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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2009-03-05 Daily Xml
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NATIONAL DENTICARE SCHEME

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (11:42): I move:

That this house urges the federal Minister for Health not to proceed with a national Denticare scheme.

I refer to the Hon. Nicola Roxon, whom I have met at national conferences and who is now the new Minister for Health and Ageing and has responsibility for this program proceeding if the National Health and Hospitals Reform Commission interim report recommendation is taken up. There are certainly sympathetic indications by Ms Roxon that this will be done as part of the health reform agenda of the new federal government. I move this motion to urge Ms Roxon not to proceed in this manner because of two things: first, it will not solve the problem and, secondly, it will be fiscally irresponsible.

Let me highlight the problem, and in this regard I agree with and note what the commission chairman, Dr Christine Bennett, said in the interim report, namely, that 670,000 adults are on public dental care waiting lists across Australia and that there is an average waiting time of 27 months for dental care and treatment, as distinct from the separate problem of those seeking dentures, for which there is sometimes a wait of three and four years, usually in the mature aged population.

She goes on in the committee's report to suggest the imposition of a .75 per cent increase in the Medicare levy to pay for the scheme, which would be called Denticare Australia and replace the existing premiums paid for private dental health insurance. It would provide a universal dental scheme without the need for private health insurance.

Everyone would pay. We have heard all this before, but herein lies the problem: will it address the fact that some 35 per cent of the population relies on and is in need of public health amenities to deal with accessing dental care? A relatively small amount of the population is uninsured at present as distinct from the population who have health insurance. We have, in fact, almost the reverse, where a significant proportion of the population relies on public health services that are non-dental. The rest of the population currently pays it for private care or private health insurance to cover their expense and access the private sector.

This recommendation came after, I note, the publication of significant health issues arising out of the public dental sector. I note that the President of the Australian Dental Association nationally, Dr Neil Hewson, made some comments in January this year (before the commission's publication of its report) on a new report from the Australian Institute of Health and Welfare which, in summary, highlighted the high prevalence of inadequate dentition and the increased presence of decayed teeth and periodontal pockets in the low-income and disadvantaged group in our oral health status.

In other words, the poor had an even higher prevalence of dental decay, etc., and that is probably not surprising to many in this house. Dr Hewson made the very clear point at the time that the public sector needs much better funding in order to retain dentists by providing improved working conditions and careers, and this is in the public dental sector. Also, more funding is needed to improve and expand the public dental infrastructure and ensure that payments for treatment to public and private clinics are regularly increased in line with costs.

He also goes on to say that there had been some impasse in the sort of blame game between the previous federal government and the current federal government as to who had the better scheme in the meantime. Dr Hewson states:

...the ALP's call for the introduction of an ill-defined and under-funded commonwealth dental health program.

That is one where patients with chronic illnesses can be referred to their medical GP for dental treatment covered by Medicare. He goes on to say:

An effective compromise between the conflicting positions espoused would be to accept the ADA's long-held recommendation to limit eligibility of federal dental schemes to financially disadvantaged Australians.

In other words, its clear message has been, 'You need to target those who are most in need.' Notwithstanding this and other parliamentary inquiries (and I will refer to those in a moment), still this recommendation comes from the commission; and I think that it makes an interesting read as to the identification of where such an idea would emanate, but, more dangerous, financially that is, would be if the federal government—in particular the federal minister—takes up this idea, which is misplaced and, clearly, will be expensive and waste the already precious health resources that we have.

I do not doubt for one minute that some members of the Australian Labor Party in this state parliament will think, 'This is a great idea. We'll just shove all this cost over to the feds and they'll pick it up', but if they muck it up and waste the money we are the victims, because, clearly, there will be less money available to spend properly for health needs. The Australian Dental Association again looked at this commission report, and said:

The recommendation is impractical, nonsensical, overly simplistic and flies in the face of much of the deliberations that have taken place on this issue over the past decade. It shows no appreciation of the real problems facing dental delivery in Australia. Two comprehensive federal parliamentary inquiries and Australia's National Oral Health Plan saw no sense in attempting to deliver a universal dental health scheme such as proposed in the commissioner's report. Recognising that about 35 per cent of the community have not been able to access proper dental care, the Australian Dental Association has for some considerable time now been calling on the federal government to focus its attention on the delivery of care to those that find difficulty accessing dental care. 'Targeted funding to those who need it is what is required,' Dr Hewson had said.

I further quote him:

To make all dentistry universally available to the community through Denticare, as is suggested by the commission, is not necessary and would be 'fiscally irresponsible' and unlikely 'to deliver quality dental care'. With current expenditure on dentistry being over $6 billion per annum, the funding of a universal scheme would be crippling and could exceed $11 billion. The ADA says target the funding where it is needed—to those who are not currently able to access dental care.

He goes on to say:

Creating a mix of private and public cover where public services are identified in the report as inadequate suggests that most will operate for the private dental health plan. The community already have complaints about health funds—so why would you place universal dental health care deliberately in their hands? The proposed scheme will create two tiers of dental care, and is supporting health funds: both inappropriate outcomes for government funding. Under any new scheme the federal government must be careful not to limit the nature of the dental care to be delivered. To generalise that some treatment is elective and other treatments are not elective is a gross oversimplification.

The fact some Australians have difficulty in accessing care should not mean that a compromised level of care is delivered to them. All Australians are entitled to expect that care delivered to them will be both safe, the highest quality. The Australian dentists are among the best in the world and general access to them for treatment should be available. Provision of poor dentistry for the poor is just unacceptable.

I understand that the ADA, which represents dentists, obviously, most of whom provide a private service. There are dentists who work in the public sector in each of the states and provide a service as best they can with limited resources for 35 per cent of the population, on average, across Australia, but they are struggling. So, rather than pour in billions of dollars to create a scheme in which, inevitably, there will be waste and which will be directed to people who do not need the service, we are reminded over and again to target the population who need it. The dentists have nothing to win or lose, and they will do the job anyway. It is important that we listen to what they are saying: where we need to have the care.

A classic example in South Australia is the Glenside hospital which has a chair, and dental services are provided to people who use the hospital services. Obviously they are people with a mental illness and it is a challenging situation for professionals to come in and provide a service to the patients or clients at the Glenside hospital. It needs to be done, it is a targeted service. We are told that the Glenside hospital will close, so rather than abandon those most in need it is important that we target those most in need and not waste it on a whole lot of the population who have an adequate service.

I strongly urge Ms Roxon to reject this recommendation. It will be expensive, woefully financially irresponsible, will not target the people who most need it and will set up a level of inequity in the community and produce two levels of care, which I suggest is inappropriate when we have a much higher demand for an ever increasing aged population who need dental just to be able to eat and stay healthy. I urge the house to support the motion.

Ms SIMMONS (Morialta) (11:54): I oppose the motion. One in four Australian adults has unfavourable access to dental care, with the cost of dental treatment being the main barrier to appropriate levels of dental care. The National Health and Hospital Reform Commission reported that poor access to affordable and timely dental care was a consistent message from its consultation process. It also reported that people with unfavourable access to dental care were almost four times as likely to have teeth extracted and receive far less preventative dental care, such care being really important as we grow old.

As I have explained to the house previously, the former federal government, the Liberal government, magnified this situation by withdrawing from the commonwealth dental health program in 1996.

Ms Fox: Shame!

Ms SIMMONS: The member for Bright is quite right, it is a shame. Closure of the program removed annual funding of $10 million from the South Australian Dental Service at that time, halving the funding available for the dental treatment of pensioners and other concession card holders in South Australia. As a result, the average waiting time for routine dental care peaked at 49 months in 2002. Since that time, this state government has provided an additional $56 million for public dental services, reducing average waiting times to 19 months. That is still not acceptable, but it is a lot better than 49 months.

The new federal government announced its intention to reintroduce the CDHP from July 2008. This would have provided $24.7 million over three years ($7.5 million in 2008-09, which has now gone) in additional funding for South Australian public dental health services from that date. This was projected to rapidly reduce the average waiting time for public general dental care to around 11 months by June 2009. What an opportunity lost.

The reintroduced CDHP was to be funded with savings achieved through the cessation of the previous federal government's Medicare chronic disease dental program. In short, the chronic disease dental program allows people with chronic disease to receive high-end dental treatment, regardless of their income, whilst pensioners and other concession card holders who are otherwise healthy miss out on basic dental care. The cessation of this program was blocked by opposition and minor party senators, as I have reported to the house before.

Between September 2008 and the end of January 2009, 8,000 pensioners and low income earners in South Australia have missed out on dental care because of the non-implementation of the Commonwealth Dental Health Program.

Today, the South Australian Liberal Party is opposing any consideration being given to the proposed Denticare scheme. It would appear that the Liberal Party is fundamentally opposed to pensioners and low income earners receiving dental care, and I think it is important that the South Australian public is aware of this.

The National Health and Hospital Reform Commission key proposals for oral health are: the introduction of Denticare for universal access to preventative and restorative dental care regardless of people's ability to pay; a 0.75 per cent increase in the Medicare levy to provide the funds; the introduction of a one year internship (post-qualification, pre-registration) for dentists, dental hygienists and dental therapists; a national expansion of the preschool and school dental services; and increased funding for oral health promotion. These are measures that are worthy of further consideration.

People would be able to opt to have their levy allocated to a private insurer and receive their dental treatment from a private provider. Those who selected the private insurer option would pay a gap payment to the private dental provider for their dental care, as is currently the case. Alternatively, people could elect to have their levy provide access to an expanded public dental sector.

Denticare would significantly increase the availability of affordable and timely dental care for many low to middle income earners in Australia, with resultant improvements in their oral health. This would result in a major enhancement of public dental services, contrary to what the Deputy Leader of the Opposition has just told us.

It is not clear what proportion of people would opt for the public dental care option under Denticare. However, as the Denticare levy funds would follow the patient, the recurrent cost of the proposal would be made available to public dental services to meet the demand. It would be important that this funding reflects the full cost of service delivery.

The proposed dental intern program would provide more than 100 additional dental providers in the public sector in SA. This would assist the South Australian Dental Service to provide services to the additional patients who select the public sector option for their insurance.

The public sector would still have the option of purchasing dental care from the private dental sector. Denticare would provide additional funding to the public dental sector, enabling it to implement targeted programs for disadvantaged groups that the private dental sector has difficulty reaching. This includes targeted dental programs for Aboriginal people and people in residential aged care facilities or supported accommodation.

Denticare would not fund specialist dental services such as orthodontics and more complex oral surgery. The PricewaterhouseCoopers supporting documentation points to the likelihood that the combined public and private dental workforce would not cope with the increased demand for dental care under Denticare in the early years; it suggests staged implementation will be needed. This is a really important initiative, particularly for us in South Australia, and I oppose the motion.

Ms THOMPSON (Reynell) (12:01): I rise to make a contribution to this debate because of the importance of a new dental system to the people in my community. I will give some brief examples of situations that we have encountered in the past few months. Lesley Smith, a single mother in her late 30s, is now retraining for the workforce at a business college. She came to us because she did not have the confidence to go to a business college because of the state of her teeth. She was very stressed about dental issues and the waiting lists and, because of the barrier that the state of her teeth—in terms of the image, the decay and the resulting odours—presented to her. We were able to help her articulate her case, and she did get earlier treatment. However, she had been on the waiting list for months and months.

Belinda is in her late 30s. She is about to have all her teeth extracted because of poor care and poor oral hygiene and insufficient funds to access regular dental treatment. Another woman in her late 20s recently called because her dentist had told her that she was going to lose all her teeth if she did not get a proper clean soon. My assistant talked to the dentist about this matter, because it had really panicked our constituent, and he expressed despair about the inadequate knowledge about oral care and the benefits of regular maintenance by a dentist that he encountered in this young woman and in many others.

This is why we need a national system that places emphasis on preventive care and early intervention rather than directing the funds to the high end of the market. My assistant who has been dealing with these issues was so concerned that she put together some information about the history of how we got to this state where my constituents are facing this dreadful problem. These are just three that were pulled out of the many because of their youth. We have had many older people who have come in to show us some rather ugly mouths. I am now at the stage where I manage to get my assistants to see them, because I have seen enough of these rather ugly mouths over the years.

It was not ever thus. Under the Keating Labor government the 1993-94 budget provided funding through the commonwealth dental health program until 1996-97. The aim of introducing that commonwealth dental health program was to improve the dental health of financially disadvantaged adults, reduce barriers to dental care, ensure equitable access and improve prevention of dental disease. That program provided $245 million for about 1.5 million services, with 200,000 patients accessing the program annually.

When the Howard government gained office in 1996, one of its first actions—and I remember the fury I felt at the time—was to terminate the commonwealth dental health program, arguing that the backlog for public dental services had been reduced. In other words, the Howard government acknowledged that the previous scheme was working.

The termination of the CDHP placed responsibility for the funding of public dental services on states and territories, and public dental waiting lists increased dramatically. In South Australia, I recall that, under the previous Liberal state government, the waiting lists blew out to more than four years. Commonwealth expenditure on dental services fell from $105 million in 1995-96 to $6 million in 1998-99. At the same time, the subsidisation of private dental health care increased, with the contribution made by the commonwealth going from $32 million in 1997-98 to $119 million in 1998-99.

The dental scheme which the Liberal government introduced and which it continues to argue in favour of is neither effective nor equitable. Individuals on higher incomes using private dental insurance receive a significantly greater government subsidy than those on low incomes, who rely on public dental care. Under the Howard government, the initial uptake of dental services available under the Allied Health and Dental Health Care initiative was low.

Over its first three years of operation, from July 2004 to June 2007, $1.8 million in Medicare benefits was paid to around 16,000 dental services, as opposed to the 200,000 patients annually accessing the Labor scheme. Additional funding of $377.6 million was allocated in the 2007-08 budget over four years, and the benefits cap was set at $2,000 per year. The Howard government estimated that this would assist 200,000 patients with chronic dental conditions, and around 171,000 did access the funding. The cap was then increased to $4,250 over two years.

However, in the meantime, the public dental waiting lists have achieved record heights, and 650,000 Australians are on the public dental waiting list because totally inadequate funding has been provided for those in greatest need. The current federal government again seeks to direct funding to those in greatest need, rather than top up funding for those who already have access to dental health care.

The following figures from the National Survey of Adult Oral Health from 2004-06 indicate the need for a redirection of funds towards a sustainable, equitable and preventative public dental health program. Nearly 6 out of every 10 adults who still have their teeth said that they needed a dental check-up; 16 per cent of Australians rated their oral health as fair or poor; 22.6 per cent had experienced orofacial pain in the preceding month; 15.1 per cent had experienced toothache in the preceding 12 months; 17.4 per cent said that they had avoided some foods due to problems with their teeth, mouth or dentures; 30 per cent of Australians reported avoiding dental care due to cost; 20.6 per cent said that the cost had prevented them from having recommended dental treatment; 18.2 per cent reported that they would have a lot of difficulty paying a $100 dental bill; and 40 per cent said that they could not access dental care when they needed it. This is a disgrace in Australia, where we seek to protect those most vulnerable.

Of course, we know that poor dental health leads to poor overall health, and my understanding is that this relates particularly to heart health, that is, there is a connection between dental health and heart health. We do not need to set up a national health scheme, as the Liberals did, that attacks those who are most vulnerable in our community.

The Liberals continue to support a scheme that does not provide dental—and therefore physical—health care to the most vulnerable in our community. Of course, the dental health situation of the Aboriginal population is absolutely appalling and brings disgrace upon us in the world situation. This increases their burden of disease in relation to so many other conditions.

If people cannot chew properly, they eat pap food that is often calorie and fat-laden and contributes to obesity and, therefore, diabetes. The Liberals in this state and nationally need to have a really good look at their consciences about what they are doing in terms of not making dental care available to the most vulnerable people in our community.

Debate adjourned on motion of Mr Goldsworthy.

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