Harry Jenkins (Scullin, Australian Labor Party) Share this | Hansard source

The opposition opposes the Health Insurance Amendment (Medicare Dental Services) Bill 2007 because we believe that it is not the right way for the Commonwealth government to involve itself in dental health. Mr Deputy Speaker Somlyay, I note that the member for Dobell made mention of a report entitled The blame game. I am wondering whether, as the member for Fairfax, you would claim the credit that was given by the member for Dobell, because the quote that he gave is open to interpretation. While this piece of legislation talks about those patients with oral health problems arising from chronic health problems, it does not necessarily mean that those who find themselves in disadvantaged economic circumstances are being totally catered for. That is the greatest concern that the opposition has with this piece of legislation.

In a debate like this, often too much attention is paid to the detail and specificity of the piece of legislation concerned. One can still be relevant to the piece of legislation if one steps back from it and poses this question: could the expenditure—and with this piece of legislation we are talking about an expenditure in the order of $380 million over four years—perhaps be targeted better? A debate like this is also the time to look at the effort of the Commonwealth government in relation to the problem before the chamber. I was a little surprised at the figures about trends in dental care expenditure. While today there has been a great deal of argy-bargy about public health and whether this is totally the province of the states or whether it should be a shared responsibility, we have not really looked at the way in which oral health expenditure is apportioned. I was a little surprised at the figures in Australia’s health 2006, the publication of the Australian Institute of Health and Welfare. In table S37, the institute indicates that total recurrent health expenditure is in the order of $69.8 billion.

The institute indicates that individuals contribute $14.486 billion of this expenditure. By my calculations that is in the order of 20.7 per cent. But the institute indicates that in the year 2002-03 individuals contributed $2,969 million of the $4,362 million spent on oral health. So individuals contribute 68 per cent of the cost towards oral health. It is something that has developed over time, but the contribution by individuals, especially since the creation of Medicare, has been a considerably larger percentage of the expenditure than for any other aspect of health expenditure.

Another problem, if we look at the contributions by the federal government, is that we see the largest slice of contribution by them to oral health is the 30 per cent private health rebate. In the earlier debate on a matter of public importance, the member for Boothby I think said that that was in the order of $400 million. That is a considerable amount a year, but does it really go to those whom we would expect the government to target? Therein lies the real problem in the way in which the resources for oral health have been allocated at a federal level. This debate has gone on for many years, but when the government were challenged that this perhaps showed an inconsistency in their stance that dental health was not their problem they said, ‘It’s a state problem; we don’t get involved.’ When we indicated by way of debate, quite rightly, that through the 30 per cent private health rebate of course the Commonwealth government are involved, Minister Abbott, the Minister for Health and Ageing, came in and said: ‘We are involved. We’re involved in oral health; we’re involved in dental health through the 30 per cent rebate.’ So why can’t we see the extension of that into public dental health? Because traditionally, before the rebate, the Commonwealth were not involved in oral health.

Another little sleeper that is even more disturbing is the way in which the Commonwealth government contributes to people’s health expenses—that is, the health rebate, which is paid back to people at tax time if they are over a threshold. In 2002, John Spencer from Adelaide university did a paper, ‘What options do we have for organising, providing and funding better public dental care?’ He produced a graph—figure 4, ‘Public subsidy for dental expenses taxation rebates, private dental insurance rebates and public dental care’. He showed the public dollar spending per household in dollar units against income groups of various householders. Regrettably, the graph showed that the highest income households had the highest public dollar spending per household. Why was that? Because of the combination of the private dental insurance rebate and the dental expenses taxation rebate. So in this 1998-99 graph it was in the order of $70 a household for households on about $120,000; the figure for a household on $35,000 was in the order of $35; and for a household on $0 to $10,000 the public dollar spending was a little over $50.

But this begs the question: are we getting the assistance packages wrong? Have we skewed them so that we are not properly directing the public resource towards those that are most in need? As I said, I acknowledge that dental health for Australian families, on the basis that private expenditure on oral health is something like 68 per cent of total expenditure, is a very difficult impost. So there is no threat to the rebates that I spoke about. But, when we are in a debate like this, we should step back and think about what the resources that we are talking about are and where they are directed.

When I visit the community health services in the electorate of Scullin—and all the community health services are involved in delivering dental health—and I see the waiting lists for some treatments in the public system, which can blow out to as long as four years for proper dentures and things like that, it begs the question: when the Commonwealth government intervened and involved itself in public health and we got the waiting lists back to zero, why is it that there was a reluctance from those opposite to continue with a scheme that was so successful?

I remind the House—because sometimes it gets lost in the argy-bargy of the debate—that, back in the Keating era, the scheme delivered services to those on the public dental health waiting list by providing additional resources to the public oral health providers and by buying in the time of private practitioners. In fact, that was one of the reasons that the Keating government did not strike much opposition from the profession itself—we recognised that, to tackle the backlog, a partnership was required with all those involved.

Many people have mentioned workforce issues in the debate on this legislation. Labor acknowledge that. If we want to get into a fully-fledged political debate, we could have an argument about whose fault it is but, at the end of the day, I think that both sides of the chamber agree to an extent about the opening up of places at rural and regional university campuses, because those who train at those campuses are more likely to stay and practise in rural and regional areas. But let us get the argument in perspective. The honourable member for Dobell quoted figures I was going to use in respect of the increased effort by the state governments in directing resources. I am not in a position to know whether an increase in funding from $270 million to $500 million would mean an increase in output in the order of that magnitude.

Mr Deputy Speaker, because of your interest in matters to do with proper financial administration, you would understand why I say often in debates that it is not about the quantum of money. We should really not rest on our laurels in this place. You could throw a host of monetary resources at a problem but, if you throw it in the wrong direction or you do not package it the right way, it might be completely useless. On the basis that there has been an increase in resources, one assumes that that is indicative of the increased effort. What Labor has proposed is a return to a scheme that was successful. I have heard some of the criticisms of that scheme in respect of whether or not the states’ efforts continued at the same rate. There is some evidence that should be a concern. That is why the Leader of the Opposition, Mr Rudd, and the shadow minister, Ms Roxon, today said that, if elected, a Labor government would make additional resources available for public dental health on the condition that the efforts by the states continue. If that gets us involved in the blame game, we will have to wear it. But this is not about blame; it is about sitting down in partnership to tackle a problem. And clearly there is a problem here.

There are 650,000 people on a national waiting list. If each of us went around to the local providers of public dental health services, we would know that those waiting lists exist. I do not wish to be churlish, but I do want to mention something which the Prime Minister said. I do not know whether it was an omission by the Prime Minister when he talked about public health being just the public dental hospitals, but I would hope that he does not really think that. I hope that he understands that this is a wider problem. The world has moved on. Now, the disadvantaged and healthcare card holders do not have to go into the public dental hospitals, which are usually only in the major cities. We have encouraged the provision of services in public oral health at the community level throughout Australia. That is proper and appropriate. It has been very successful, and it needs to continue.

I am not really interested in the debate about whether this is a Commonwealth responsibility or a state responsibility. There is another aspect of the health debate that we have not really dealt with. If we step back from these pieces of legislation, which are like jigsaw pieces from different puzzles, and look at the way in which we provide resources for health, there is a lot of overlap. When the government talks about chronic health in respect of this legislation, it means that it recognises the tie-in between a person’s health circumstances and their oral health and often it is a bit hard to say which follows what. It is really a chicken and egg thing: is a person’s demonstrably bad oral health a result of their chronic diseases or is it not? I was really interested in the contribution from the honourable member for Moore about the way in which somebody’s oral bacterial health can affect their heart, their circulation system, replaced joints and the like. We have to recognise that all these things are intertwined.

In providing resources to address the needs of those people who are on the public health waiting lists, there are likely to be savings in a whole host of areas—for example, where they do not have to go to the GP as often or where their oral health does not contribute to the extent that their general health deteriorates and they require hospitalisation. And that is when the arguments put forward in the report from the inquiry that the member for Fairfax chaired are important—because, on those occasions, it does not matter which sector of government is paying the bill. What really matters is that we have a first-class system that gives a member of our society who is going through health problems the opportunity to get the best outcome.

Another aspect which I found interesting—and I must admit that I have not really looked at the knock-on circumstances of this—was a comment by the member for Moore about how we have dentistry and medicine separated. There is a need for a holistic approach to people’s health, involving not only medicos, general practitioners and specialists but also other allied health professionals, dentists and the like. We have seen this done very successfully in other areas, and we really need to get back to models that combine those services. That is why things like community health centres and public dental health schemes are very important. (Time expired)

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