Monday, 17 September 2007
Health Insurance Amendment (Medicare Dental Services) Bill 2007
We will move on to the Health Insurance Amendment (Medicare Dental Services) Bill 2007and the dentists all suffering under Work Choices legislation. Dental services have been an issue for nearly 12 years now. In Tasmania, particularly in the seat of Lyons, I have hundreds of constituents who just cannot get in to see a dentist, let alone afford dental treatment, and it is severely affecting their health.
This bill amends the Health Insurance Act 1973, which of course was a Labor bill, in order to provide for the expansion of the government’s Medicare dental program for people with chronic conditions and complex care needs. It also puts a monetary limit on Medicare benefits for dental services to be introduced for eligible patients. The limit is $4,250 over two consecutive calendar years, and it will be set out in a ministerial determination made under subsection 3C(1) of the health insurance amendment.
Medicare benefits will be paid for the supply of dental prostheses, such as dentures, under the new dental items. The government’s Medicare dental program for people with chronic conditions and complex care needs was initially established in July 2004 and has been hampered by extremely low take-up due to complexity of referrals and the high copayments involved. It is very difficult for people to get hold of these benefits.
The government announced in the last budget that it would pour an additional $377 million into this failing program, probably knowing that it would not be spent. The budget announcement included an annual diagnostic consultation and increased the maximum benefits available for dental treatment to $2,000 in benefits for each calendar year. The government subsequently announced that eligible patients would have up to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years, increasing the cost of the program to $384.6 million over four years—but referrals, copayments and restricted eligibility would all remain.
There will be no impact on the cost or availability of dental treatments to the wider community, including families, from this bill or the policy changes that underpin it. No assistance will be provided to most of the 650,000 people on public dental waiting lists. When the Howard government scrapped Labor’s Commonwealth Dental Health Program, it could quite easily have continued it. There was a need; the assessment was that there was a need, and it should have continued. It led to the public dental list blow-out, and there has been a sharp deterioration in dental health standards among low-income people and, of course, young children. Despite the states and territories more than doubling their funding to public dental care since the CDHP was abolished, the Howard government has constantly asserted that the states and territories are totally to blame for Australia’s dental care crisis.
The Howard government’s initiatives on dental health have been limited to subsidies of 30 per cent or more for those people with private dental health insurance and the ineffective Medicare dental program for people with chronic conditions and complex care needs. The targeting of the existing program to people with chronic conditions and complex care needs has severely limited the uptake of the program to date, with only 7,228 Australians helped with their dental care between July 2004 and June 2007. While I am very pleased we have been able to help those people, that is only just over 7,000 out of 650,000. The need for high copayments from patients and complex referrals from GPs have been additional impediments that have stopped more people taking up this program.
Nationally, the rising cost of dental care is a major cost of living issue for families and has contributed to a national dental crisis which has left one in three Australians avoiding dental care because of the cost. The increase mentioned earlier to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years may assist in reducing the high copayments, but the retention of limited eligibility, to people with chronic conditions and complex care needs, will necessarily mean that only a small proportion of the population will be able to take up this assistance. So there will be no impact on the cost or availability of dental treatment to the wider community, including families, from this bill or the policy changes it underpins. No assistance will be provided to most of the 650,000 people on public dental waiting lists.
Labor have been highly critical of the program and we indicated at the time of the budget that, in government, we would be likely to use the increase in funding to invest in dental care for the benefit of ordinary Australians. Australia is facing a crisis in dental care, with one in three people reporting that they avoid dental care due to the cost and with more than 650,000 on waiting lists for public dental care, some waiting years for treatment. In recent years we have seen a dramatic increase in kids’ tooth decay and up to 50,000 hospitalisations annually for preventable dental conditions. People are ending up in hospital because their teeth have gone bad. Talk about a health system that needs some help! But it is not only young people; most people on age pensions and self-funded retirees have been leaving their teeth out of their health care with disastrous results. I have had a number of cases recently where people have given up on public dental waiting lists and are trying to access private ones, but are taking out loans to have their teeth done. Others simply cannot eat anything hard. This is an awful situation.
One of the first acts of the Howard government when it came to power in 1996 was a shameful decision to abolish the Commonwealth Dental Health Program, ripping $100 million from public dental health. The state and territory governments have doubled their investment in dental health care over the past decade, but John Howard and Tony Abbott continue to blame the states for Australia’s dental crisis. The impact of the increased need for health services for dental health is an appalling state of affairs and one that can only be laid at the feet of the Howard government—and, if that was not bad enough, it has ripped money out of the health system as well. The Howard government has failed to meet the rising costs of providing health care by providing adequate funding and so the states have had to find and spend more money.
My electorate has been affected harshly by this. Because of the withdrawal of dental and health funding, the people of Lyons are suffering. Because of the lack of funding from the Howard government, the sustainability of many services in Lyons is under threat. Dental services are at a bare minimum. A lack of health funding has resulted in the communities of Ouse, Beaconsfield and Rosebery facing closures, and some elderly people have had to move away from their local area. Dental services across the electorate of Lyons are lacking. Many people must travel to major centres for dental and health care. There is no reason why the provision of dental health services could not be undertaken through a multipurpose health care approach to health care delivery. Is the Howard government interested in this approach? No.
I have been working with a number of communities concerned about health services, particularly the Ouse community. This community wants to extend services in its local area, not close them down. This community wants to build independent living units and continue to provide additional health promotional services. I see no reason why dental services could not be added to the list. On 21 August I presented my policy ideas to that community for discussion, sending information to the Mayor, Deirdre Flint, and to the Chair of the Medical Subcommittee of the Central Highlands Council, Ann Jones. The ideas for discussion included using the concept of multipurpose health centres for care delivery in regional areas of Tasmania, particularly in Lyons. Labor developed the idea of the multipurpose health centre and, in fact, the first one was built in my electorate, at Oatlands. The Howard government has failed to be innovative and extend this concept in any way. The Howard government has been too busy taking away funding from the dental health scheme to worry about health in regional Tasmania. My ideas presented for discussion also raised the issue of improving transportation, undertaking a comprehensive health needs analysis and improving community education regarding the problems our health system is facing. While Medicare benefits for the supply of dentures is a good idea, it is not much use if you cannot get to the dentist in the first place.
After 11 years of playing the blame game and denying that dental care was its responsibility, in its last budget the Howard government took a small step towards addressing the national dental crisis. Why can’t we have innovation? Why can’t we have multipurpose health centres delivering a whole range of health outcomes and drawing money from state and Commonwealth governments, the community and anywhere else that they can source income opportunities? Unfortunately, this belated and long overdue measure to supply dental care to people with chronic diseases will do nothing for the vast majority of people on public dental waiting lists around the country, nor will it make dental care any more affordable. Labor believes Australia should use its prosperity to help people get the basic dental health care they need and deserve. That is why Kevin Rudd announced in December 2006 that a Rudd Labor government would restore Commonwealth funding for dental care. It is on the table.