Ken Ticehurst (Dobell, Liberal Party) Share this | Hansard source

The purpose of the Health Insurance Amendment (Medicare Dental Services) Bill 2007 is to amend the Health Insurance Act 1973. This will implement the 2007-08 budget measure to increase access to dental treatment under Medicare for people with chronic conditions and complex care needs. The Commonwealth government has announced an expansion of the current enhanced primary care dental items to provide higher Medicare rebates and more services to eligible patients.

The measure is targeted at patients with chronic conditions—for instance, cancer, diabetes and cardiovascular disease—who also have complex care needs, such as requiring care across a team of health or care pro-viders. Patients whose oral health is impacting on or likely to impact on their general health will be referred by their GP to a dentist who is registered with Medicare Australia. In order to be eligible, these patients must have a GP management plan as well as a team care arrangement in place. However, for residents in aged care facilities their GP must have contributed to the multidisciplinary care plan prepared for the resident by that facility.

It is estimated that approximately 200,000 patients will benefit from this measure over the first four years, as they will have access to dental services provided in the community. From 1 November 2007, eligible patients will be able to access Medicare benefits for dental services of up to $4,250, including the Medicare safety net benefits they may be entitled to over two consecutive calendar years. This limit was introduced following consultation with stakeholders after the budget was handed down, providing more flexibility for patients to receive dental assessment and treatment when they require those services.

Patients will be able to access benefits for any combination of dental assessment and treatment services covered by the new dental items, based on a patient’s clinical needs. These new dental items include services from dentists and dental specialists, and dental prostheses. The new Medicare items are likely to include dental assessments, preventative services, extractions, fillings and other restorative work—for example, crowns, bridges, implants and dentures. Dental services that are of a purely cosmetic nature will not be covered by a Medicare rebate, which will ensure that the people who really need dental health care will be able to receive the treatment.

This arrangement further enhances the $377.6 million over four years announced in the budget, which provided for patients to receive an initial diagnostic consultation and a maximum of $2,000 in Medicare benefits for dental treatment each calendar year. The measure now represents a $384.6 million investment over four years. The new dental items will be introduced under the Medicare Benefits Schedule, replacing the current enhanced primary care dental items. It is expected that GPs and patients will find it easier to locate a dentist as more dentists are willing to participate in this scheme under these enhanced arrangements.

The Department of Health and Ageing is also working with the professional bodies representing dentists and GPs to improve information resources and to improve communication between individual dentists and GPs at a local level. Patients who access this scheme will greatly benefit from the increased communication between doctors and dentists locally, as it will provide for appropriate referrals and regular feedback between dentists and GPs on clinical matters. In fact, all patients will greatly benefit from the increased collaboration between doctors and dentists, as doctors will now have greater understanding of oral health and will be able to make more accurate referrals to help their patients.

Many patients with chronic and complex conditions are often really ill and are undergoing other medical treatments which may not be subsidised by Medicare, creating a large financial cost for patients and their families. This bill will ensure that these patients who also need dental health care will have access to it at an affordable price, helping to relieve some of their financial burden. Under this scheme, the only costs eligible patients will need to pay is the gap, which Medicare does not cover and which will depend on how the dentist chooses to bill for their services. If the dentist bulk-bills, the patient will not be charged a copayment for dental services covered by Medicare. If the dentist charges above the Medicare rebate, any out-of-pocket costs for those services will count towards the patient’s or the family’s threshold under the extended Medicare safety net. Once a patient or family reaches the annual safety net threshold, 80 per cent of the out-of-pocket costs will be met by the government under the Medicare safety net. This will apply up to the limit.

To further help patients, Medicare Australia will operate a telephone helpline to provide patients and dentists with a progressive total of dental benefits paid to those patients. Dentists will also be required to provide patients with a quote or cost estimate prior to commencing a course of treatment, to further assist patients to understand the potential cost of treatment. Patients will also have the option of choosing whether they will use Medicare or their private health insurance ancillary cover to pay for these services. However, patients cannot use their private health insurance ancillary cover to top up the Medicare rebate paid for the services. While topping-up is not permitted for an individual service, where a patient has reached the two-year benefit limit for dental treatment services under Medicare, additional dental services can be claimed under private health insurance arrangements, within the rules and limits of the person’s ancillary cover.

In Australia, the different levels of government have different and complementary roles in assisting Australians with their dental health. The Australian government and the states and territories must do their fair share for the system to work properly. The planning and provision of public dental services, including services to concessional patients and children, is the state and territory governments’ responsibility. Currently, all states and territories have programs of universally available, free or reduced-cost school based dental care, ensuring that all schoolchildren have access to dental services at affordable prices for their families. State and territory governments are also allowed to levy a patient charge for dental services which varies across Australia.

There is no denying that there are presently lengthy waiting lists for some public dental programs. However, this situation could readily be changed were the states and territories to fund these services adequately, as is their acknowledged responsibility. In 1994-96, the Commonwealth Dental Health Program provided limited funding of $278 million over four years to the states and territories to reduce excessive waiting times and to improve access to public services. While the program was part of the Australian Labor Party’s election platform in 1993, Labor made no commitment to keep the program beyond 1996. With evidence of substantial reductions in waiting times around the country, the government took the decision to abolish the dental program in the 1996-97 budget. Funding ceased from 1 January 1997.

Beyond the one-off nature of the program, there were problems with it. Most significantly, the states and territories were not encouraged to invest in improving their public dental services. The states and territories continued to shift their own dollars from dental care to other areas, effectively cost-shifting public dental health to the Australian government. The most recent figures from the Australian Institute of Health and Welfare show that state funding for dental care has increased from $373 million in 1999-2000 to $503 million in 2004-05.

Federal Labor, on the other hand, do not have a coherent dental policy. They should be supporting the government’s approach and encouraging their state and territory mates to take their share of responsibility for dental services rather than trying to fob off people in need on the Commonwealth government. Federal Labor continue to makes excuses for the failure of the state and territory governments, which just shows again that they are patsies for the states, as well as, of course, for the union movement.

On the Central Coast, the federal government has recently funded places for the Bachelor of Oral Health at the Ourimbah campus of the University of Newcastle. The number of new enrolments for this course has increased from 55 in 2005 to 77 in 2007. A total of 180 students are currently enrolled in the course. These university places are greatly benefiting the residents of the Central Coast, as they are offering students the opportunity to study dentistry on the coast, with students conducting practical work experience with local dentists. The Ourimbah campus is also home to a fantastic initiative funded by the federal government: an oral health clinic run by the staff and students of the Bachelor of Oral Health. The oral health care clinic provides students studying dentistry with the unique opportunity to gain on-the-ground experience of working in a dental clinic in a supported learning environment.

The clinic also greatly benefits the local community as it provides free check-ups and teeth cleaning to concession card holders, which helps them to prevent tooth decay. These services are also offered to the general public for a small fee. By enabling third-year university students to carry out these vital consultations it enables local families to keep their teeth healthy at affordable prices while providing students with experience and confidence for when they graduate. During these consultations students are also able to identify any other oral health issues patients may have. For instance, if a tooth needs a filling they are able to recommend that patients go and see a dentist. A few months ago I had the pleasure of visiting this centre with the Minister for Science, Education and Training to show her first-hand what a great facility the Ourimbah campus has, as well as the vital work they do in our community. I would like to congratulate the staff and students of the oral health unit for doing a tremendous job.

This bill also provides another avenue for dental services for people with chronic and complex conditions, which will be particularly helpful for those who would otherwise have to wait for services. In order to accurately assess who will be eligible for these provisions, patients must be referred to a dentist by their GP, as they are the primary care provider and care coordinator for these patients. Other Medicare items targeted to people with chronic conditions and complex care needs—for example, allied health services such as podiatry and physiotherapy—will also operate on referral from a GP. Professional associations representing dentists and GPs are working together to ensure that GPs have a better understanding of oral health issues and the relationship between oral health and general health.

The new Medicare dental items will replace three dental items introduced in 2004 under the enhanced primary care arrangements. The existing Medicare dental items allow eligible patients access to up to three dental services per calendar year, with a Medicare rebate of $77.95 per service. This new scheme will entitle eligible patients to unlimited visits to the dentist. This will effectively increase the access to dental health services for patients, at more affordable prices. It will also greatly benefit patients as they will have more flexibility to get dental work done under the Medicare system, which was previously not something afforded to them. The new schedule of Medicare dental items will more closely reflect the way that dental providers currently practise and bill private patients and veterans.

Mr Deputy Speaker Somlyay, it was great to see that under your chairmanship the House of Representatives Standing Committee on Health and Ageing inquired into health funding and released The blame game report, which made some important recommendations. Recommendation 3 has been taken up by the government in this bill. That recommendation was:

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.

It is great news that a report that has only recently been handed down has already been enacted into legislation.

In closing, the Health Insurance Amendment (Medicare Dental Services) Bill 2007 will greatly benefit the people of Australia with chronic and complex conditions who need dental health care. These items will provide a significant increase in Medicare benefits for eligible patients and will make it more attractive for dentists to provide a wider range of dental care to more patients. The new items will be more consistent with the way that dentists practise and will cover a broader range of services to help ensure that Australian people have access to dental health care. I commend this bill to the House.

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