Wilson Tuckey (O'Connor, Liberal Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, prior to question time I raised the issue that I think is fundamental to this debate on the Dental Benefits Bill 2008 and the government’s decision to change the mechanisms by which this Australian parliament delivers assistance to persons suffering due to the need of dental treatment. I was making the point that it was the Keating government who had previously made a genuine attempt with $100 million a year over four years to assist the states in catching up with a huge backlog of waiting lists of persons requiring dental treatment who obviously otherwise could not afford it. Dental treatment costs have escalated significantly in recent times, and those of us who attend dentists from time to time soon learn about that. The government changed during the provision of that money and at the end of the period it is my clear recollection that the waiting lists had not decreased for the $400 million of Australian government taxpayers’ money that had been expended.

I pointed out that in his address today, and in fact opening the response of the opposition to this bill, the member for North Sydney pointed out that the reality is that less than 10 per cent of the Australian dental workforce is employed in the public sector. In that circumstance, the government’s response, which is to give cash to the states to upgrade and dissolve these waiting lists, is a case of you can put the wages up of the existing staff but you cannot double their output, and therefore it is misconceived. That became patently obvious to the Howard government and, in looking at that particular problem, the Howard government came up with an alternative. It was to create dental services on a referral from a GP—they were not just wide open; they were for persons who could anticipate serious health problems and had a Medicare number. Now that meant such moneys as the Australian government spent were spent on a scheme over which it had control and, therefore, which made a very significant difference to the outcomes. Above all, as is consistent with Medicare, it gave those on the waiting lists access to private practitioners—the 90-plus per cent of the dental workforce. The member for North Sydney, as I recollect, informed us that somewhere over 300,000 services have been granted over what is a very short span of possibly nine months. The other tragedy is that some of those people are only halfway through their treatment and, as I understand it, they are now denied completion of that service and must go back in the queue waiting for the under-resourced state entities to get on with the job.

The Deputy Prime Minister frequently tells us about all the wonderful training initiatives that are being implemented. There will not be a doubling of the Public Service workforce coming out of university next week or next year. I have no understanding that the government, in producing this compromise, promoted it during the election. It is an interesting point that we get lectured in here at question time every day about attacking the so-called $20 billion surplus, but it appears to me that the issues which we are debating with the government are those for which the government had no mandate. I believe this is one of those occasions. I do not recollect at any time during the election campaign—and a following speaker can correct me if they have the evidence—the government telling the people that on election it would cancel this very effective Medicare initiative and go back to something that has been tried and failed.

The first of two ministerial statements we have just heard was about the tragedy that has occurred in the gas industry in Western Australia. I do not know what proportion of this $250 million will get to the WA government, but it struck me that they cannot even run gas for their hospitals sufficient to do the laundry. Of course, it is the lack of pressure that the government put on by building cheap electricity generators running on gas instead of keeping with a system that was going to produce another coal-fired power station in Collie—where they have strong political support, I might add—that has created the problem. The problem is not for Western Australians; even in this depleted nature, that problem has now stopped the manufacturing of bricks, stopped the manufacturing of plasterboard and put a lot of people out of work. The reality is that it need not have happened if there had been better administration of the energy facilities in Western Australia, and here we are debating sending money to those same people—and, if they deal with it in the fashion they have dealt with energy management, do not hold your breath if you are on the waiting list.

Another initiative raised in this composite legislation relates to teen dental services. This is an initiative which can be applauded as a concept. The problem is that in Western Australia there is a school dental program already. That should be applauded. The issue relating to this proposed section of the legislation is, as I understand it, that a maximum of $150 will be available for teens to have their teeth checked. If in the process the dentist says, ‘Yes, there is the tooth that is giving you this dreadful toothache, but you will have to pay me to take it out or fill it because that is not allowed for; I can only check and tell that you have crook teeth,’ I am wondering what the benefit is. Typically, if you go to a dentist and they find that there is work to be done, they do not charge you for looking; they just charge you quite a large fee for fixing it. But we now have this rather amazing process where the government is saying to people, ‘We will pay to have your teeth looked at, but if they are found to require treatment we will not give you any money or assistance for it.’ Hopefully, it will not happen very often with young people. Under the previous legislation introduced by the Howard government they could have had a free check-up and, if it were serious, they could get a referral from their GP and have up to $4,200 available for the treatment that was necessary. That makes a huge difference.

It is really a test of this government’s capacity to manage. I spoke recently on health matters and talked about measuring excellence by expenditure. From my observations over a long period in this place, I have noticed that both sides of the House pay too much attention to the money they have spent and too little attention to the outcomes. More particularly, I have found myself in debate in times gone by with otherwise capable public servants who were most anxious to just send the cheque, and I frequently wanted to know a bit more about what the taxpayer was going to get for this money. It is still an issue with me and I think it is amazing that we have this philosophical hang-up within government and the Labor Party that, if the government does not do the job, it will not be done properly. That is not the view of the common citizen. Whenever they can possibly afford it, they send their kids to a private school. Whenever they can possibly afford it, they take out private health insurance when they know there is a need. Nevertheless, that will be proved quite a tragedy because of this attack on private health insurance and the private hospital system. We will see an escalation in premiums that will start to make the whole scheme unviable for the simple reason that the non-claiming young will decline to continue to be members of a private health fund.

Anybody who chooses to do the numbers—and the minister at the table, Minister Emerson, claims to be one of them—and wants to sit down and find out how you could improve the cost to government and the service to consumers should look at this. Instead of spending huge amounts of money sending cheques to state governments to run hospitals you could in fact use that money to subsidise—up to 100 per cent in deserving cases—the private health insurance of many individuals. Then (a) the cost of overall insurance would drop because everybody would be in the system and (b) everybody would have the same access to hospital services. Hospitals—be they government or otherwise—would become anxious to give the service because they would get paid for the service. They would not get, as applies with this legislation, a lump of money which they would then have to budget and which would mean that patients—be they dental or hospital—would become a liability. You do not want too many of them. That is the way that governments fund their hospitals.

It is commonly known amongst senior hospital administrators—and I have heard it said publicly—that waiting lists are part of the budgetary process. I reminded the House the other day of the complaint of a senior New Zealand administrator at a conference I attended years ago. Having said just that, she complained about the administration of the waiting lists. This is the other problem. She pointed out that, if you have a sufficiently energetic member of parliament—and I guess this applies to some degree with dental waiting lists—you get pushed up the list, to the detriment of others who do not. I gave the example of a member of parliament who did not have private health insurance but whose wife got private hospital treatment and, what is more, her doctor of choice. People who want to do a bit of research will find out who I am talking about. This is the bad side of this type of service. It is a tragedy that, without warning to the Australian people, a clearly beneficial and practical response to those in need of serious dental treatment is being taken away and replaced with something that history has proven does not work.

Mr Deputy Speaker, I assume the gentleman who has just entered the House is the next to speak. If not, I would not want to leave the opposition in trouble. Is that the truth?

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

Indeed it is.

Wilson Tuckey (O'Connor, Liberal Party) Share this | Link to this | Hansard source

Fine. Thank you very much.

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Dental Benefits Bill 2008 and related bill. It is no surprise that the member for O’Connor ran out of things to say, because there is indeed not a great deal that the members of the coalition parties could have to say about their record on dental health.

Wilson Tuckey (O'Connor, Liberal Party) Share this | Link to this | Hansard source

That’s the truest thing you’ve ever said. It’s a dog.

Mark Dreyfus (Isaacs, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to have the endorsement of the member for O’Connor that the coalition parties’ policies did not provide him with much to say! It was interesting to hear this from him. He said that there had been too much attention paid to money and not enough to outcomes. Well might he say that; for the policies of the previous government in relation to dental care there was—particularly in relation to the Commonwealth dental care program—no outcome, because the primary decision made by the former government immediately on coming to office in 1996 was to scrap the Commonwealth dental program. Well might the member for O’Connor say that not enough attention was paid to outcomes—by the previous government. This government, as part of its commitments to the Australian people made at the last election, said it would take seriously the dental crisis that the country is experiencing. This government is acting, and that is what we see in the legislation before the House. Notably, this legislation will create the Medicare Teen Dental Plan, and that is part of delivering on the commitments made at the last election by our party.

The scale of this crisis is not one which should be understated. Oral disease continues to be prevalent among Australian adults, and it is worth considering some of the national statistics. The first is that one in four adult Australians has untreated dental decay. Tooth decay is Australia’s most common health problem. The second statistic is that one in five Australians cannot afford to get the dental care they need. Additionally: one in six Australians has over the last 12 months avoided eating certain foods because of problems with their teeth; there are about 650,000 Australians on public dental waiting lists; 30 per cent of Australians are reported to have avoided dental care due to the cost of services; and 50,000 people were treated in hospital for preventable dental conditions. I want to speak about the work of some of the community health centres and the waiting list statistics in the dental health area in my electorate of Isaacs, in south-east Melbourne. The Central Bayside Community Health Service has people waiting 39 months for an appointment and 43 months for dentures. The Greater Dandenong Community Health Service has similar statistics—that is, people waiting 39 months for an appointment and 43 months for dentures. The Frankston Community Health Service has very similar statistics.

Each of these community health centres is a very fine local community health service. Despite a major increase in state government funding over the last nine years, these community health centres have found themselves simply unable to meet the demand for dental health services which they are faced with. The lack of Commonwealth government funding to dental health has been a significant contributor to the problems being faced by these community health services.

It is clear that socioeconomic status plays a critical role in determining health outcomes and in no area is that truer than in determining oral health outcomes. There is a very important social dimension to the crisis in dental health, and that is that it particularly impacts on low-income households and upon older people. Commonwealth and, of course, state involvement in dental health is an important public health measure and it is an important social welfare measure. Understanding these facts is important in understanding the scale of the problem.

It is worth pausing to recall and attempt to understand what this discussion about dental health actually means in the day-to-day lives of people. One can do that through meeting people who have been affected by an inability to access dental services. There are very many people in my electorate who have been unable in recent years to access appropriate levels of dental health care. These are people for whom daily life has become exceptionally difficult because, notwithstanding that they live in a prosperous country, they have been unable to access what should be regarded as basic health care. These are people who are chronically ill and have become regular attendees at public hospitals in part because the previous government would not properly address this issue of dental health care.

The fact that there are people in my electorate who have waited years for a dental appointment is simply unacceptable. From the very first day I was preselected as the candidate for the seat of Isaacs in 2006 I was approached by people who had truly appalling stories of the consequences for them of being unable to obtain dental care. These are stories of misery and pain caused by going without adequate care, which has led to problems that have compounded over the years. In very many cases it has led to them being unable to work or to becoming patients at public hospitals with compounded problems that, had they been attended to at an earlier time, might never have arisen.

For the national government to have abdicated responsibility for dental care was short-sighted and indeed shameful. Yet that is indeed what the previous government did on its election in 1996. The previous government abolished the then $100 million Commonwealth Dental Health Program and then for several years did nothing at all. While millions of Australian families were kept away from dental services because of the cost, the previous government did nothing. While hundreds of thousands of Australians were stranded on public dental waiting lists, the previous government did nothing. While tens of thousands of Australians were admitted to hospital for dental conditions that were avoidable given appropriate and timely treatment, the previous government did nothing. Eventually the previous government came up with a poorly implemented and half-baked scheme that assisted far fewer than it was supposed to. The actions of the previous government show in stark terms why the Liberal Party and its coalition partner cannot be left with responsibility for public health. The record of the past 11½ or 12 years shows that the coalition parties do not truly believe in public health programs. The coalition parties do not truly believe in a public health system. For them, any action in this area is simply a matter of political expedience.

For our side, in the Australian Labor Party, access to high-quality health services for all Australians goes to our core values of fairness, equality and compassion. With this legislation that is before the House, indeed with the 2008-09 budget and the new Australian healthcare agreement, this government will address the dental crisis that our country has been facing. Unlike those on the other side, Labor believes that there is a need for government action to protect and improve the health of the Australian people. We believe that government has a legitimate role in this field. I remind honourable members that the government, when in opposition, proposed two very significant programs that would re-establish the role of the Commonwealth in dental health care. The response of those opposite, then in government, to our proposals was to reject them.

This legislation, as I have indicated, introduces the Medicare Teen Dental Plan which, subject to the passage of this legislation, will commence in July 2008. It is a $490 million program which is targeted at those who most need this help. Eligible teenagers aged between 12 and 17 will be provided with up to $150 for an annual preventive dental check-up. It is worth noting that generally Australian children by international standards have excellent dental health but that dental health starts to decline during teenage years. This bill by introducing the Medicare Teen Dental Plan will help to address this problem.

In order to be eligible, teenagers must be living in families receiving family tax benefit part A or be in receipt of the youth allowance. More than one million teenagers will be eligible, on those criteria, for the Medicare Teen Dental Plan. The legislation creates a new Dental Benefits Schedule to operate as part of the broad Medicare arrangements and will include annual preventive dental checks that include an oral examination and other preventive services. Preventive check-ups are very important. It is appropriate that that kind of dental care be funded because it means that problems can be detected and dealt with early. An annual check-up is critical in ensuring ongoing oral health. As has been pointed out, people who visit the dentist for an annual check-up are less likely to attend for a dental problem than those who do not. The plan will help to instil in teenagers the need to visit the dentist regularly and to care for their teeth properly, behaviour that it is hoped they will carry on into their adult lives. Eligible families will receive a voucher from Medicare Australia and will then be able to receive a preventive check-up from their dentist. This will enable them to claim a rebate from their local Medicare office or be bulk-billed by the dentist, with $150 to be reimbursed by the Commonwealth.

I now turn to the Commonwealth Dental Health Program. Through the Australian healthcare agreements that are currently being negotiated with the state and territory governments, the Rudd government is re-establishing the Commonwealth Dental Health Program. This was the program that was abolished by the Howard government upon coming to office in 1996. In contrast to that neglect—indeed, ‘neglect’ is not a strong enough word; it should be ‘abandonment’—of responsibility by the former government, the Rudd government will be providing an additional $290 million over the next three years for dental health.

The Commonwealth Dental Health Program will help the states and territories to fund an additional one million dental consultations and treatments in the coming three years. We are working with the states, not working against them. We are ending the buck-passing and the irresponsible blame game played by the previous government. The Commonwealth Dental Health Program is an example of what can be achieved with the various levels of government working together to deliver policies that address the problems our nation faces. It is part of a broader push to coordinate better the actions of each level of government. It is part of a broader push that we are seeing in many areas of government activity, not simply in this area of dental health care. But, specifically in dental health care, states and territories are going to be required to at least maintain their current funding for their public dental health programs.

This too is, in a very real sense, a targeted program. It will target those in our community who are in the most need. States and territories will be required to ensure that Commonwealth funding is targeted at those who are most in need, such as people living with chronic disease such as cardiac patients and people living with HIV-AIDS, as well as people who have heightened oral health needs, including preschool children, seniors and Indigenous Australians. The re-establishment of a real role for the Commonwealth in the field of dental health, which is what this legislation represents, is a reflection of this government’s belief in the importance of the role of the national government in public health. It reflects this government’s willingness to work cooperatively with the state and territory governments and to deal with the dental crisis presently faced by our nation that the previous government did little or nothing to solve. I commend the legislation to the House.

Michael Johnson (Ryan, Liberal Party) Share this | Link to this | Hansard source

I am pleased to speak in the parliament today on the Dental Benefits Bill 2008 and the related bill. The bills go to a subject of great interest to me as both a citizen of this country and, of course, the federal member for Ryan. I represent the great people of the seat of Ryan. Ryan is a federal seat in the western suburbs of Brisbane. In the six or seven years that I have been the federal member, I have had the chance to meet many local residents who have certainly raised with me issues of health, including dental health.

Before I go to the contents of the bill, I want to say that I largely agree with the thrust of the member for New England’s observation that perhaps dental care should be part of the overall health profile of a person. I am not quite sure why we treat dental care as something unique and different to the rest of someone’s health. It really is very important to someone that their dental care is up there with the rest of their health care. I certainly think that is an observation worthy of consideration at some future point, particularly by the professionals in this area. Of course, that is not in any way to diminish it as a specialty or as a profession; in fact, it acknowledges that it is very significant, because dental care is very important. It is part of overall health and someone’s capacity to engage in the community and the workplace and to go about their daily life and their daily work.

I refer also to the comments of the previous speaker, the member for Isaacs. He referred to the previous government ‘abandoning’—I think that was his word—the funds that would have gone to this area and the overall health architecture of our country. If one turns one’s mind back to 1996, when the Howard government was first elected, I do not think too many Australians would need to be reminded that, at the time, the incoming Howard government faced a massive budget debt. In fact, such was its scale that almost no area of government expenditure was left untouched. Certainly members of the parliament would know—I know that the people of Ryan know full well—that when the Howard government came to office it faced a $96 billion budget debt. There was no way that any responsible government could go forward with all kinds of worthy programs and yet have a $96 billion debt hanging around the neck of future generations.

Interestingly, I just came across a paper that referred to 21 April 2006 as being the official date that the Commonwealth’s debt was repaid. So it took almost a decade to pay off this whopping $96 billion of debt. Of course, we do not face that problem now. The Commonwealth does not face the problem of how to pay off debt. It has a massive $22 billion surplus—and it is good that we have this surplus. It is good that the Commonwealth can spend these funds on important areas of the community. I know that the government claims that it has raised $22 billion in surplus in six months of office. I think even the little plastic turtle in my front garden would not be convinced of that. Quite frankly, it is just remarkable that the government, after six months in office, claims to have created $22 billion of Commonwealth surplus. But, anyway, it has $22 billion of funds and I certainly commend any program that goes to issues of the health of our fellow citizens. We in this parliament are perhaps privileged that we have access to schemes, private health insurance and dental specialists if we need them whereas so many of our fellow Australians do not. As I say, any scheme that tries to redress that is a good thing.

Labor promised in the campaign to provide funding to establish two dental programs if it were to win office: the Commonwealth Dental Health Program and the Teen Dental Plan. In fact, it promised up to $290 million to fund a dental program that it claimed would assist up to one million Australians to access public dental treatment. Under the proposal, funding would be made available to states and territories to assist them to clear public dental waiting list backlogs by funding up to one million additional dental services over the next three years—waiting lists, I might add, that are really the creation of the state Labor governments around the country. Certainly all states and territories are the primary delivery mechanisms for public dental care, through public dental clinics or through the hospitals. During 2005-06 the combined expenditure on public dental health services by state and territory governments was just over $500 million. In fact, it was a measly $515 million, and that is notwithstanding the fact that the states receive every single penny of GST revenue. Every single dollar of GST revenue goes to the states, and yet collectively across this country state and territory governments were only willing to spend a measly $515 million.

Eligibility for public dental services is often means tested so that it is targeted at concession card holders and those on low incomes who cannot afford to access private dental services. The Rudd government’s new Commonwealth Dental Health Program, the CDHP, is, interestingly, modelled on the former Keating government’s Commonwealth Dental Health Program. Speaking of the former Prime Minister Mr Keating, I understand that he is going to be the face of Australian tourism. I note that it has certainly raised a lot of eyebrows already that the former Prime Minister will be the face of Australian tourism. I thought we were trying to attract tourists to this country, not turn them away. But, as I said, this Commonwealth Dental Health Program is going to be modelled on the Keating government’s Dental Health Program. But, unlike the former program, which targeted adult concession card holders, the new program will require the states and territories to target other priority groups—specifically those with chronic diseases, Indigenous Australians and preschool children.

Full details of the allocation of funding for the proposed CDHP to the states and territories do not appear to have been set in stone yet. The Minister for Health and Ageing described discussions with the states and territories as being well advanced, but it seems that these have not been finalised, so I am not sure where we stand in relation to that. I would have thought they were pretty fundamental to this being an effective scheme.

From 1 July 2008 eligible families—that is, those in receipt of family tax benefit A, roughly 1.7 million people—and teenagers in receipt of Abstudy or youth allowance will be provided with a voucher to allow them to access an annual dental preventive check for teenagers. These teenagers will be aged between 12 and 17. The voucher will provide a dental benefit for a service up to the value of $150. I understand that the dental check-up can be delivered by either a public or a private dentist.

It is proposed that the Teen Dental Plan would operate in a similar way to the Medicare arrangements through a new dental benefits schedule also to be established by this bill and to be administered by Medicare Australia. The government estimates that around 1.1 million teenagers would be eligible for the vouchers in any one year. The bill proposes billing arrangements that are similar to what currently occurs under Medicare, which would allow for a range of billing practices. Under the proposed assignment of dental benefits, as I understand it, the bill provides for three means of payment. The first option allows provider dentists to bulk-bill Medicare Australia for the check-up service, which is then considered a full payment for the service, so the teenager would pay nothing. The second option allows the dentist to bill the teenager, who can then request a cheque from Medicare Australia to be issued in the name of the dental provider, up to the value of $150. The teenager would then be responsible for providing that cheque to the dental provider. As to the third method of billing proposed under this bill, it would appear that the teenager pays the dental bill and then makes a claim to Medicare Australia for a rebate, again up to $150.

Of the three billing mechanisms in place, I would have thought that only one—the bulk-billing option—would guarantee that the teenager or family would pay nothing for the service. As the Rudd government’s own estimates suggest, the cost of a dental check-up is around $290 and dentists are free to set their own fees. Patients accessing dental benefits who are not bulk-billed may be exposed to significant out-of-pocket costs. So you are covered up to $150 under the scheme, but the cost in reality is $290. To me, this really highlights the Rudd rhetoric and does not meet the Rudd promise. This is not universal dental care for young people; this is really a scheme that is going to see a lot of young people fall through the cracks. I just do not see how 1.1 million teenagers who may be eligible for these vouchers in any one year are going to enjoy the full benefits of the dental check-ups covered by this legislation.

The other fundamental flaw in this bill, of course, is that beyond the $150 there is nothing. So, a teenager goes to see their dentist and is told that they have decay or need massive work done on their teeth or gums, but then there is nothing else. There is no subsequent financial coverage; there is no further support mechanism. If they want to go back and see the dentist again, as they might need to, they would have to find their own financial means. This is an example of the government trying to look as if it is doing something serious but not really doing anything—because the check-up does not lead to anything at all. It is like going to hospital and being told you are really unwell with, for instance, bronchitis or pneumonia but that there is no bed in the hospital or subsequent care available for you. You just have to go home and take care of yourself.

The Chairman of the Association for the Promotion of Oral Health, Professor Hans Zoellner, who is at Sydney university, argues that funding the two proposed replacement programs is ‘money poorly spent’ because there are no strings attached for the funding to the states and the dental checks for teenagers do not include treatment services. I think that goes to the nub of this piece of legislation. It is a check-up—and that is fine for what it is worth—but why not provide financial services and assistance for teenagers who are professionally advised that they need further dental care? As I said at the outset, the Commonwealth government has $22 billion in its bank account. Why not spend some of that money on young people—in fact, on anybody who is disadvantaged—to help them with something pretty fundamental to their capacity to fully engage in our country?

The Australian Dental Association has raised similar concerns. I take the opportunity of quoting a media release of 13 May 2008 from the President of the Australian Dental Association, Dr John Matthews, in relation to this issue. It goes to the subject, first of all, of the states and territories’ responsibility:

For far too long, the States and Territories of Australia have failed to meet their obligations to ensure proper delivery of dental care to poor and disadvantaged Australians. This Government had the opportunity to rectify some of the specific deficiencies that existed by introducing some coordinated plans that are able to be built upon or modified to meet future needs.

He said further:

Instead it has provided the State/Territory Health Services with additional funding [less than provided more than 10 years ago] to prop up schemes that have not delivered to date. It’s a Band-Aid solution at best.

So there you go. That is not coming from a politician, from a member of the coalition, from someone who does not have expertise or from someone who has no professional or personal interest in this area—this is coming from the Federal President of the ADA. He has no claim to any special treatment; he is giving a professional opinion. He says it is a bandaid solution at best and points out that the funding is less than was provided more than a decade ago. That, I think, speaks volumes for the attitude to this bill of those who count.

The ADA also has concerns that the Teen Dental Plan is too narrow and fails to provide a ‘complete course of treatment’, which it argues could lead to teenagers who require more treatment moving back onto public sector dental waiting lists. If this occurs and substantial numbers of teenagers move onto public dental waiting lists, it is not clear if the proposed new CDHP would be sufficiently resourced to provide public dental services for the new groups that the government now wants it to target. These include those with chronic diseases who would no longer have access to the AHDCI, preschool children and, importantly, Indigenous Australians. State based public dental programs already provide services to people on low incomes and to students through school dental services, but, as has been noted, there are substantial waiting lists for many of these services and, although the government has committed $290 million over three years for the new CDHP, this is less than was provided to the states under the former program by the Howard government. Again I emphasise to the constituents of Ryan, who would be very interested to know this, that this $290 million is less than was provided to the states under the former Howard government.

While the minister has allowed for public sector dentists to provide the preventive dental check-ups, it is not clear how these will be provided in a timely manner, given the already long waiting lists for public dental services and the level of funding for the proposed scheme. Instead of the coalition’s very successful Medicare dental scheme, the Rudd government is going to allocate $290 million to push dental patients into the overburdened and inefficient state health system. We should be encouraging people out of the public health system by encouraging those Australians who can afford it to take out private health insurance, not be encouraging them to go into the state health system.

Queenslanders will certainly take no comfort from this. Any Queenslander listening to this debate would be fully aware that the Queensland health system is in a really appalling state. Given that we have a Prime Minister from Queensland, I would like to think that he will come to the aid of the Queensland health system. Of course, the Labor government in Queensland has been in power for almost 20 uninterrupted years—nearly two decades—yet we have so many flaws in that system. I have said in the parliament previously that I have a brother who is a neurosurgeon and a sister who is a doctor, so I am not speaking without some degree of informed knowledge here. This bill is no major long-term solution to teenage dental health care problems.

In conclusion, I take this opportunity to encourage the students in my electorate of Ryan to, as far as they can—they are young people, of course—keep to a minimum eating things like lollies, candy and cakes. I encourage you to look after your teeth. It is very important that you do that because in your professional working and adult lives it is very important to be a healthy Australian and to set a good example for others. I say to any young person in the Ryan electorate listening: look after your teeth and drink plenty of milk because milk has a lot of calcium and it is very good for young people. (Time expired)

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to hear the member for Ryan encouraging young people in his electorate to adopt good dental health practices. He might also like to encourage them to access the Teen Dental Plan. This program will benefit young people in the Ryan electorate, just as it will benefit young people in the Shortland electorate. He should be out there making sure that every young person who is eligible to benefit from this program does so. I trust that that will be the action he will take.

This dental benefits legislation recognises the fact that oral health is paramount for overall health. It also recognises that prevention is better than a cure for dental problems, as it is for most health problems. You are much better off if you can prevent the problem rather than have to deal with the consequences. The Dental Benefits (Consequential Amendments) Bill 2008 establishes the legislative framework to allow the government to deliver on a key election commitment. No issue was bigger in the electorate that I represent in this parliament than dental care. People in the Shortland electorate have been waiting for a very long time to access dental treatment. On a daily basis I was hearing from my constituents just how difficult it was to get the vital treatment that they needed.

The government gave a commitment prior to the election to implement the Teen Dental Plan. This is the first part—I emphasise ‘first’—of the government’s plan to improve dental health in Australia. The Teen Dental Plan is going to benefit many young Australians. It is part of the overall plan that the Rudd government has to deliver dental health care to Australians. In this year’s budget the government announced $780 million over five years for these two new dental programs: the Commonwealth Dental Health Program and the Teen Dental Plan. The government will be providing $490.7 million over five years for the legislation we are discussing today—that is, the Teen Dental Plan—and $290 million over three years for the Commonwealth Dental Health Program.

In July 2008 the government will provide towards a preventive check-up up to $150 per eligible teenager between the ages of 12 and 17. I certainly hope that not only the member for Ryan but all members on the other side of this parliament publicise this program and make sure that the young people in their electorates utilise it. It will be available for families receiving family tax benefit part A and teenagers in the same age group receiving youth allowance or Austudy. Approximately 1.1 million Australian teenagers will benefit from this plan. As I said at the outset of my contribution to this debate, prevention is much better than treating the problem.

These bills also provide the legislative framework for the payment of other dental benefits under the dental benefits schedule, and the DBS could be expanded to include other dental benefits items in the future. The DBS is broadly modelled on the relevant provisions of the Health Insurance Act 1973 relating to the payment of Medicare benefits but, unlike the Medicare Benefits Schedule, it is not a universal program. The DBS provides an opportunity for dental benefits to be targeted to specific groups of patients. This program will provide financial assistance to parents to keep their teenagers’ teeth in good condition and to young adults to take responsibility for their own oral health and give them a good start in life.

This is a contrast to what happened under the Howard government. Under the Howard government we saw the Commonwealth dental health scheme withdrawn. This was one of the first acts of the Howard government. At that time I was in the state parliament of New South Wales. As a state member I saw constituents on a regular basis. They were able to get the dental treatment that they needed. Overnight, those dental waiting lists absolutely skyrocketed. The Howard government stands condemned for that one action in relation to dental health—along with many others, I might add. Their failure to continue the funding for the Commonwealth Dental Health Program has created problems for thousands and thousands of Australians.

We need to look at dental health care and what has happened with our dental health over the last few years. Over the last three or four decades, dental decay has actually reduced, but—and this is an important factor—there are still 19 million people with dental decay whose teeth have been untreated. These are people who have not been able to access dental treatment because they cannot afford it or because there is not a program out there that they can use—people who are among the 650,000 Australians waiting on the public dental waiting list to see a dentist and people who did not qualify for treatment under the Howard government’s dental health program. I will talk about that program in a moment. I do not know whether members of this House are aware that each year 50,000 Australians end up in hospital because of problems with their oral health—such as tooth decay or abscesses—and these are non-essential admissions to hospital. If they had had the treatment prior to their dental health condition deteriorating to the stage it did, they would not have been in hospital. That emphasises the need for us to concentrate on prevention rather than treatment.

It is interesting to look at the funding of dental health within Australia. In 2005-06, the combined government expenditure was $995 million, with $480 million from the Commonwealth. As members on the other side of the House have frequently told me, the Commonwealth’s obligation has been met through funding of the 30 per cent private health insurance rebate. Then there was $515 million for the states. I have sat in this House and listened to members on the other side arguing that it is not the Commonwealth’s responsibility to contribute to dental health, other than through the 30 per cent rebate. We on this side of the House do not believe that. We believe it is a Commonwealth responsibility. We believe it is everyone’s responsibility to put money into ensuring that all Australians have good oral health and consequently good overall health. In 2005-06, individual Australians were the ones who contributed the most to their own dental care—$3.5 billion was contributed by individual Australians. We in the Rudd government want to address that. We believe that there is a role for government.

The teen dental health program will put an extra $490.7 million into dental health. The Commonwealth Dental Health Program will put an extra $290 million into dental health. All up, there will be $780 million put into dental health from the Commonwealth government—big change and big moves. This is a significant increase in funding, and it is a move to address the most prevalent chronic health condition in Australia. I do not know if members of this House are aware that dental health problems are the most prevalent chronic healthcare condition in Australia. I base that statement on information from the Australian Institute of Health and Welfare.

The other issue which impacts on people’s access to dental care is the workforce issue. Under the Howard government, the chronic shortage in the dental workforce has ballooned. This is something that we on this side of the House have already taken steps to address in the last budget.

The Howard government’s dental health program was a poorly targeted program. It was only available to people who were suffering from some sort of chronic disease. It did help a number of people, but it also meant that a lot of people in desperate need of dental health care were unable to access it. Pensioners, people who found it very difficult to make ends meet, people who had some sort of concession card and people who were struggling were unable to access the Howard government’s dental health program. It was available to everyone with chronic disease, no matter what their income level was, whereas the programs that we are introducing are targeted to those people who have the greatest need. If you look at the people who have the poorest dental health, socioeconomic factors play a very big part in that. People who have the least money have the most chronic and the worst dental problems.

In the last parliament, I was the Deputy Chair of the House of Representatives Standing Committee on Health and Ageing at the time that we brought down the report, which I have in front of me, The blame game. This is the report that the member for Fadden said that the member for Fairfax had been responsible for. I would like to put on the record that every member of the committee, including the member for Ryan who just spoke, contributed to this report. It was a report that brought down a recommendation that:

The Australian Government should supplement state and territory funding for public dental services so that reasonable access standards for appropriate services are maintained, particularly for disadvantaged groups. This should be linked to the achievement of specific service outcomes.

I am sure it will be no surprise to the House that the Howard government did not even respond to this report. Labor has looked at that recommendation and tonight I have referred to two programs that actually do exactly what recommendation 3 of The blame game report said. Under the dental care heading the report also went through and identified a number of issues. One of them at 3.112 was that dental care should be given in a timely manner. It also recognised the fact that it can significantly affect a person’s life and future health costs. The Australian Dental Association noted:

Like the health system generally, the organisation and delivery of dental care in Australia is characterised by the involvement of Commonwealth, State and territory, and Local Governments. Unlike the health system though, dental care in Australia is largely financed by individual out-of-pocket expenses ...

I refer back to the point I made earlier in my contribution in this debate where I said that in 2004-05, $3.5 billion of treatment had been paid for by the individual. That means that those people who can least afford it are the ones who miss out and in this legislation we seek to address that very issue. A person’s financial ability will not determine whether or not they get dental treatment; rather, it will be determined by a person’s need. The Teen Dental Plan is available for all young people between the age of 12 and 17 and is one that will be utilised by and benefit all people in that age group. It is a preventive program, as opposed to one that targets chronic illness. It is a program that will stop our young people developing chronic dental problems throughout their lives.

Paragraph 3.114 of The blame game stated that there was a need for the Commonwealth to show leadership and that was also identified by the Australian Dental Association. You have no idea, Mr Deputy Speaker Washer, how disappointed I was when the Commonwealth did not show leadership under the Howard government. I was extremely disappointed that they would not make sure that everybody, no matter what their financial status was, was able to benefit from and access dental health care.

One of the other issues identified in this report was the waiting time for public dental health services. Under our programs we aim to address that. We aim to make sure that people do not languish on waiting lists for two or three years and then end up ill and taking up an acute care bed in our hospitals. We have before us today a totally different approach to dental care, an approach that will ensure young people who need dental care will be able to access it. It will happen from 1 July this year when the government will provide up to $150 towards an annual preventive check for eligible teenagers aged 12 to 17 in families receiving family tax benefit A. As I mentioned earlier, this will benefit approximately 1.1 million teenagers who will be eligible for the Teen Dental Plan. The dental treatment services will be for oral examinations and will include things like X-rays, scale and clean and other preventive services.

This will set in place a sound grounding for young people in learning how to care for their teeth. It will ensure that they develop good oral health practices. At the same time, if they need other treatment, they will be able to be referred on to have that treatment. The dental health program is partly funded by the redirection of funds from the previous government’s chronic disease dental program, but this is an ongoing commitment to the oral health of all Australians. It is a new era in dental health and it is recognising that if a person does not have good oral health, if a person does not have in place good prevention strategies, then they will develop chronic problems, and the burden to them and to Australia as a whole will be enormous.

Debate (on motion by Dr Stone) adjourned.