Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Hansard source

I rise to speak to the Dental Benefits Legislation Amendment Bill 2014 and indicate that the opposition will be supporting this legislation. This is legislation that would have been adopted by Labor if we had been in government, so we indicate that we will support it. The purpose of the Dental Benefits Legislation Amendment Bill 2014 is to amend the Health Insurance Act 1973 and the Dental Benefits Act 2008 to specify that Professional Services Review Scheme, which enforces compliance with appropriate practices, applies to services provided under the Child Dental Benefits Schedule. It is also to waive debts incurred by dentists under the superseded Chronic Disease Dental Scheme before 1 April 2010 due to noncompliance with administrative requirements. It waives debts incurred after this date if a dentist can demonstrate an intent to comply with the scheme. The bill also will ensure compliance with the legislative requirements for the payment of dental benefits and it allows the minister to delegate powers to insert a definition of a dental provider and allow for protected information to be shared between agencies.

The Child Dental Benefits Schedule—CDBS—was closed on 1 December 2012. It operated under Health Insurance (Dental Services) Determination 2007, as made under section 3C of the Health Insurance Act 1973. The scheme provided for up to $4,250 over two calendar years in Medicare benefits for private dental services for people with chronic medical conditions and complex care needs. The Department of Human Services conducted audits on the CDBS and found that there was a high rate of noncompliance with the provider reporting requirements set out in section 10(2) of the determination. Debts were raised against dentists found to be noncompliant through the audit process.

Further, more than 20 per cent of recipients were not pensioners or concession card holders and more than 20 per cent of spending was on high-cost restorative services. Section 10(2) of the determination required a dentist to provide a treatment plan to the referring medical practitioner and the patient and a quote to the patient before starting treatment. Audits for claims of benefits under the CDBS found that many dentists did not comply with these requirements. As a result, benefits were incorrectly paid and under section 129AC of the Health Insurance Act. These amounts are due to the Commonwealth from the dentists concerned.

Representations from the Australian Dental Association and other groups outlined that dentists had not been aware of their obligation under the Chronic Disease Dental Scheme until April 2010 and the government has decided that debts due to the Commonwealth solely as a result of noncompliance with section 10(2) before April 2010 should be waived. The government has further decided that debts solely due to noncompliance after April 2010 should be waived as long as the dentist can demonstrate an intention to comply with the CDBS obligations.

At present, the debt waivers are proceeding under section 34 of the Financial Management and Accountability Act. However, the government thinks this is a slow and unwieldy process that requires unnecessary administration and processing in both the Department of Human Services and the Department of Finance. This has resulted in the government's decision to include a special debt waiver provision in the Health Insurance Act. Powers to assist the chief executive of Medicare in determining and enforcing compliance with legislative requirements for the payments of benefits are inserted under part 3—compliance. Equivalent powers were inserted into the Health Insurance Act through an amendment in 2011 and the provisions in this part are modelled on those Health Insurance Act provisions.

Part 4 of the bill provides for a delegation of ministerial powers, which is currently not included. Part 5 amends the definition of the dental provider to align with the definition under the national law dealing with the registration of health professionals. Part 6, the provision of information, allows for information obtained under the act to be disclosed to the minister and the department administrating the Veterans' Entitlements Act 1986 if the disclosure is for the purpose of administering the Dental Benefits Act, as people may be eligible for dental benefits if they are receiving certain allowances paid by the Department of Veterans' Affairs. Part 7 is a minor technical amendment.

The Child Dental Benefits Schedule commenced on 1 January 2014 and provides two- to 17-year-olds who meet a means test with access of up to $1,000 of benefits over two calendar years for basic dental treatment. The Child Dental Benefits Schedule replaces the Medicare Teen Dental Plan and provides more comprehensive coverage through a greater range of services to a larger group of children. The CDBS formed part of Labor's $4.1 billion dental reform package announced on 29 August 2012. The dental reform package comprised $2.7 billion for around 3.4 million Australian children, who will be eligible for subsidised dental care through the CDBS. It provided $1.3 billion for around 1.4 million additional services for adults on low incomes, who will have better access to dental care in the public system, and $225 million for capital works and workforce in the dental area to support expanded services for people living in outer metropolitan, regional, rural and remote areas.

There are potential risks to the Child Dental Benefits Schedule. Minister Dutton flagged concerns with the way he thinks the CDBS has been structured in the second reading speech to this bill in the other place. He said he was going to keep a watching brief on the outlays and the initial usage rates, as well as practices across states and territories in relation to their operation of this scheme. I am concerned, and I put this on the record, that this could be the government's commencement of undoing this very successful scheme. It is extraordinary that in our country it is only in recent years that we have included dental services in our federally funded health system. Unfortunately, when Medibank was first being negotiated, dental services were not included. It was seen that having a big conversation, if I can put it that way, with both the medical profession and the dental profession at the same time would be a hard thing to achieve, so a decision was made not to include dental services.

That has been a concern to Labor for a long period of time. That is why when we were in government we put a lot of effort into ensuring that we improved our effort from the federal perspective to provide support, particularly for low-income earners, to receive proper dental care. We do not have a good dental record in this country, and it is time that we make sure that children particularly are attending the dentist as regularly as they should and that they get into the habit, frankly, of going to the dentist. Unfortunately, not many of us like doing that, but that is why we established the Child Dental Benefits Schedule when we did, to basically get into place the habit of going to the dentist on a regular basis. Prevention is better than cure, no more so than when it comes to dental services.

This also gives me an opportunity to apprise the Senate of work that the Senate Select Committee on Health has been doing to inquire into changes to the health system that the budget proposes. I want to go to the question of GP co-payments. I listened to AM this week, and Mr Hockey was asked about why the GP co-payment proposal was not considered prior to the election and whether that wasn't a broken promise, because no-one was told during the election campaign that the government was going to require a co-payment to be paid but, come the budget, we find that there is a tax on going to the doctor. Mr Hockey said, 'But we promised that we would fix the budget bottom line', or words to that effect. I was surprised that the interviewer did not pick him up on that, because the budget papers show quite clearly that the funds raised by the GP tax will go to the Medical Research Future Fund.

That will not fix the budget bottom line, and that is an issue that has been canvassed by the Senate Select Committee on Health in a number of places. Not every witness to the committee, but almost all, is extremely critical of the measures in this budget that say that we will tax those who are sick and those who are poor, particularly to go to the doctor but also to get their pharmaceuticals filled and to use diagnostic imaging. We had evidence in the committee from people saying that the people who will be most disadvantaged by this, as I said, will be the sick and the poor but particularly homeless people, people who are living in rural and remote areas and people who use the services of Aboriginal medical services. There is a lot of work being done to try to ascertain the real cost that will be incurred in our Aboriginal and Torres Strait Islander community from people who defer receiving primary healthcare services. So, the GP tax, the GP co-payment, has been broadly and widely criticised for being poorly targeted and because it will add to the health burden of the country. Once again, to go back to Mr Hockey's comment about fixing the budget bottom line: it does not, and he should know that; he is the Treasurer.

Finally, I want to go to some commentary around the disbanding of Medicare Locals. Mr Abbott said, prior to the election, that there would be no change to Medicare Locals—that the 61 Medicare Locals as they existed would be there into the future. Now we find that Medicare Locals have all been abolished; they will cease to operate at the end of June next year. We also know that the potential cost of disbanding and winding up those Medicare Locals is $120 million. Some of that money may be saved if some of those Medicare Locals transition into Primary Health Networks, but the costs are huge, and for what benefit? I say that the reason this government does not like Medicare Locals is that they have the word 'Medicare' in there. Liberals do not like Medicare. We know that. We saw that back in the 1970s when the Liberal Party got rid of Medibank. We had to reinstate it as a Labor government when we came into power. I suggest that the reason this government is disbanding the Medicare Locals system is that they do not like the name, because the Primary Health Networks essentially do a similar job, but they will now do it over a much larger geographic area.

As a person representing particularly a regional area in the country, I express real concerns about this. The geographical area that the North Queensland Medicare Local will now cover will go from the Torres Strait Islands, from the border with Papua New Guinea, to south of Mackay and over the Great Dividing Range. It is a massive area and the health needs of those different communities are enormous. That we could have a local health service connected to local health needs over such a vast area is a fundamental design mistake, in my view. Our committee will continue to investigate the development of the primary health networks. We will continue to do the work to uncover these design mistakes that we believe—certainly Labor members believe—are inherent in the design of the primary health networks. In continuing that work, hopefully we will be able to provide some advice to the parliament about some of those issues in the short term.

To come back to the bill, I reiterate that Labor will be supporting the passage of the Dental Benefits Legislation Amendment Bill. I commend the bill to the chamber.