Manchester Unity Building

Media item: article

Date published: 1 June 2012

Subject: the Manchester Unity Building, Melbourne

This page records the media item. The original article is the property of its publisher and is not reproduced here.

Note: this archive holds several 2012 items on the building. The architecture and origins are at Have a Deco at a Classic; the interior and access at Inside the Manchester Unity Building; the illumination at Let there be light for Manchester Unity's brighter future; adaptive reuse at Manchester Unity all lit up again.

The organisation that built it

The building was commissioned by the Manchester Unity Independent Order of Oddfellows and completed in 1932 to a design by Marcus Barlow. The anniversary coverage is at Party time to mark milestone.

The Oddfellows were a friendly society — and the history of friendly societies is the most interesting thing about this building, because it is the history of how ordinary Australians paid for health care before there was a public system.

Friendly societies: Australia's first health cover

A friendly society was a mutual organisation owned by its members. Members paid a small regular contribution into a common fund, and drew on it when they could not work or when they needed care.

What that actually bought, typically:

• Sick pay — an income when illness or injury stopped you working, in an era with no sickness benefit and no workers' compensation as we know it
• Medical attendance — societies contracted doctors on a capitation basis, the so-called “lodge doctor” system: the society paid the doctor an annual fee per member, and members were attended without further charge
• Medicines, through friendly society dispensaries — member-owned pharmacies that supplied medicines at cost. Some still trade today. The regulatory difference between pharmacy and dentistry that this points at is set out in Is dental really different to pharmacy?.
• Funeral benefits, which mattered enormously to people for whom a pauper's burial was a genuine fear

By the early twentieth century, a very large share of Australian working families belonged to one. The societies were not fringe institutions: the Oddfellows, the Ancient Order of Foresters, the Hibernian Australasian Catholic Benefit Society and the Independent Order of Rechabites operated at national scale, which is exactly why one of them could build a landmark tower on the best corner in Melbourne.

Why they declined

Several pressures at once. The lodge doctor system was resented by the medical profession, which regarded capitation payment as underpayment and campaigned against it for decades. The Depression put unprecedented strain on the funds while members could not pay contributions. And from the 1950s onwards, government schemes and commercial health insurance progressively displaced the mutual model.

What replaced them, and why dental was left behind

This is the part that explains the situation Australian dental patients are in today.

1938 — National Health and Pensions Insurance Act. Legislated a contributory national insurance scheme. It was never implemented, defeated by professional opposition and then overtaken by the war.

1946 — the social services referendum. Australians voted to insert section 51(xxiiiA) into the Constitution, giving the Commonwealth power to provide, among other things, “medical and dental services” — subject to a proviso against civil conscription of practitioners, added to answer the medical profession's objections.

Dental services are named in the Constitution. The power to fund them federally has existed since 1946. It has simply never been exercised in any general way.

1948–1950s — the Pharmaceutical Benefits Scheme established subsidised medicines, after a constitutional fight.

1953 — the Menzies government's national health scheme: voluntary private insurance through registered funds, with government subsidies. Dental was, at most, an extra.

1975 — Medibank, then reshaped and largely dismantled over the following years.

1984 — Medicare, which is substantially the system Australia has now. Dental was not included.

Since then, dental has been dealt with in short-lived programs rather than as part of the system:

• The Commonwealth Dental Health Program funded public dental care from 1994 and was abolished in 1996.
• The Chronic Disease Dental Scheme provided Medicare-funded dental care for people with chronic conditions from 2007 and was closed in 2012.
• The Medicare Teen Dental Plan ran from 2008 and was replaced in 2014.
• The Child Dental Benefits Schedule began in 2014 and continues — capped, means-tested, for eligible children, and significantly under-claimed. Services Australia sets the benefit at up to $1,158 for each eligible child over two consecutive calendar years for basic dental services, with the cap indexed on 1 January each year; the child must be eligible for Medicare and the family in receipt of a qualifying payment. An earlier period capped it at $1,095, so an older figure is not necessarily wrong — it may simply belong to a different period. See Child Dental Benefit Schedule and how the scheme operates.

The pattern is unmistakable: dental is funded in programs that begin and end, rather than in the permanent architecture of Medicare. Every major review of oral health in Australia has identified the same consequence — cost is the leading reason Australians delay or avoid dental care, and the burden of untreated dental disease falls hardest on people who can least manage it.

The measured version of the cost point: a submission to the Senate inquiry into the value and affordability of private health insurance and out-of-pocket medical costs, published by the Parliament of Australia, cites an Australian Institute of Health and Welfare survey finding that nearly a third of people aged 5 or older — 32% — avoided or delayed visiting a dentist because of cost (AIHW, 2013). The same submission argues that ‘the absence of a national dental fee schedule may have contributed to the comparatively high cost of dental care in Australia'; that is the submitter's argument rather than a government finding, but it is the argument on the parliamentary record.

The consequence turns up in hospital data. The AIHW records roughly 88,600 potentially preventable hospital admissions due to dental conditions in Australia in 2023–24 — about 3 in every 1,000 people — up from a 2019–20 low of 2.6 per 1,000. A 2023 systematic review in Dentistry Journal puts dental-related admissions at 10% of all potentially preventable hospitalisations and 22% of those due to acute conditions, and reports a rise from 57,955 in 2007–08 to 72,000 in 2017–18. Our sources do not support breaking those admissions down by cause, state, remoteness, Indigenous status or age, so this page does not attempt it. The one distributional figure we can attribute comes from the ADA's Children and Young People Oral Health Tracker: 10.8 in every 1,000 children aged 5 to 9 are hospitalised for potentially preventable dental problems, rising to 14.3 per 1,000 for Indigenous children, and only 56% of children see a dentist before age 5.

What delay does clinically is set out in How does tooth decay develop?, The stages of dental decay and How often should I go to the dentist?.

The line from the building to the present

So the sequence is this. A mutual society founded to help working people afford medical care built a tower on Collins Street in 1932. The model it represented was superseded by a national health system that, uniquely among the major categories of health care, left the mouth out.

Ninety years later, a dental practice operates in the building, and its patients are still paying privately for care that a 1946 referendum expressly gave the Commonwealth power to fund. That is not a comment on any government; it is a durable fact about the Australian health system, and it explains almost everything else on this site — why cost is discussed on nearly every page (see the Price Guide and Understanding Your Treatment), why the Child Dental Benefits Schedule is repeatedly flagged, why public dental eligibility is worth checking, and why people are drawing down superannuation to pay for treatment — see Explosive uplift in Australians tapping into their super for dental treatment, Patient payment plans: the next big disruption on the dental horizon and Buy now pay later: abuse of process in the sales-centric approach to health care.

Related pages: Have a Deco at a Classic, Explosive uplift in Australians tapping into their super for dental treatment, Is dental really different to pharmacy?, Specialist dental care in Australia: what's in store, Children's Dentistry, General Dentistry, and the full Our Media archive.

The other Manchester Unity Building pages in this archive

• Art Deco oasis in the heart of Melbourne, Barry Humphries gets his teeth into art deco beauty
• Our City: Manchester Unity Building, Melbourne, Australia: Manchester Unity Building
• The Manchester Unity Building — Costa Rolfe, John Gollings, Penny Craswell, Leonard Joel
• The new shopping centre opens today
• Open House: Melbourne Open House, Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7

Two further items borrow the building's name without being about the building: Mothers in Unity, which is about maternal oral health, and Unity in Smiling: Suzanne Carbone, which is about oral health and mental health.

Common questions

Dental is named in the Constitution but not in Medicare. So what help actually exists for me now?

For adults, very little that is general — which is the whole point of the history above. For children in eligible families, the Child Dental Benefits Schedule is the one continuing national scheme, and it is under-claimed for reasons that are largely administrative rather than clinical.

Two details explain most of the under-claiming.

You do not apply for it. Services Australia states plainly: ‘You don't need to apply or register for CDBS. If your child is eligible we'll send you a letter.’ Eligibility requires that the child is ‘eligible for Medicare’, is ‘0 to 17 years old for at least one day that calendar year’, and that you or they ‘get an eligible payment at least once that calendar year’. People who never received or never opened the letter simply do not know they have it.

It covers real treatment, not only check-ups. The listed services are ‘check-ups, X-rays, cleaning, fissure sealing, fillings, root canals, extractions’. What it does not cover: ‘orthodontic dental work, cosmetic dental work, any dental services in a hospital.’ Services Australia adds that ‘There are some restrictions for basic dental services. You should check with your dentist if there are any item or time restrictions before starting your service.’

And the part that costs families money: the benefit is up to $1,158 per eligible child across two consecutive calendar years, and ‘If you don't use the full amount within the 2 calendar years, you can't use the remaining funds.’ An unspent balance is forfeited, not banked. It is also worth knowing that CDBS services ‘don't count towards the threshold’ of the Medicare Safety Net or the Extended Medicare Safety Net. Child Dental Benefit Schedule.

Who sets dental fees in Australia, and is there anywhere to complain about one?

Nobody sets them, and that is the direct consequence of the funding history on this page. There is no recommended national dental fee schedule, and the parliamentary submission cited above treats that absence as the core problem: ‘Without a dental fee schedule, access to private sector dentistry is unnecessarily inequitable. It is well known that private patients can go to multiple dentists and receive conflicting diagnoses and widely varying quotes for unpredictable dental fees. There are no consumer guidelines to ascertain the reasonableness of dental fees charged.’ That is the submitter's argument; the absence of a schedule is not in dispute.

The nearest published reference point is the profession's own survey. The Australian Dental Association's Dental Fees Survey 2022 reported fees as at 1 July 2022 from 3,819 valid responses of 11,035 dentists invited, and found that across 122 items, fees charged by general practitioners ‘appear to have increased by 3.7% during the two-year period since 1 July 2020’ — smallest in preventive services and periodontics (1.6%), largest in orthodontics (6.9%). Its most useful finding for a patient is that ‘there was considerable variation in the fees charged within and between states’, with SA and WA lowest on average and the ACT and NT highest, the ADA itself cautioning that the ACT and NT samples are small and ‘should be viewed with caution’.

On complaints, separate the two things. Advertising and professional conduct are regulated: AHPRA records that the maximum financial penalty per advertising offence rose in 2022 ‘from $5,000 to $60,000’ for an individual and ‘from $10,000 to $120,000’ for a body corporate. The amount of a fee is not. The submission's verdict on that is blunt: ‘there is no public body for patients to complain to about Australia's high dental fees.’ Which is why an itemised written quote and a second opinion do more for you than any complaint afterwards. Understanding Your Treatment and Second Opinions.

The Oddfellows paid doctors an annual fee per member. Is there a modern version of that in dental care?

There is, and the parallel is closer than it first looks — the payer has changed from a members' mutual to a shareholder-owned insurer, but the mechanism of a contracted provider paid to hold costs down for a defined membership is recognisably the same idea.

The parliamentary submission describes the current version: ‘private health insurer owned dental clinics (with no-gap fees) and preferred providers (less gap) cluster in major cities.’ It adds the geographic consequence — ‘The out-of-pocket expenses for rural patients are thus likely to be greater’ — because ‘most private sector dentists cluster in wealthier populated suburbs’. So the benefit of the arrangement, like the lodge doctor's, is unevenly distributed.

The objection has also changed shape. Where the medical profession resented capitation as underpayment, the modern complaint runs the other way, and the submission puts it from the patient's side: that collecting a patient's fund status ‘can result in excessive and unnecessary dental treatment or “over-servicing”’, and that this ‘mirrors dentists' overuse of the Medicare funded Chronic Disease Dental Scheme (2011)’ — the scheme this page records as closing in 2012. The submission also notes that the ADA has arrangements with particular insurers underwriting members' professional indemnity insurance, ‘outlined in numerous Australian Competition and Consumer Commission (ACCC) Exclusive Dealings Notifications’.

All of that is one submitter's argument, not a finding, and it should be read that way. What it supports practically is a habit: get the examination findings and the treatment plan before you hand over a fund card. If the recommended treatment grows once the remaining annual benefit is known, that is the thing to ask about.

Why is my dentist called ‘Doctor’, and what does the register actually tell me?

As a courtesy, in most cases. The same parliamentary submission records the regulator's position: ‘the Dental Board (2010) argues that there are no provisions under National Law that specifically prohibit dentists from using the title “doctor”, any use is merely a courtesy title.’ So ‘Dr’ in front of a dentist's name is conventional usage rather than a medical qualification, and it tells you nothing about training. Some dentists also hold a doctorate; most do not, and the title does not distinguish them.

What the AHPRA public register does tell you, free and without an account, is more useful: whether the person is currently registered, in which profession and division, whether any conditions, undertakings or reprimands are recorded against the registration, and whether they hold an additional registered entry in one of the fields the Dental Board approves. The Board records that ‘there are 13 dental specialties in Australia which are approved by the Australian Health Workforce Ministerial Council’ — a closed list, and one that does not include several titles used in marketing.

What it does not tell you is how good anyone is, how much they charge, or how many of a given procedure they have done. Those are questions to ask directly. Dentists & Registered Specialists, and the register itself at ahpra.gov.au.

Related reading

• Filming inside a working health practice

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. See also Our Location and Contact Us.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general historical information. It is not a diagnosis, a treatment plan, legal advice or a claim about clinical quality. Eligibility for government dental programs is determined by the relevant government body and changes; confirm current eligibility with them. The fee figures quoted above are the ADA's survey of its own members as at 1 July 2022 and are not current prices. Third-party published content is not reproduced.

Smile Solutions trades under ABN 28 193 514 103.