Senate debates
Tuesday, 18 September 2012
Documents
Chronic Disease Dental Scheme
5:06 pm
Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source
I move:
That the Senate take note of the document.
I want to make some comments, if I may, in relation to this response. I suspect that the minister in his response is basically going to be very critical of the Chronic Disease Dental Scheme. Despite its assistance to so many thousands of people who have been suffering persistent and complex dental conditions, this is a scheme that the Labor government has been trying to shut down ever since it came to power. Its first attempt was back in May. A legislative instrument failed and the Senate did not vote for disallowance of the determination. Another attempt was made thereafter. When they could not achieve the change legislatively, they tried a different tack. They decided to embark on what can only be described as a disgraceful campaign aimed at discrediting the scheme.
The scheme has been very successful, as I have said, but the government, aided and abetted by their Green alliance partners, will close the scheme on 30 November. No new services will be provided after 7 September. It has been an enormous success and I want to take the Senate to that in a moment. It has been the only dental scheme that has provided treatment for adults. It has provided $4,250 in Medicare dental benefits over two years for eligible patients with a chronic health condition. We have seen approximately 20 million services provided since 2007 to over one million patients. It is so typical of those opposite: they have deliberately gone out of their way to try and dismantle this program. Why? Because it was established by Tony Abbott as the health minister. Therefore, it has been a success. Like for many other things, Minister Roxon and now Minister Plibersek, because this was a Tony Abbott initiative when he was health minister, say, 'Let's just shut it down.'
Let us look at some of the furphies that those opposite have been peddling, apart from the pursuit of dentists. I will come to that; that was part of the Senate inquiry. Despite claims of supposed blowouts in the scheme, the average claim per patient, according to Department of Health and Ageing figures, is actually $1,716, well below the allowable $4,250. Indeed, some more recent estimates suggest that the average cost per patient has fallen to below $1,200 per patient. I reiterate and put on the record once again that the coalition did offer to work with the previous health minister to refine and improve the scheme and look at ways that we could make it better, including looking at processes where we could provide high-cost items, such as crowns and bridges, and of course this was rejected.
It is reported that about 80 per cent of the services under the Chronic Disease Dental Scheme have been provided to concession card holders, and a high percentage of those are older Australians. It should be noted that Medicare is a universal scheme that all Australians pay for through the Medicare levy and the taxation system, but the evidence suggests that the dental services have been predominantly utilised by low-income Australians. So we have those opposite—indeed, as recently as this week—purveying the furphy that somehow it is about millionaires. It is not about millionaires. On their own statistics, low-income concession holders have been the beneficiaries of this scheme. Many of these people would otherwise have been forced to go without treatment or would add to the already 650,000 people on the public dental waiting list.
What happens after 30 November? It simply shuts down. Many people will not be able to afford the full cost of private treatment, and, like most of the things that those opposite are promising, the new scheme is not going to start until well into 2014. What happens to those patients? As I said, many of them are concession card holders and are in the middle of very complex treatment. Are they going to have to pay for the rest of their treatment themselves? We already know that many of them do not have the funds to be able to do that.
In the remaining time, let me make some observations. I have to say that, during the inquiry that was undertaken to review the private member's bill put up by Senator Bushby in this place and by Mr Peter Dutton in the other place, we really did see the length to which the government was prepared to go to dismantle this scheme. The bill that Senator Bushby introduced into this place sought to redress an injustice. Indeed, this response follows the motion that Senator Di Natale put up on 21 March. Having said that, it was very clear that there was an attempt to denigrate the scheme. Very clearly the evidence that was given demonstrated that the audit process not only caused inordinate delays, particularly in relation to the communication of outcomes; the distress caused to patients and families and the undermining of reputations of dentists was absolutely appalling. The Australian Dental Prosthetists Association made some observations. I will not go to all their evidence but they made the observation that their members were left in limbo, with the fear of possible financial ruin. One submitter indicated that family members of deceased patients were contacted as part of the audit. That was the extreme length to which the government was prepared to go to discredit the scheme.
The issues revolved around a series of very minor oversights by dentists, where they had failed to comply with minor issues, and it was very clear from the evidence that many dentists had never been involved in a Medicare-like system. This was the first time they had been involved and so there was a lot of evidence given that clearly demonstrated that there were innocent oversights; yet, somehow, that was perpetrated as some grand fraud on the Commonwealth. I say to those opposite, having gone through this whole debacle, through the Senate processes and what we are now seeing—because of course we are now having many people contacting their local members as a consequence of this shutdown—I think you are going to find it very difficult to get dentists. It will be once bitten, twice shy after the way that many of them were treated so appallingly by the government as a consequence of this process. In my view, you will not be able to meet the promises you are making today about your new scheme.
5:17 pm
Richard Di Natale (Victoria, Australian Greens) Share this | Link to this | Hansard source
I also wish to speak on the response to the resolution of the Senate by Senator Kim Carr. I think it is important to perhaps separate some of the issues that have been discussed here this evening. The first point is the question that relates to the audits of the Chronic Disease Dental Scheme. It is critical that we understand that the Greens and the coalition together both expressed concerns at the way that the CDDS was audited. In fact, we worked together on this issue through the Senate estimates process and in a range of other ways. We agree with the opposition. We felt that a number of dentists were targeted who had provided treatment in good faith, who had ensured that people who would otherwise not have been able to afford dental treatment were offered that treatment, but they were caught up in a tangled web of paperwork and bureaucratic requirements that were quite arduous and unlike any other Medicare process. We agree with the opposition that something should be done about it. In fact, we have worked with the government to ensure that there is a resolution to that issue and we remain confident that the government has acknowledged that there were problems in the way those audits were done and that many innocent dentists were caught up in that audit process. We hope that issue will be resolved.
The Chronic Disease Dental Scheme requires some explanation. On one hand the scheme was described by the Minister for Health as the worst example of public policy that she has ever seen; on the other hand, we hear that the opposition believe it was a perfect scheme. I have not heard any criticism of the scheme from the opposition in terms of the way the scheme operated, and they have had very little constructive to say on how it could be improved. I think the truth lies somewhere in between those points of view. The Chronic Disease Dental Scheme did provide treatment to some people who would otherwise not have been able to afford it. That is a good thing. It did, however, have some serious structural flaws. We had an issue where people were required to go to their GP, and that GP was then required to ensure that an appropriate referral was made to a dentist. Many of the dentists who were involved in the scheme were unaware of what was required from them in terms of responding to the GP in providing written quotes and so on, so there were some serious administrative problems with the scheme.
There was also an issue around equity. We had one scheme operating in dental care which was very generous, which provided over $4,000 worth of treatment over the course of two years, and we had a scheme that was not means-tested. What that meant was that there were people, many of whom would otherwise have been able to afford dental treatment, getting very expensive dental treatment and there were many others in the community who simply could not afford dental treatment who were missing out. Some people who were missing out could not afford to get a filling while people at the other end of the spectrum were able to get things like crowns, bridges and implants done. So that was a serious inequity, and we recognised that. We were willing to entertain a reform of the CDDS so that we modified it and put some restrictions around the scope of service to ensure that it was means-tested and to abolish the onerous referral requirements. The government was not keen on that change. It wanted to see the scheme scrapped, and in its place they wanted to see the foundations laid for genuine Medicare funded dentistry, beginning with children but also ensuring that people who are covered by the scheme were still able to access treatment through the public dental service. So the package that was negotiated was a package that essentially will lay the framework for Medicare funded dentistry, starting with children. That is a huge win. It is something we are very proud of. It means that we are going to see $2.7 billion invested in Medicare funded dentistry for kids. There are 3½ million kids who will now be able to go to the dentist in the same way as they go to the doctor.
We saw over $1 billion invested in state and public dental services. It is true that there is a gap between that funding stream and the abolition of the CDDS. That was a case of the Greens not getting everything we wanted and being forced to compromise, which we did. We compromised because we knew that what would be rolled out through the National Dental Scheme is something we can build on. It is something that means that, over time, all Australians will get access to Medicare funded dentistry. That is an important policy priority for the Greens. It is something that we think has to be pursued by both sides of politics.
We know that we are in a country that, while it does very well in terms of its overall health outcomes, when it comes to dental health does poorly. We do poorly because we have a situation where people who need dental care simply cannot afford it. By laying the platform for Medicare funded dentistry so that kids get access to care in the way that ensures that it is essentially funded through the Medicare system, we lay the foundations for what ultimately we hope will be Medicare funded dentistry for all Australians.
In the interim, those people who have a chronic disease and are a concession card holder will be able to access treatment through the state public dental system, although I do acknowledge that the increase of investment in the state public dental system will take some time to roll out. But, as I said, that was a question of compromise. The government was not willing to entertain the notion of any changes to the CDDS. They wanted to see its abolition and they wanted to see the start of a new scheme in its place. We came to that negotiation in good faith and ultimately that is the outcome that we have agreed on—an outcome that I think we can all be very, very proud of. What is important to note is that over time we would like to see all Australians being able to access dental care in a way that current patients of the CDDS can do—that is, through their dentist, and ensuring that there is an entitlement that allows at the very least important preventative dental treatment to occur.
Ultimately this scheme will be judged by what rolls out over the next few years. I am very, very confident that, once young children start going to the dentist—and let us not forget that we have got a situation where the oral health of young kids is declining—all health will improve. One of the real concerns is that we have seen a decline in the oral health of some young children, and that is something that will impose a huge costs on the health system down the track. So prioritising our kids is a good, sensible investment. It is the right place to start. I do acknowledge that the space between the new dental scheme operating and the abolition of the Chronic Disease Dental Scheme is one where we would have liked to have seen that gap narrowed. But in totality I am pleased with the outcome that we have managed to secure.
I know that some people will be disappointed—those people who are receiving treatment under the Chronic Disease Dental Scheme—but what has been interesting is that through all the correspondence that we have had with people, when we discuss what is actually going to start from 1 July 2014—Medicare funded dentistry for young kids; a huge boost to state public dental, over $1 billion; a quarter of a billion dollars for regional and rural dental services infrastructure and so on; an increase in training; relocation packages to move to regional and rural areas—people generally accept that what we have got is much better than the status quo. It is for that reason that the Greens were very happy to be able to announce that package with the government several weeks ago.
5:27 pm
Sean Edwards (SA, Liberal Party) Share this | Link to this | Hansard source
I seek leave to continue my remarks.
Leave granted; debate adjourned.