Tuesday, 18 September 2007
Health Insurance Amendment (Medicare Dental Services) Bill 2007
I rise in the House today to support the Health Insurance Amendment (Medicare Dental Services) Bill 2007. We have heard myriad discussions, but it was interesting to hear the contribution of the previous speaker, the member for Scullin, because it was not so much about the blame game. We have had a barrage of issues and allegations directed from both sides of the House—they did this, you did that, and somebody else did something else—but I do not think that that is what this debate is about. This debate is about a piece of legislation that is going to provide services and facilities to enable people with chronic conditions and complex care needs to be treated. The dental system and the way it works across Australia in every state are very difficult issues. I really do not know how people can afford to have dentistry work done. It is extraordinarily expensive. That is why there is a need to look at various options in coming up with a suite of measures to respond to the longstanding issues that dentistry has presented us with for a number of years.
This bill provides some much needed services. From 1 November 2007 new dental items will be introduced to the Medicare Benefits Schedule. This will enable people who suffer with chronic conditions and have complex care needs to receive Medicare benefits for a broad range of dental services. To resolve the problems regarding the shortage of dentists and the cost of dentistry to the general public is going to take us a long time—it is going to take the nation a long time—and it is going to take cooperation between the states and the Commonwealth. I often wonder about the cost of dentistry, though I am not at all accusing dentists of profiteering—because I do not really think they do.
When you go to a surgeon, a surgeon diagnoses your need for a knee replacement or a hip replacement, or diagnoses your kidney disease or whatever, and they generally then send you to a hospital where they will utilise the technology and the equipment that has been put inside the private hospital or public hospital. This equipment and technology is generally paid for from the public purse or by the institution if it is private. To be able to deliver their professional services, a surgeon needs a set of rooms and a secretary and they need to see and diagnose patients at appointments and send them off to hospital, where they will be able to utilise the hospital’s equipment, which they do not have to purchase. A general practitioner generally has a small bag—a little black bag—and diagnostic equipment. He might have something to check your reflexes and he might have a thermometer, a stethoscope and other diagnostic equipment. But if you require further treatment—X-rays or the use of some kind of technology—you will go off to a medical imaging centre or a hospital where all of that equipment is in place.
A dentist has to equip their surgery and they have to provide up-to-date technology. They have to be able to see to every aspect of oral hygiene care and dental requirements. They have to be able to diagnose, for example, whether it is a cancer related illness affecting the jaw, teeth, bones et cetera. No longer does your dentist just pop you in the chair and, if you have a cavity, whip a drill around and fix it up in a few minutes or pull out a pair of pliers and take the tooth out. That is no longer the way dentistry is performed. It is very precise and technical, requiring an enormous amount of fit-outs in surgeries. It is extraordinarily costly. I am wondering whether there should be an option whereby dentist surgeries can be fitted out so that dentists do not have to meet the costs of all that equipment, thereby making their services a little cheaper for the general public to access. There have to be different ways of thinking about how dental services can be financially accessible to the majority of the public.
Then there is a workforce issue, and maybe that brings up competition. It is a strange thing for me to stand up here and say maybe we need competition and that that may reduce prices. Let me say to you that I do not for one second believe that dentists are profiteering. They have to pay extraordinary overheads in order to be able to run a surgery. If there are not enough dentists around to be able to meet the demand then surely there is an option for some people to be able to charge higher prices. You are really captive to the market. Yes, if you have private health insurance, you can get a rebate on some of those dental works if you have been in your health insurance for a period of time. But if you are just the average worker who is earning, say, up to $35,000 a year, and maybe you are even a one-income family—my electorate is full of people in those circumstances, as I am sure are the electorates of many members—and you are sending children to school, trying to feed and clothe them and do all of the things that you have to do, the thought of spending $1,000, $3,000 or $6,000 on your child’s braces is almost unacceptable. You would love to do it, but it is almost impossible. Just going on regular checks to the dentist to keep your oral hygiene up to date and to have early intervention is even more difficult. So it comes back to the days when we did not have fluoride, when we had tank water—that may be an issue again in the future, with the issue of bottled water, which I raised this afternoon. It comes back to the fact that you only take a trip to the dentist when it is a chronic or acute issue—you have decay in your teeth and they need to be pulled or filled or something. It is such an extraordinarily expensive thing to do.
We have to think outside the square. We have to determine that we need to work as a team across Australia. We have to address the workforce shortage. And the government has done that. I am very proud that the government has funded Charles Sturt University with $65.1 million to open a school of dentistry and oral health in my electorate and in the future electorate of the current member for Macquarie. I think it goes into the electorate of the member for Parkes as well as the electorate of the member for Farrer. But the primary structures will be in Wagga Wagga and Orange. I am very proud to have been a part of delivering that. We are now giving rural students an opportunity to become a rural professional in a rural setting, which will almost guarantee that many of those students will then practise in a rural area. That is where there is an enormous shortage of dentists and access to dentistry. That is one measure.
I appreciate the government’s budget announcement this year, wherein they provided this $65.1 million, and we are just procuring all of the requirements that we will need into the future. As I said, there is a significant range of interest being shown in that program, with more than 300 calls from prospective students from across inland and rural Australia. That is without any marketing campaign. But that school will open in 2009. It will have a preclinical and clinical facility in Orange and Wagga Wagga. There will be education clinics in Albury-Wodonga, Bathurst and Dubbo in New South Wales. There will be 240 new training places for dental and oral health students over that five years, training in a rural setting—which, as I said, will go a long way to providing the supply to meet the demand.
But then you have to work out how you are going to actually enable people to afford to access the supply, rather than standing in the chamber debating the rights and wrongs of a 1992 or 1993 program that was put in place to try to assist the waiting times in the states—which, might I add, from the feedback that I have had, was not a successful outcome. As they typically do, the states, whether they be coalition or Labor, if the Commonwealth is going to put in money, withdraw their money and use it on something else. So you really are just robbing Peter to pay Paul and you are not progressing very far at all. So I am not interested in that scenario. We have done it to death. I have done it to death myself in this House. I have raised dentistry a number of times. I have played the blame game. But it really does need us to sit down as a team and work out how we are going to move forward.
These are significant steps forward. These are significant moves being made by the government. They do not deserve criticism. Nobody has the answer at the moment. The states do not have the answer, except to put bucketloads more money into public dental health practices or school dental health. But how does that really affect the man on the street, or mum or the children, who want to go to their local dentist and keep their teeth healthy but who are not able to access public dental services? Those services are primarily there for low-income earners like pensioners and disability pensioners—and so they should be.
What we should be doing is saying, ‘Okay, this is an excellent measure,’ because, at the moment, we do not have enough dentists to meet the demand, particularly in rural and regional Australia. We know that we have to train a workforce, so we are going to put 240 training places at Charles Sturt University. We are going to give them $65.1 million in order to establish their campuses so that this can be successful.
The second thing is this. We know we have got people out there in every electorate across Australia with chronic conditions and complex care needs who require some urgent assistance to be able to access dentistry. This is what we are here to deal with tonight through this bill, because it does enable eligible patients to receive a Medicare benefit of up to a specified amount of $4,250 over two consecutive years for dental services. This is for those people with chronic conditions and complex needs. It will also enable Medicare benefits to be payable for the supply of dental prostheses, including dentures, to those many people who are elderly and have chronic conditions and complex needs. They need dentures to be able to have a normal balanced and healthy diet. In my view, this is a good positive move that does not deserve to be run down or criticised because it is supposedly not dealing with the whys and wherefores of every dentistry problem across Australia. It is a good measure that deserves attention and consideration as going a long way towards achieving some of the outcomes. It does not achieve all of the outcomes but it gives some choices and options, so it is a good measure that does not deserve criticism.
Having started on the workforce issues, we then started to put in place measures to address the complex care needs of those people with chronic conditions. Now we want to move forward so that in the future we will look at how we manage to provide cheaper access to a dental service so that it is within the realm of the majority of the people who are on incomes of less than $35,000 in my electorate—and, believe me, they do represent a significant part of my electorate. Many receive even less than that, given the drought and the current state of disarray that the Riverina is facing with its seven consecutive years of dry land, three catastrophic frost events and four years of crop failures—and irrigators have also entered into this same predicament. That means that more and more people are on lower and lower incomes and on government benefits, support which they are not used to being on. So how do you make dentistry more affordable so that they can have a real form of oral health management that will offer early intervention and prevent further invasive treatments being required? I recall that when I was a young mother my three sons were in a dentist’s chair every three months. I now feel quite cross sometimes that they, having grown into adulthood, have not been taking care of their teeth, given how during their young lives I struggled and scrimped and saved to be able to cash my Medicare receipts for them to be at the dentist’s. Now they have their own money but they will not spend it on their own teeth, which is a real problem.
What we have here is the scenario of the majority of families where accessing a dentist is a luxury because of the way in which the families’ income is structured and because of the costs of dentistry. I think more attention will have to be paid to this in the future. If we must think outside the square as to how dentists can be provided with all the technology that they require in their surgeries in a way so that they do not have to pay it off and so that they do not have to get so much back from consumers in order to meet their costs, so be it. These are things that we should consider, given that most medical practitioners are not required to provide all of that technology. They use technology that has been provided by state or Commonwealth governments in another place, whether it be a private hospital or a public hospital. They are able to go in and use that technology. I think that is where we should be heading.
I commend this bill to members, not because it is a panacea that is going to bring to an end all the dental problems across Australia but because it deserves to be given support. It deserves not to be criticised. It deserves to be dealt with in the context of the purpose for which it is intended: to resolve some of the problems that we can resolve at this time. You cannot resolve in one fell swoop all the dental issues across Australia through any election campaign announcements, because they are simply difficult and complex things to deal with and we need to be honest in the way in which we assess and deliver programs. I support the bill that is before the House. I believe that it is a good bill that gives people the capacity to have an opportunity that they have not had before. Is it the Commonwealth’s responsibility or is it the states’ responsibility? You know what: people really don’t care. All they want is to be able to afford on a regular basis access to a dentist in their community, so we have to address the workforce issues, address these chronic care issues and address, somehow in some way, how dentistry can become more affordable in the future. I commend the bill to the House and I urge everyone to support this bill because it is before us with the right intentions. It always has been considered with the right intentions. Coalition members have as much heart and compassion for their constituents as opposition members have. We also lobby hard along the way for these types of initiatives because we care as well. In fact, if the truth be known, every member in this House cares for their constituents, so I am hopeful that this legislation will be allowed to provide people with some much needed access to dentistry. It is not a panacea, as it is not going to solve all the problems, but it will go a long way to resolving the problems of some people with chronic conditions and complex care needs who will be able to access this package.