Public or Dental Private Sectors?

Government approval for expenditure over $50 000 (at 1983 prices), even if they have raised the monies from their own resources, traditionally a very important feature of the Victorian system. In Queensland, Cabinet approval may be necessary in addition to Departmental approval for capital works while expenditure from unfettered trust funds also may require Ministerial approval. Although the whole system of control of capital funding for periodontics across the country may be justifiable clearly on the grounds of developing a comprehensive, integrated system of public dental hospital services in each State, where the system also involves politicians it would seem to be inevitable that charges of political patronage or favoritism will be made. However, the whole area of expansion or contraction of dental hospital services and cosmetic dentistry is intensely political and, to judge from the experience of the New South Wales dental hospital rationalization and consolidation programs, the technocratic decisions of the State authority need, if they are unpopular or run counter to the vested interests of powerful groups, the strongest possible political backing.



The existence, nature and size of the private dental hospital sector is potentially within the control of State Governments which, since the end of the 19th century, have licensed and limited the activities of private non-profit and private for-profit dental hospitals under relevant State legislation. Traditionally State controls were aimed primarily at ensuring the physical safety and well-being of patients that need dental surgery through such measures as setting minimum building standards and staffing levels. However, the more recent desire to provide a comprehensive, integrated dental hospital service with less bed capacity has focused more attention on the need for State Governments to be able to influence more effectively decisions to expand or contract the supply of dental hospital facilities and services in the private sector and dental medicine in order to increase co-ordination and reduce competition with the public to exert planning controls in the public sector but not the private sector would be to demonstrate an extraordinary faith in the combined ability of altruism and market forces to achieve comprehensiveness and co-ordination. Recent activities, as demonstrated in New South Wales and Victoria, point towards a more planned and controlled approach for the private sector, albeit more tentative than for the public sector where, as discussed above, a strong financial nexus also prevails.