Richard Di Natale (Victoria, Australian Greens) Share this | Hansard source

I rise today to discuss a matter of crucial importance to the nation—that is, the question of dental health. Australians find themselves in a very curious position when it comes to health care. For some reason we have decided to treat the mouth as separate from the rest of the body. If somebody has a problem with an ear, an elbow or an eye, they can go to see their GP or to a hospital and their treatment is likely to be covered under Medicare. It is not a problem if you do not have the ready cash available because you can get your treatment covered through the publicly funded medical insurance scheme known as Medicare. But for some reason, if you have a sore tooth, the treatment options are very different. If you cannot afford to get the care done immediately the chances are that you will leave it and the problem will get worse, you will end up at the GP, where you might get some pain relief and some antibiotics, and if that does not sort out the problem you eventually will end up in one of Australia's public hospitals.

The reality is that the high cost of dental care means that, unlike in the medical system, a number of people simply do not go to the dentist. The result is that we have an epidemic of poor dental health in this country. Dental disease is now one of our most pressing public health problems. In short, there really is not any rationale for treating our teeth and our mouth as separate from the rest of our body. This has a very direct medical impact. As I said earlier, dental disease can cause pain, which can affect sleep, and it can lead to malnutrition and, ultimately, to serious infection. This is particularly true of people who have chronic diseases such as diabetes and heart disease.

Apart from the immediate medical problem of the pain and discomfort associated with untreated dental disease, it can have a huge impact on other areas of people's lives. People with poor dental health often have issues with self-esteem. They find it difficult to find work. It often puts you behind the eight ball in a job interview when you smile and your front teeth are missing. Likewise if you are looking for a rental property, the real estate agent is not likely to look favourably upon you if you have a smile where most of your teeth are missing.

This is an issue that goes far beyond the medical system; it is in fact an issue of social justice. The fact that this is happening to so many people in this country is of course alarming, but the fact that it mostly affects those people in this country who are less well off is simply unacceptable. I want to say a few more words about the dimension of the problem we face. Around 61 per cent of Australians have intermediate, unfavourable or poor oral health. We know that that results in 20,000 to 30,000 hospital visits each year. We know that an estimated seven per cent to 10 per cent of visits to a GP are the result of untreated dental disease. The problem is particularly bad for our young kids. The oral health of children and teens is steadily worsening; in terms of our ranking in the OECD on these measures, we are falling rapidly. There is a huge economic cost associated with untreated dental disease. Between Medicare, hospital admissions and the PBS, the problem of untreated dental disease costs us up to $500 million each year. And that does not say anything about the billions more that are lost as a result of lost productivity.

We have a two-tiered dental structure. Around 90 per cent of dentists in this country provide their services through private fee-for-service practice. But we also have a publicly funded dental health scheme through the state dental health programs. Approximately 700,000 to 800,000 people are seen in the states. But it is interesting that this is only about 11 per cent of people who are eligible for publicly funded dental treatment. In large part, that is because the system simply cannot meet the huge demand that exists. People on those public lists face waiting times of several months and often up to several years. People simply give up and defer treatment. We have two health systems: one health system for our body and another health system for our teeth. Within that oral health system, we have a two-tiered system. Within that system, 90 per cent of services are provided through private dentistry and the rest are provided through a public dental service that cannot meet demand.

If you look at the costs to patients associated with our medical system, about 12 per cent of general medical costs are out-of-pocket costs. For hospitals, only in the order of three per cent of the total costs are out-of-pocket costs. When it comes to dental services, however, the total out-of-pocket spend is about 60 per cent—a significant difference. One thing that is certain: this is a problem that is going to get worse. Oral health is an issue that affects older people as much as it affects young people. As people get older, the way dentistry is changing in this country means that more people have more teeth. As a result, there is going to be an increased burden on the system.

We got to this point largely through historical artefact. Through the 1970s and the 1980s, the dental healthcare system was left out of Medicare, and so we have ended up with this two-tiered system that cannot meet the needs of the Australian community. To deal with this, in 1994 the government introduced the Commonwealth Dental Health Program. The principle objective was to essentially direct care received by healthcare card holders from emergency care to general dental care—so, things like teeth extraction, restoration and the treatment of caries. It was also intended to provide some basic preventative treatment. Essentially, $245 million was spent over four years on this program.

It was regarded as partly successful. But it was underfunded. The level of capacity within the service was limited. Rather than improve the system, the Howard government decided to abolish it. To its credit, it introduced the Chronic Disease Dental Scheme. That is a scheme that has helped people with chronic disease. Their overall health is more severely compromised by poor oral health than the health of the general population. We know that the Chronic Disease Dental Scheme has had some problems. There are issues around how well the scheme is targeted, around the scope of services that it provides and around the fact that a large number of people who certainly warrant treatment are not getting it. But it was a promising move; it was a start. It is something that we should build on. I want to talk a little bit about that in the few moments that I have left.

We are currently in the midst of a process in which a number of dentists who have provided services under the scheme established by the Howard government in 2007 are currently being audited over the treatments that they have provided. Under the scheme, a dentist is able to provide $4,250 worth of dental work over two years to any patient diagnosed with a chronic illness whose dental condition is deemed to make the illness worse. It requires a GP referral. The dentist needs to then provide a report back to the GP. This is all managed through what is called a GP care plan. As I said, the aim is to improve the health of the chronically ill—for example, people with diabetes and heart disease. As we know, they are very important population groups in terms of oral health and we need to make sure that we address those groups as a priority. A total of 13 million dental services have been provided to over half-a-million Australians. That is no small feat. It is being done largely through private dentistry. By most measures, the scheme has been moderately successful.

There has been some criticism directed against the scheme, as I said, including the issue of how well the scheme is targeted and the scope of services provided. But one of the other criticisms that has been levelled at the scheme is that it is being rorted. That is the issue I would like to talk about today. On that basis, the government has tried to close this scheme twice and is now targeting dentists through Medicare audits, which is causing serious concerns among many dentists who have provided services through the CDDS. I will talk about several examples, including Wilma Johnson from Tasmania. Dr Johnson has been audited for potential failure to comply with Medicare requirements. Let us look at what Dr Johnson did wrong.

Dr Johnson received $35,000 in Medicare benefits for treating 34 patients. In every case, the patient had a valid referral. In every case, the patient was entitled to the treatment. In every case, the treatment was carried out in good faith. Importantly, there was no gap charged to the patients. Every single one of those patients was bulk billed. Dr Johnson's crime was that she did not file treatment plans in time and did not give written quotes to patients who were being bulk billed. They are certainly requirements under the scheme. However, it is clear that, for a dentist who bulk bills patients, a written quote is unlikely to be of significant benefit and Dr Johnson did not gain directly from that practice. Dr Johnson is now being asked to repay about $30,000 for work that she provided in good faith to deserving Australians.

Dr Helen Arabatzis, who is from my home state of Victoria, practises at the Brunswick family dental surgery. That practice had essentially the same issue with treatment plans and quotes—it provided a number of services. Dr Arabatzis is one of those people who took up the scheme with gusto, providing services to people with conditions like diabetes and heart disease—importantly, providing treatment that would prevent these conditions from becoming worse. She is now being asked to repay $713,000, which is likely to bankrupt her dental practice. The question is: are these people rorting the chronic disease dental scheme or are they in fact guilty of minor administrative errors and should be given some latitude on those errors?

A professional services inquiry has highlighted deficiencies in the education provided to dentists through Medicare. In fact, in some cases, the information that was provided to these dentists through Medicare was inadequate and did not adequately emphasise those two particular paperwork requirements. It is true that that information was available, but the question is: how adequate was the training provided to these dentists? I have spoken with dentists who did not see any materials from Medicare until the scheme had been running for several years. These dentists were accustomed to billing Medicare for work under the Department of Veterans' Affairs and were, essentially, signing the same slips. They did need special attention to inform them that the system under which they were operating was very different from the system they were used to working under through the Department of Veterans' Affairs. We should not tolerate rorting, and we know that in a small number of instances there have been some dentists who have taken advantage of this scheme. But the truth is that many of the dentists who have been audited provided legitimate and important treatment. Many of these dentists provided that treatment in good faith and, as I said earlier, some latitude should be given to those dentists in relation to the treatment they provided.

The Greens believe that, ultimately, we can improve the chronic disease dental scheme. We know that dental health is a pressing and urgent issue in this country. It is a matter not just of ensuring that the health of the Australian community is improved but also of giving people the same life opportunities that most of us enjoy in the treatment of dental disease. The Greens have long called for a publicly funded dental system. We think the chronic disease dental scheme needs to be protected. We think it needs to be improved. We look forward to working with the government on this issue in the coming months, and we hope that, in the long term, we can achieve a universal and publicly funded dental scheme that Australians can cherish.