a review of people who were admitted to intensive care due to a head and neck infection of dental origin.
In 2019, the New Zealand Dental Association published the paper Access to Oral Health Services for Low-income Adults. Building on our policy position. This paper, developed with PwC, found that investing in basic dental services for low-income adults can have a positive return on investment for government and improve societal well-being. The paper outlined a roadmap of 4 steps to improve access to oral health services. The first step of extending urgent dental grants was acted on by the government in 2022. However, further work remains, and the New Zealand Dental Association supports ongoing policy programmes to improve access to dental care for people aged 18 years and over in New Zealand.
While affordability is a key aspect to improving access to dental care, it is not the only factor. Many associated issues influence the decision of people not to attend a dentist. These include fear and past experiences of dental care, not having a regular dental practice to attend, high prescription co-payments when the prescription is written by a dentist, lack of access to funding for laboratory tests taken by a dentist and copayments for hospital dental outpatient visits but not for other secondary health service outpatient appointments.
As discussed in the previous section, there are persisting inequities in the levels of dental decay, and other oral diseases. The Association considers it is time to consider the issues of vertical equity in our delivery of oral health services. Vertical equity considers the basis of need and that different groups have differing health needs, and that some require more health care.
The Association is concerned that the separation of funding for adult oral health care across several government policy areas (Social Development, ACC and Health), and the limited ability to combine funding to ensure affordable access to care, are barriers to affordable access to care. New Zealand Dental Association members have also noted that very limited funding of dental care under health insurance policies in New Zealand can create a further barrier to care.
The Association supports the right of Māori to lead the design, delivery, and monitoring of health services that reflect their values, aspirations, and tikanga. Achieving equitable health outcomes requires sustained investment in culturally grounded services led by and for Māori. Service design and funding must honour Te Tiriti o Waitangi and reflect the Crown’s obligations to uphold tino rangatiratanga in all publicly-funded oral health services.
4.3.1 Older Adults
The New Zealand Dental Association believes that adult dental care must be considered a health service and recognised as a human right. There is no sensible reason for oral health issues not being considered as part of general health and as part of health services.
However, the 2023/24 New Zealand Health Survey reported that of New Zealanders in the highest quintile of deprivation (NZ Dep 5) only 36% visited a dentist in the past 12 months, 72% only attend a dentist for a problem and 52% had avoided dental care in the past 12 months due to cost. In contrast, for adults in the same category 74% had seen a GP in the last 12 months and only 18% avoided a GP visit due to cost.
The UK King’s Fund reported in 2023 that in a comparison study of 9 countries New Zealand had the second highest rate of people on lower incomes skipping dental care, after the United States.
4.3.2 People with Disabilities and Complex Health Needs
Whaikaha-Ministry of Disabled People estimates that there are over 1 million New Zealanders living with a disability and Health New Zealand | Te Whatu Ora estimates that one in four New Zealanders live with multiple chronic health conditions such as diabetes, cardiovascular diseases, stroke and cancers.
Disability and complex chronic health conditions may lead to complex oral health needs and a higher incidence of oral disease.
In New Zealand, oral health services for some people unable to access oral health care services in the community are provided at Hospital Dental Services. They are delivered by clinicians in dental units at many, but not all, New Zealand hospitals.
Where available, the services can provide dental treatment that is an essential part of hospital treatment for a current medical or surgical condition. The service can also provide hospital admission because of the need for special management facilities, including general anaesthesia, when the person’s health or disability precludes access to dental care in the community.
The clinicians in these services provide high quality support to specific groups of vulnerable people. However, services are fragmented, there is a great deal of variability in services available at different hospitals, and care can be less than optimal due to a lack continuity and insufficient capacity.
Health New Zealand | Te Whatu Ora have identified in Workforce Plan 2024 that they are experiencing shortages in their dental workforce to deliver these services.
The Association supports the funded availability of specialised oral health services for people requiring access to hospital-based dental services and the dental workforce that delivers this care, many of whom are Association members.
However, the Association is concerned that access to care for people with disabilities and complex health needs is variable across New Zealand, and that continuity of care is frequently poor. There are limited options for people with disabilities and complex health conditions that do not require hospital-based care to obtain funded care in primary and community–based oral health services.
The Association supports designing, testing and implementing adult oral health care programmes and dental service models that are appropriate for vulnerable population groups in the community. These services and programmes should complement hospital-based dental services.
The Association also supports the professional development of general dentists, specialist dentists, and oral health professionals required to support people with disabilities and complex health needs, as well as the development of intra- and inter-professional teams to deliver these services.
4.4 ACC Access to Care
The New Zealand Dental Association position is:
That all New Zealanders have the right to good oral health.
That it is concerned about accessibility and affordability of accident-related oral health care for children and adults.
That it is concerned to ensure adequate compensation for ongoing dental care that may be needed after an accident.
Dental and maxillofacial injuries are frequently sudden and unexpected events. Dental injuries to teeth have a limited capacity to heal, and frequently require treatment shortly after the injury, followed by ongoing dental treatment that can continue for many years. Maxillofacial injuries involving bone or soft tissues of the face have a greater ability to heal but can be significant injuries that may involve hospital level care, time off work and create ongoing treatment and rehabilitation needs.
The New Zealand Dental Association believes that dental and maxillofacial injuries to children and adults must be considered a health service, their treatment recognised as a human right and recognised within New Zealand’s Accident Compensation scheme.
Financial coverage by the Accident Compensation Act 2001 for dental and maxillofacial injuries must be sufficient to enable timely, equitable and fair treatment. Coverage must include time for rehabilitation from dental and maxillofacial injuries, including sufficient income-related compensation when a person is unable to work as a result of dental or maxillofacial injuries and compensation for the ongoing dental care that may be needed after an accident.