Judi Moylan (Pearce, Liberal Party) Share this | Hansard source

Dental health has certainly been a topic of considerable discussion today. It is a fact that dental health is fundamental to overall health and wellbeing. People who have a chronic illness such as diabetes, cardiovascular disease or cancer are more susceptible to oral health problems. In fact, poor oral health may contribute to heart disease and stroke, according to the American Heart Association. People undergoing treatment for cancer are also at risk of oral health conditions that without treatment pose a very serious additional risk to health.

Poor oral health can affect a person’s ability to eat, swallow and speak. It can result in considerable pain, the possibility of infection and loss of teeth. While the dental health of children—with the exception of some children in the Aboriginal and Torres Strait Islander population—has improved, with a significant reduction in the number of children with tooth decay, there remains a problem in the adult population. In fact, Australia ranks first amongst OECD countries for the oral health of children. Conversely, in the adult population, according to a 2001 study by the Australian Institute of Health and Welfare, there are 19 million untreated decayed teeth—the most prevalent chronic condition affecting health. Australian adults rank third last in oral health status in the OECD.

For some years state governments have failed to maintain the dental health system, and the waiting lists have grown so that there are an estimated 500,000 people now on state government waiting lists. In Western Australia in particular I find this totally unacceptable. It is a wealthy state and there is no reason for the large number of people on waiting lists.

This situation exists despite the federal government having provided a four-year catch-up program in 1994, with the allocation of $278 million over that period. Under the Commonwealth Dental Health Program, 1.5 million services were provided, and the Australian Institute of Health and Welfare carried out an evaluation of the program in 1997. Despite some positive outcomes, including shorter waiting times, fewer extractions and a greater level of satisfaction, there were also some shortcomings of that program, and these included only a small difference in emergency care treatment despite the intention of the scheme to shift the emphasis to general care.

The people eligible for care under the CDHP, Commonwealth concession card holders, were more likely to present for tooth extraction and were more prone to toothache than the general population, and the range of services was restricted, with insufficient incentives for private practitioners to participate in the scheme. Despite the investment of the federal government in the CDHP, by June 2002 the waiting list for people in Western Australia had more than doubled, to 26,000 people, with the waiting time increasing dramatically from eight months in 1997 to 13 months in 2002. I think you would agree that this is a deplorable situation for a wealthy state. Similar figures, I understand, applied in other states.

Following the 2007-08 budget announcement on dental health measures the government, in consultation with stakeholders, has provided greater flexibility for patients to receive complex treatments as required. And the scheme is more generous since the announcement in the budget. The Health Insurance Amendment (Medicare Dental Services) Bill 2007 will improve and increase access to dental treatment under Medicare for people who have a chronic condition and who have complex care needs. New dental items on the Medicare Benefits Schedule will be introduced from 1 November 2007, and this will enable eligible patients to receive Medicare benefits for a broad range of dental services. Up to $4,250 in Medicare dental benefits over two consecutive calendar years will be available to patients. This includes any Medicare safety net benefit payable to the patient. The treatment will be based on clinical needs.

In total, the government has committed $384.6 million over the next four years so that patients can have access to dental treatment in the private sector. This is meant to complement and take the pressure off existing state dental services, not to supplant them. It is, after all, a state government responsibility. There are clear lines of responsibility, and this is one that falls within the state parameters.

To be eligible for the Medicare dental benefit a person will need to be managed by a general practitioner under specific chronic disease management and multidisciplinary care plans. Patients will need to be referred by their general practitioner to a dentist. The Health Insurance Amendment (Medicare Dental Services) Bill 2007 will also enable Medicare benefits to be paid for the supply of dental prostheses, including dentures, which will be of particular benefit to the elderly.

This program complements other government initiatives announced in previous federal budgets designed to increase access to dental treatment. Measures announced in the 2004 budget by the Howard government allowed a patient to be referred to a dentist if they had a dental problem that was exacerbating their chronic condition, whereas now a patient can be referred to a dentist if their oral health is impacting on, or likely to impact on, their general health.

The existing EPC dental items have had low uptake since they were introduced in July 2004. The new items will be more consistent with the way dentists practise and will cover a broader range of services, including dentures. This, combined with a significant increase in Medicare benefits payable, will make the arrangements much more attractive. The new arrangements will also be widely communicated to both GPs and dentists. Considerable investment by the government in a new School of Dentistry and Oral Health at Charles Sturt University, more rural clinic placements and dental scholarships for Indigenous students will ensure the delivery of services into the future.

Quite apart from these new measures, the Commonwealth undertakes a number of other dental health services, including: Medicare benefits for dental services provided to in-patients and patients in public hospitals, including oral surgery, cleft lip and palate and X-rays; Medicare benefits under the cleft palate scheme; subsidised medicines prescribed by dentists under the Pharmaceutical Benefits Scheme; and university training of dentists and dental auxiliaries. Today we heard the Minister for Health and Ageing speak about the number of places that have been made available; I think it was in the order of 356 new training places. Also included are dental services provided through community controlled Aboriginal medical services; dental services on Cocos and Christmas islands; private health insurance rebates; and a full range of dental services to Australian defence personnel and the Army reserves and eligible veterans at no charge. Dental services provided through the Local Dental Officer Scheme are a central part of the arrangements for the provision of health care services for eligible veterans, war widows and dependents.

I think the criticisms of the opposition are totally unfounded. The Commonwealth is more than pulling its weight in delivering dental services to the community, and the shortfall remains under the responsibility of the state governments. The constituents of Pearce are eager for the government, in general, to improve dental services, with the priority toward preventative dental care, and I fully support the work of the Minister for Health and Ageing thus far to address the needs of people in Pearce and the broader community in delivering dental care services.

As always, it is the people in the lower socioeconomic groups, including Aboriginal and Torres Strait Islanders, who struggle to access dental care. Often it is the people with a disability or a chronic illness, the aged and those on fixed incomes who are the most disadvantaged and are likely to have more serious dental health problems. AJ Spencer, in a paper called What options do we have for organising, providing and funding better public care?, through the Australian Health Policy Institute in Sydney, reported that about 10 per cent of the Australian population suffered complete tooth loss. This rose to 16 per cent in the Indigenous population and to almost 25 per cent for health card holders.

One of my constituents wrote to me recently, pleased with the improved resourcing of dental health by the Commonwealth but urging us to do more. This constituent felt that with ‘good economic times and a large budget surplus, we must improve dental services’. As a first step this constituent called for ‘a free course of preventative dental care every two years for low-income Australians’. I am sure that many Australians would support that call, and I am strongly committed to ensuring that all Australians have access to quality, affordable dental care with particular emphasis on preventative care. In the meantime, this bill is a significant step forward, and I give it my wholehearted support.

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