Tony Zappia (Makin, Australian Labor Party) Share this | Hansard source

This legislation, the Dental Benefits Amendment Bill 2021, builds on a Labor initiative, the Child Dental Benefits Schedule, which since its introduction in 2012 has provided $2.3 billion in benefits and has delivered 38 million services to over three million Australian children—services and treatment that benefit children, their families and the public health system more broadly, because early intervention in dental treatment will very likely prevent other future health issues, as other speakers have said time and again in this debate. It's $2.3 billion that has been spent, which, in my view, if we could calculate would also have resulted in much more than that in public health savings as a result of that expenditure being made for dental treatment at an early age. Early dental intervention will also increase the likelihood that good dental care practices are ingrained from childhood and carry through right into teenage years and adulthood.

The legislation, in my view, corrects an anomaly in the Child Dental Benefits Schedule, which provides eligible children aged between two and 17 years access worth up to $1,013 for basic dental services, with benefits capped over two consecutive years. Under the proposed changes, the eligibility commences at birth rather than at two years. That means that around an additional 300,000 children will now be eligible for child dental treatment. On those figures, it is estimated that some 15 per cent, or 45,000 children, will access the scheme. It seems to me to be a commonsense correction. Indeed, I don't quite understand why it didn't start when the scheme was introduced. But nevertheless the correction is being made, and I am sure that it will not only make a difference but will assist so many children and families.

Failure to address dental issues at an early age can lead to more serious dental issues and health complications in adult life. The latest Australian adult Oral Health Tracker, of 2020, indicates that dental care amongst Australians is deteriorating. One in three Australians has untreated tooth decay, an increase from one in four in 2018. In just over two years, the figures have deteriorated that much. Adults reporting toothache rose from 16.2 per cent in 2018 to 20.4 per cent in 2020, again a considerable increase over a two-year period. Fifty-two per cent of people without private insurance and 26 per cent of people with private insurance avoided dentists because of the cost. In actual numbers, that translates to about two million Australians every year avoiding a dentist because of the cost.

Apart from the discomfort to those people who needed the dental treatment, the reality is that avoiding the dental treatment will mean other complications down the track and perhaps much more costly complications. For example, poor oral health is directly associated with chronic diseases including stroke and cardiovascular disease. As others have also said, it can also affect a person's confidence, appearance and general wellbeing. It's a pity we haven't had any costings done of what the cost to society is as a result of people not having dental treatment when it is needed.

Dental care was not included in Australia's universal health scheme, Medicare, at its inception, and, four decades later, dental care is still not covered by Medicare in full. This is a partial covering of it, but it's a very limited covering. As other speakers have pointed out in this debate, it would be in the national interest to have dental care included in Medicare. Just why it was not included from day one is still somewhat of a puzzle to me. I understand that, at the time, there was some objection to it from dental groups throughout the country, but nevertheless it seems to me that, had it been included at the time, we might not be having this debate right now, because it would have been part and parcel of everyday health care. Indeed, I suspect that it might be the case that, had it been included, we would have seen a net saving in public health costs throughout the country.

Dental care is health care, which is why several other countries, including Finland, the UK, Sweden, Italy and Greece, all have a form of universal dental care. Those countries clearly recognise the benefits and importance of it, yet Australia still continues with very limited public dental support. It is often shared, in a complicated way, between the state and federal governments; indeed, it varies from one state to another. The sad reality is that, even for those who are eligible for public dental treatment in this country, sometimes the waiting lists are such that people are waiting months or perhaps even years for that treatment. I can't imagine someone who is in urgent need of dental treatment having to wait months or years for it. It would have to be incredibly uncomfortable. I can recall speaking to people several years ago about that very issue and the impact it was having on their lives as a result of not being able to get the treatment that they needed, because they couldn't afford it and so had to wait and rely on the public services for it. While it's not surprising that people on low incomes are more likely to skip dental treatments, somewhat surprisingly it is often people in the 20- to 40-year age group. I say 'somewhat surprisingly' because I would have thought that those would have been the people who might have been in the workforce. But, again, they are also people with lots of financial burdens hanging over them during that stage of their life. That's perhaps why they are the ones who frequently skip dental treatments.

Even when those people do visit a dentist, the statistics would show that the type of care they choose is often determined by the cost of the treatment, rather than the treatment that they would otherwise want to get or the treatment that the dentist suggests they get. Again, even when treatment is available, sometimes it is not the treatment that they should be getting and, because of costs, they choose the cheaper option. Again, it is always people on lower incomes who are missing out. It's unsatisfactory that most people are ineligible for state or federal funding of dental treatment. We have conditions under which people can access that federal funding or that state funding, but if you don't fit in or you're ineligible then you simply can't get it.

Australia lags well behind comparable countries, such as the UK and Canada, with respect to the population overall getting good dental treatment and getting the treatment and care that they need. My understanding, from one report, is that in 2017-18 about 72,000 hospitalisations for dental conditions may have been prevented had earlier treatment been provided. Again, that just highlights the point that if people are going to hospital because they avoided getting dental treatment that they should have got, what is the cost to society for that hospital treatment—and the hospital stay in some cases? I simply don't know, but I can imagine it would have been much greater than the initial cost of the treatment had they been able to afford it or, indeed, had the public paid for it. It actually makes economic sense to look at a more broadly based public dental service that could be made available here in Australia. Dental services in Australia cost around $10.5 billion in total in 2017-18. Given those figures are now two years old, my understanding is that today's figure would be around $12 billion. Of that, half is paid by individuals and the rest is paid by governments and health funds. It seems to me, in proportion to the health cost throughout the country, that something future governments should consider is having 'Denticare' or something similar to that included in our Medicare system.

The other point I want to make about all this is the point that others have made and which I alluded to earlier on in my comments—that is, people on lower incomes are more likely to be the ones that miss out on dental treatment, because they simply can't afford it. The statistics and facts will confirm that. One of the groups that clearly misses out a lot is Indigenous Australians, who are twice as likely as non-Indigenous Australians to not be able to afford dental costs. We were talking about the Closing the Gap statement in the parliament in recent days. This is a terrific example of where a gap needs to be closed, particularly for Indigenous people across the country and those in rural and remote areas, where not only is it a case of cost but quite often also a case of access to dental practitioners. We need to do a lot better and a lot more.

The last point I want to make is this: as part of dental treatment, we know full well that nutrition and, in particular, the consumption of high-sugar foods and drinks has a direct impact on tooth decay and the like. We haven't done enough to address this issue over the years. If we want to minimise and reduce dental costs, and indeed health costs more broadly, throughout the country, we should look at prevention rather than the care afterwards as our priority, yet we don't do enough of that in this country. There is no question whatsoever—and the research will show this and the statistics will bear it out—that the consumption of the wrong types of foods, in particular of high-sugar foods, in this country is contributing greatly towards the dental costs and the health costs of the nation. We should be doing a lot more to either educate or in some way modify behaviour in this country so that people's health is improved through preventative action rather than through having to treat conditions once they arise.

With those comments—and others have made this point—we support this legislation. It is good legislation. A lot of people are going to benefit from it. I commend the legislation to the House.

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