The Dental Technological Ladder

(Photo credit: http://www.griffith.edu.au)

One of the major underlying determinants of both the size and the Distribution of Australian dental hospitals has been the pattern of settlement In the 19th and 20th centuries with few major concentrations Of population outside the eight capital cities but with many small
Rural towns, not too distant from each other in parts of Victoria but Often widely separated in Western Australia. Given the difficulties Of rural transport and communication in earlier years, the low levels Of technology in dental hospitals, the paucity of rural specialist medical Staff and the absence of both the concepts of and the mechanisms For health services planning, the logical result was the establishment And operation of a large number of small general acute dental hospitals  able to survive on a mixture of fees, subscriptions, donations, Bequests and subsidies, with the latter component steadily assuming The greatest importance.

Today the greatest proportion of the smaller rural general dental hospitals in the public sector are not simply free-standing local institutions but are rather the lowest rung of an informal technological ladder. They offer basic in-patient, out-patient and accident and emergency services to their local communities and may also be part of or provide other community health services. To the small town their importance is not limited to the health and welfare
services they provide because they may be one of the largest employers and an important part of the town's social fabric.

Patients requiring a more intensive level of services or skills are normally referred to Base dental hospitals in the larger centres where a greater variety of more specialized abilities and technology are found. However, even the Base dental hospitals do not provide a complete
range of services and consequently they are linked, again by formal arrangement or by informal referral patterns, to major teaching dental hospitals, usually in the capital cities. Depending on circumstances, transport of patients may be by surface or by air through services Provided, subsidized, controlled or regulated by government’s Some patients' and attendants' costs may be met under the Commonwealth Isolated Patients' Travel and Accommodation Assistance Scheme.

In some instances, general acute facilities provided by the public sector in rural areas may be duplicated by private dental hospitals. Rural psychiatric and geriatric dental hospital facilities, in contrast to general facilities, are provided usually by a much smaller number of much
larger institutions sited in a few of the larger towns, a legacy of both earlier social attitudes and of government, as the provider of last resort, seeking economies of scale.

Within the capital cities one usually finds a number of large general and specialist teaching dental hospitals, which are often among the earliest established; substantial public district dental hospitals some of which are used as associate teaching dental hospitals; small public or non-profit community dental hospitals; private dental hospitals of varying size and purpose; and the very small number of federally provided dental hospitals. The specialist teaching dental hospitals, a legacy of the l9th century, developed as responses to the then needs of certain categories of patients (such as children or women) or to disease sites (such as eyes
Or ears).