Wait no more : the use of private dental services by welfare recipients in Australia

Dental services in Australia are available both privately and publicly. However, access to public dental services, like access to public hospital services for non-urgent treatment, is subject to a considerable waiting period. Moreover, access to public dental services is restricted to certain categories of welfare beneficiaries who qualify for a health care card. Because of the waiting time for public treatment, there is a frequent call for more public dental resources. This paper addresses the issue of what the waiting time for public dental services represents. One view largely confirmed by our research is that state governments are using the waiting time as a way of trying to push more and more people into the private sector. We find that more and more health care card holders are using the
private sector for dental services.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

The use of contracting out : a case study of decision-making and organisational learning in local government

One objective of government is to provide services at least cost whilst maintaining or improving service quality. While this may be an important objective, questions are being asked whether services can be provided more efficiently and effectively by the private rather than by the government sector. The shift of service provision from the public to the private sector is known as outsourcing or contracting out. The objective in this study is to critically examine whether the contracting out of services by local government to the private sector is an efficient management practice.

The contracting out of Parks and Grounds Maintenance services for the City of Kingston in the State of Victoria, Australia, is used as an exploratory case study to identify the variables associated with management decision-making in the contracting out process. Factors relevant to the contracting out decision such as the criteria used in selecting a contractor; the evaluation of a contractor’s performance; and any subsequent changes to management practice relating to the contracting out of the services are identified and discussed.

Political forces were found to be an important consideration in the initial contracting out decision, and the selection of a contractor was influenced by the potential to avoid costs. It was also found that under-bidding and associated cost /profit constraints lead to contractors engaging in non-sustainable environmental practices which resulted in the degradation of the local government’s Parks and Gardens assets. A sustainable asset management philosophy as opposed to an avoidable costs approach now underpins the contracting out process to ensure the preservation of such assets. Further, administrative processes have been revised to make tender specifications more prescriptive, critical components of services have been brought back in-house, and management practices have been amended so that a greater degree of control is exercised over contractors’ activities.

The use of public transport in coastal Australia : modes of travel to work and greenhouse emissions

Commuting to work is one of the most important and regular routines of transportation in towns and cities. From a geographic perspective, the length of people’s commute is influenced, to some degree, by the spatial separation of their home and workplace and the transport infrastructure. The rise of car ownership in Australia from the 1950s to the present was accompanied by a considerable decrease of public transport use. Currently there is an average of 1.4 persons per car in Australia, and private cars are involved in approximately 90% of the trips, and public transportation in only 10%. Increased personal mobility has fuelled the trend of decentralised housing development, mostly without a clear planning for local employment, or alternative means of transportation. Transport sector accounts for 14% of Australia’s net greenhouse gas emissions. Without further policy action, Australia’s emissions are projected to continue to increase. The Australian Federal Government and the new Department of Climate Change have recently published a set of maps showing that rising seas would submerge large parts of Victoria coastal region. Such event would lead to major disruption in planned urban growth areas in the next 50 years with broad scale inundation of dwellings, facilities and road networks. The Greater Geelong Region has well established infrastructure as a major urban centre and tourist destination and hence attracted the attention of federal and state governments in their quest for further development and population growth. As a result of its natural beauty and ecological sensitivity, scenarios for growth in the region are currently under scrutiny from local government as well as development agencies, scientists, and planners. This paper is part of a broad research in the relationship between transportation system, urban form, trip demand, and emissions, as a paramount in addressing the challenges presented by urban growth. Progressing from previous work focused on private cars, this present paper investigates the use of public transport as a mode for commuting in the Greater Geelong Region. Using a GIS based interaction model, it characterises the current use of the existing public transportation system, and also builds a scenario of increased use of the existing public transportation system, estimating potencial reductions in CO2 emissions. This study provides an improved understanding of the extent to which choices of transport mode and travel activity patterns, affect emissions in the context of regional networks. The results indicate that emissions from commuting by public transportation are significantly lower than those from commuting by private car, and emphasise that there are opportunities for large abatment in the greenhouse emissions from the transportation sector related to efforts in increasing the use of existing public transportation system.

Use of an arginine-enriched oral nutrition supplement in the healing of pressure ulcers in patients with spinal cord injuries : an observational study

Aim: Pressure ulcers are a serious secondary consequence of spinal cord injuries. The objective of the present study was to determine whether an arginine-containing nutritional supplement can reduce the healing time of pressure ulcers in people with spinal cord injuries compared with those not consuming the supplement until full wound healing.

Methods: Thirty-four spinal cord injured patients with a grade 2, 3 or 4 pressure ulcer were prescribed two 237 mL tetrapaks/day of a supplement containing additional protein, arginine, zinc and vitamin C. Pressure ulcer healing was assessed with the Pressure Ulcer Scale for Healing tool.

Results: Twenty patients consumed the nutritional supplement until full pressure ulcer healing had occurred, while 14 patients ceased consuming the supplement before full healing occurred because of intolerance, compliance or taste issues. A 2.5-fold greater rate of healing was observed in patients consuming the supplement until full healing compared with those who ceased taking the supplement (8.5 ± 1.1 weeks vs 20.9 ± 7.0 weeks respectively; P = 0.04). There were no significant differences in age, nutritional status, gender or reason for admission between groups. Comparison of healing rates in the group consuming the supplement to full wound healing against expected rates derived from the medical literature showed a significantly shorter time-to-healing (grade 3 pressure ulcer: 6.5 ± 0.8 weeks vs 18.2 weeks; grade 4: 11.4 ± 2.0 weeks vs 22.1 weeks; P < 0.001).

Conclusion: The present small-scale study demonstrated the potential for specialised wound healing nutritional supplements to shorten the time to pressure ulcer healing in spinal cord injured patients.

Use of reference in the narratives of Kurdish-Persian bilingual children

This study investigates some of the differences and similarities between Kurdish-Persian bilinguals and Persian monolinguals with respect to the use of referring expressions in spoken narratives. The narratives were elicited from 36 participants, consisting of 24 bilinguals (groups 1 and 2) and 12 monolinguals (group 3) in the first four grades of primary school using the Mayer’s (1969) book ‘Frog, where are you?’. The results have revealed that group 1 (bilingual told the story in Kurdish) used definite noun phrases most frequently followed by zero anaphors, indefinite noun phrases and pronouns. Group 2 who narrated the story in Persian produced definite nouns most frequently followed by pronouns, zero anaphors and indefinite noun phrases and group 3 (Persian monolinguals) employed definite noun phrases followed by zero anaphors, pronouns, and indefinite noun phrases. The significant difference between groups 1 and 2 and groups 2 and 3 has been in indefinite noun phrases and between groups 1 and 3 in the use of pronouns. One reason is that children universally apply similar strategies regardless of their first language (Berman, 2001). The conclusion is that some of the differences are due to the difference in the structure between Persian and the dialects of Kurdish.

B is for baby: the use of iPhone app technology in childbirth education

Midwives play an important role in antenatal education and there is a need for child birth education to be delivered more effectively and in the earlier stages pregnancy. There are numerous inconsistencies existing between the theory and practice of child birth education. A new direction is needed. The evolution of child birth education needs to quickly gain pace to meet the needs of today's expectant women. Contemporary technology presents a modern approach to support and promote child birth education classes. Consequently, this recent post graduate diploma student midwife project was to investigate the introduction of the use of iPhone app technology as a valuable tool in which to deliver child birth education. The conduction of the project included several elements, beginning with an extensive literature review, ethics approval; a survey completed by thirty two midwives at St Vincents Private Hospital (StVPH) was collected and generated the foundations for the prototype childbirth education iPhone App, and B is for Baby was constructed. This was then presented back to the midwives at St Vincent's Private Hospital as a means to compliment and contribute to the traditional face to face child birth sessions.