Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Hansard source

The purpose of the Health Insurance Amendment (Medicare Dental Services) Bill 2007 is to amend the Health Insurance Act 1973 in order to provide for the expansion of the government’s failing Medicare dental program for people with chronic conditions and complex care needs. As indicated in the debate on this legislation in the other place, Labor will be opposing this bill. Labor will be opposing this bill because it is an election year patch-up job by a government that has presided over 11 years of neglect in dental health. Labor has consistently and loudly highlighted not only the weaknesses of this particular policy but also the Howard government’s negligent approach to the dental health needs of Australians over the last 11 years. A decade of Howard government neglect cannot be fixed by throwing millions of dollars at a failing policy. Failing policy cannot be made effective simply by pouring more money into it. The basis of this policy is wrong, and that is why Labor will not support it.

There is little doubt that Australia is in the midst of a potentially catastrophic dental care crisis. Let us look at some of the facts. Currently there are 650,000 Australians on public dental waiting lists around the country. Many wait years for treatment. Thirty per cent of Australians have reported avoiding dental care due to cost. Dental workforce shortages mean that Australians simply cannot get in to see a dentist when their teeth need attention. In the public sector that means long waiting lists. In the private sector it means not being able to get in to see a local dentist on short notice. These dental workforce shortages are particularly felt in outer metropolitan, regional and rural areas where there are simply not enough dental professionals. These problems with accessing affordable dental care are contributing to Australia’s deteriorating dental health. Tooth decay ranks as Australia’s most prevalent health problem, while gum disease ranks fifth highest. Untreated dental decay in the Australian adult population stands at 25.5 per cent—that is, a quarter of Australians are not getting the dental care they need.

A recent study found that one in six Australians had avoided certain foods during the last 12 months because of problems with their teeth. Some 50,000 Australians a year are being hospitalised for preventable dental conditions which have escalated into more serious problems because they have not been able to access treatment when needed. And perhaps the biggest indictment is that while Australian kids had the world’s best teeth during the mid-1990s there are now pockets of real concern. For example, between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous decay. This was matched by soaring hospitalisation figures for the removal or restoration of teeth. According to the NSW Chief Health Officer’s statistics, hospitalisation rates for children under five have increased by 91 per cent between 1994-95 and 2004-05—a finding confirmed by disturbing claims-information recently released by health insurer MBF that showed a 42 per cent increase in children being treated in private hospitals for dental cavities.

It is clear that Australia needs action on dental health. Rather than addressing this range of issues to improve accessibility to affordable dental care, the Howard government have instead spent much of the past decade cynically playing the blame game on dental health. Time and time again Prime Minister Howard and the Minister for Health and Ageing, Mr Abbott, have deflected criticism onto the states and territories, saying, curiously, that Australia’s public dental care crisis and deteriorating oral health standards were entirely a state and territory problem. We have seen more of it this week, with all of the carry-on that occurred in the other place on Tuesday afternoon.

Of course, in seeking to blame the states and the territories, the Prime Minister and the health minister conveniently ignored two key facts. Firstly, it was the Howard government which scrapped Labor’s Commonwealth dental health program in 1996, ripping $100 million a year from Australia’s public dental system. Make no mistake about this: the government axed it, abolishing the scheme as one of their first acts in government. Do not believe the revisionism exercised by the minister for health this week when he said that the Howard government did not review the Commonwealth dental health program. The program had a year to run, and the government cut off the last year of funding.

While the state and territory governments have more than doubled their investment in public dental care over the past decade, the Howard government has withdrawn $1.1 billion in public dental services over the last 11 years. The impact of the Howard government decision in 1996 still reverberates today, not least within the hundreds of thousands of Australians languishing on public dental waiting lists.

But that is not all that the government has done. Dental care in Australia is in a crisis because of underfunding and because of workforce shortages. The Howard government seems to have forgotten that the training of dental professionals is entirely a Commonwealth government responsibility, but its neglect in this area is of long standing. The Senate Community Affairs References Committee recommended a national oral health training strategy for oral health care providers and other health professionals as long ago as 1998. But the Howard government has failed to act. In 2003, researchers highlighted that there would be a shortage of 1,500 dental professionals by 2010 unless action were taken. In 2004, dental graduation levels were found to be at their lowest for 50 years.

Belatedly the government has recently increased dental-training places at Australia’s universities, and Labor welcomed the recent budget announcement of a new dental school at Charles Sturt University, but a comprehensive and strategic national policy is required to ensure a long-term solution to the crisis. Not enough has been done, in particular to address public sector shortage and regional and rural demand for dental professionals. While we are talking about dental schools, I place on the record my support for James Cook University’s desire to establish a dental school in my home town of Cairns. I commend them for the work that they have done. It is unfortunate that they were overlooked and Charles Sturt was successful; they can be assured I will continue to advocate on their behalf.

We have needed training for dental professionals for some time. Affordability is also part of the issue. Over the last four months I have been conducting forums for older Australians around Australia. In every single one of those forums the issues of dental health, affordability of dental services and access to dental services have been raised with me. When you talk with these older Australians about the systems in place—the measures that the government introduced some three years ago—firstly, they are not aware of them. Then you explain how they work, and they say, ‘That wouldn’t help me anyway because I can’t afford the copayment.’ These are people who are on pensions. They simply cannot afford the copayment. If you need evidence, you just need to talk to older people who are on pensions and fixed incomes. They will tell you very clearly that the current policy approach of the Howard government simply is not working.

The other thing that I do is ask people from the community what the waiting lists are like at public dental clinics. By way of example, I can report to the Senate that the small community of Edmonton, south of Cairns, a community of around 6½ thousand people, has a waiting list—the worst I have heard of—of 4,000 people. That is 4,000 people out of a community of not more than 6½ thousand. Admittedly, the collection area is probably larger than that, but there are 4,000 people on the waiting list. I did not ask how long it took for them to gain treatment.

Unfortunately, though, this government is far more interested in playing the blame game than in providing solutions for Australia’s dental crisis. The Howard government’s initiatives on dental health have been limited to the subsidies of 30 per cent or more, depending on the person’s age, for people with private health insurance—rebates that, I have to say, Labor supports. But the other initiative that the government has undertaken is the ineffective Medicare dental program for people with chronic conditions and complex care needs, which is the focus of this legislation. This program was initially announced in March 2004 and commenced in July of that year. Under this policy, Australians were eligible for assistance with their dental care if they had a chronic medical condition, like heart disease or diabetes or malignancies of the head and neck, and they had poor oral health or a dental condition which was exacerbating their chronic and complex disease and they were being treated under a multidisciplinary care plan. You had to jump through three hoops to get into the system.

These complex and restricted eligibility criteria, limiting the program to people with chronic conditions and complex care needs, have severely limited the uptake of the program. High out-of-pocket expenses have also proven to be a significant barrier to uptake. Under the original policy, patients could claim up to three items in one calendar year, at a cost of $220 per year, for a program of treatment. But according to the 2005-06 data released earlier this year, the average out-of-pocket expense for assessment or treatment by a dental specialist under Medicare item 10977 was $692. It is hardly surprising that this has adversely affected the program’s take-up.

Complex referral processes between GPs and dentists have also been cited as a significant problem. The Australian Dental Association, in evidence to the Senate Standing Committee on Community Affairs, which examined this bill, stated that the paperwork in the initial system was ‘a bit cumbersome’ and that administration of the scheme, most particularly practitioners’ unfamiliarity with Medicare, continues to cause concern. The AMA noted in their submission to the committee that there was:

... some ongoing concern that GPs have difficulty locating a dentist who will accept the rebates as full payment when referring patients.

To get an idea of just how poorly this program has been executed, I refer again to the media release of 10 March 2004 from the Minister for Health and Ageing, where he stated that the new dental services would provide for ‘up to 23,000 people under multidisciplinary care plans’. In fact, in the three years between its introduction in July 2004 and June 2007, the program provided for a mere 7,000 patients, at a cost of $1.8 million. The minister predicted that 23,000 people would be supported under that program; only 7,000 people were.

Labor has consistently highlighted the weaknesses of this policy. The minister for health has himself, as recently as Tuesday, in the other place, openly acknowledged the failure of this policy. This makes it all the more remarkable, then, that the government announced in the budget in May that it would pour an additional $377 million into an expansion of the failing program. This figure was subsequently increased to $384.6 million. A program that is so flawed that it has only managed to spend $1.8 million in three years has now been allocated $385 million over four years.

The budget announcement included a change in the benefits available under the program, although, again, it was subsequently adjusted. From 1 November, eligible patients will be able to access up to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years. This might sound good to a casual passer-by, and the change might go some way to addressing the out-of-pocket expenses incurred by eligible patients, but the key problem of how few people are eligible remains.

Given the extremely poor take-up to date, Labor has no confidence that the extended program will be any better, particularly because the government has failed to address the range of other problems besetting the program. Most importantly, the eligibility criteria remain totally unchanged by this legislation. Further, the government has failed to address the complex and restrictive referral processes identified as cumbersome by dentists and doctors alike. In fact, the department revealed to the Senate committee which recently examined this legislation that the current three Medicare items will be expanded to more than 450 Medicare items under the extended programs.

Labor is not convinced that moving from three Medicare items to 450 Medicare items can possibly simplify the program or encourage greater take-up—by patients or practitioners. Throwing hundreds of millions of dollars at a failing program is an appalling piece of public policy. Labor objects to the continuation of a policy that not only is failing on its own narrow objectives but also will do very little to address Australia’s public dental waiting lists, will do nothing to make dental care more affordable and accessible to Australian families and fails to even contemplate Australia’s dental workforce crisis.

It is for those reasons that Labor will be opposing this bill. This is a very brief bill. The provisions simply provide the legislative framework for the policy detail still to be fully revealed by the government. The bill makes amendments to the Health Insurance Act to enable a monetary limit on Medicare benefits for dental services to be introduced for eligible patients. The amendments provide for Medicare benefits to be paid for the supply of dental prostheses, such as dentures, under the new dental items. According to the explanatory memorandum, details such as the Medicare dental items, including the schedule fees, the eligibility requirements for dental providers and patients, and other administrative requirements, will all be set out in a ministerial determination. Perhaps we will be surprised by the policy developments outlined in this detail, but for now Labor are not convinced that this is a policy worthy of our support. Pouring hundreds of millions of dollars into a failing program is simply not good policy and will not help the hundreds of thousands of Australians in need of dental care.

As announced by my colleagues Labor leader Kevin Rudd and Nicola Roxon earlier this week, rather than propping up the Howard government’s failing and narrowly targeted dental scheme shambles, Labor will draw on these funds and redirect them to Labor’s own dental policy. In the first instalment of Labor’s plan, we have committed $290 million to supply up to one million additional dental consultations and treatments for Australians needing dental care. As part of federal Labor’s determination to take national leadership and end the blame game in dental health, this funding will be available for the states and the territories to help clear the waiting list backlog. States and territories will utilise their existing infrastructure to either supplement their existing public services or purchase private sector appointments for the hundreds of thousands stuck on their waiting lists.

Labor’s Commonwealth dental program will ensure that Commonwealth investment is directed towards a broad based scheme that better addresses the priority oral health needs of those groups in the community most in need of assistance. Labor’s approach stands in sharp contrast to the Howard government’s failing chronic disease scheme—a stark choice between helping one million Australians with their dental care or the dismal 7,000 who are offered assistance under the government’s failing policy. Rather than focus on a policy with such restricted eligibility, a Rudd Labor government will re-establish a Commonwealth dental program and ease the pressures on public dental waiting lists. (Time expired)