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Standing Committee on Health and Ageing
Adult dental services in Australia
House of Reps
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Standing Committee on Health and Ageing
CHAIR (Ms Hall)
Coulton, Mark, MP
Irons, Steve, MP
Lyons, Geoff, MP
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Standing Committee on Health and Ageing
(House of Reps-Friday, 17 May 2013)
Content WindowStanding Committee on Health and Ageing - 17/05/2013 - Adult dental services in Australia
MULLER, Mr Peter, Dental Prosthetist, Dubbo
Committee met at 11:00
CHAIR ( Ms Hall ): I now declare open this public meeting for the inquiry into adult dental health services. I would like to thank Charles Sturt University for hosting us today and providing the committee with a tour of the excellent dental facilities and oral health clinic this morning. It was great stopping and talking to people as we went around. It was really wonderful to meet so many dedicated professionals who are working here and see a state-of-the-art facility like the one here at Charles Sturt University. I would also like to thank everyone for attending and making time to speak with the committee.
The fundamental importance of good oral health to general health and wellbeing is well recognised. The context of this inquiry is the federal government commitment to provide $1.3 billion to the states and territories under a national partnership agreement—throughout the day we will just refer to it as the NPA—to expand adult dental health services. The aim of the inquiry is to obtain a range of perspectives which will help to inform the development of the NPA by identifying priority areas for action. The committee welcomes this opportunity to hear more about dental health needs from regional and rural areas in Australia.
Although the committee does not require you to speak under oath, you should understand that these hearings are formal proceedings of the Commonwealth parliament. Giving false or misleading evidence is a serious matter and may be regarded as contempt of parliament. We have received this submission from you. I would like to offer you the opportunity to expand on your submission by making a short introductory statement. Following that the committee members will ask you some questions.
Mr Muller : I want to hand something over so you have a little bit of background on where I am from and why I did this and the concerns. Then we can discuss this.
CHAIR: Thank you for preparing this for us.
Mr Muller : I have only one opportunity and I have come this far, so I want to address this not only for myself but for the ADPA as well. They put in a submission as well in March I think.
CHAIR: Yes, we met them in Canberra.
Mr Muller : When I came to Dubbo there was great demand for dental services and fewer practitioners, so I had the opportunity to work for Great Western and the AMS medical centre. I was very surprised that we had such good facilities. At the time there were some issues. But I want to address the real problem, which is the money issue. It is not only the logistics or the facilities; it is money problems, particularly in this area where you cannot afford private insurance.
When you go through this document you will see the problems I have found in the last 2½ years, in the private area as well. Dental services in rural and remote areas have fantastic facilities. If I look back to 20 years ago when I lived in Dubbo, there was nothing. There was just the mention that we would get a university. Now it exists. But there is a big problem here: we do not have the practitioners. I am not a practitioner; I am working with my head and I am working from my heart.
We are dealing with people in the chair who have not only denture problems; they have mental problems, they are ill, they are on drugs or alcohol and they have social problems. So you have to listen to them. We talk about this in the ADPA. We are not psychologists, but you need the ability as a practitioner to read the people when they are sitting in the chair. When they are sitting in the chair you are committed, whatever the outcome is.
When Medicare introduced this closure I was shocked and surprised because there was no forewarning. There was nothing at all. There were no emails from the association. There was nothing. I had 35 patients in treatment that I could finish but under a time pressure because on 1 December the dental prosthetists provider number will not exist anymore. So we would be illegal if we touched them. But a nice letter from the health minister came saying that all costs would go to the patient. Which patient? You tell me which patient has the money under this scheme? Some patients should never have this $4,250 grant because they cannot handle this. I mentioned a couple of times when I searched because I wanted to know more. When I was in Bourke and Lightning Ridge with my caravan, I knocked on the door and the public said: 'I don't want to see you. I've got enough.' I said: 'Why? Let me know because I want to help you. I do not want to suck your money; I want to help you.' Finally, today, this morning, I had two calls saying, 'When are you coming to Lightning Ridge?' So it works. They need people they trust. They need people who want to help them.
I had very good experience with Great Western. Why I quit was political. I had a very good connection with AMS. It was the money issue or something else. Particularly Orange was fantastic. I came in and it was organised. It was very good.
It is communication. We have to go deeper. Dental prosthetists, hygienists, therapists, dentists and specialists—I feel sometimes we are the Road Runner. We fill the gap. We are very important. Technicians and prosthetists are not covered by dentists anymore. It is just minor. They refer to us, so we have the ability. But we also have to select good practitioners and that happens at the university or at the dental school. We are dealing with humans, and this I feel is very important.
Making the denture is just mechanical. But there are the issues of whether you can chew, whether you can talk and whether you feel comfortable. The time frame when they closed the CDDS was not long enough. That is why I protested very sharply. My philosophy is that I have to address this every day. When I was in Sydney I joined a petition with Professor Hans Zoellner for a new scheme. It was signed up by 8,560. We raised about 14,000 signatures and then suddenly it stopped, because it became too political. I cut this out.
As an ex-professional, I am trained, I have this skill and I want to help people in the community. We need money. My idea is to introduce something that is very simple. We have to split Medicare medical and introduce Medicare dental, like it is in Germany. It is wonderful but it collapsed because of fraud, misleading conduct and misusing it. It was easy money. That is teaching us that it was from the heart and not from the head. If we introduce Medicare dental, for example, of 1.1 per cent from $4,000 gross—this is not a high income. Say it is $16 a month, times 10 million taxpayers, making it $160 million a month, which is nearly $2 billion a year for just dental—extraction, cleaning, filling and preventing. With dentures to fill the gaps, it would be $1,200 maximum and the rest would have to be our own cost or whatever. One submission states that there are 89,000 adults on the waiting list for preventative care. I guess there are 45,000 who need a denture. So, it will cost the government about $60 million to give 45,000 patients a decent denture so that they can talk, eat and smile. So we will not have the problem of people who are telling us they cannot chew or cannot handle the denture. I hear these things every day. It is a time factor. Time and money are both important.
The Medicare levy should be compulsory, but nobody will see this. For example, when I explain to patients that they can save $1 a day for a denture in four or five years, they say that it is cheap and they will start. But if it comes suddenly, it is $4,000 or $5,000 or more and they cannot afford it. My example is very simple. They will spend money on a coke, which is $4, and on a lotto ticket and on cigarettes and that will amount to $80, whereas we are talking about $16 a month. So even a pensioner can afford this: 1.1 per cent. I believe it is possible and that if we have the money just for dental care we solve a big social problem we have in this country. If you cannot eat the right food it affects the chemistry in the body and you get grumpy from day to day. It starts in the family, in the community and in schools—this is the issue. If we cut this down and address this to the public in advertising and at schools that when you have a problem with teeth the scheme covers you, we will have a better society. I believe this. We have to make something different. Medicare cannot pay for everything.
We have to teach the community as well. That is what I do when patients come in. I say: 'Honestly, that is your fault. Your denture is 25 years old. Look how the denture is. I can show you a picture. This is disgusting.' And people are running with this in their mouths. If you address this, they get ashamed and they do not come back. But you have to start somewhere. I am honest. It is my obligation to patients to say what is wrong and what is right. If we can build into the foundation something like this then I believe AMS, such as Greater Western here in this area, will not be so under pressure. We will need it still, but $2 billion just for dental for one year is a lot of money.
Why did CDDS collapse? We know. They did not understand the system. They misused it because it was easy money. Whether you are a good dentist or a bad dentist, you get the same money. This system should never have had a gap fee. This is a patient referral from the government, and if the dentist or somebody else says, 'I will charge you $6,000,' and I got $2,000 from them, that is not on; it should never happen. A scheme like this, provided out of tax money to the public, should be limited. What I want to address last is that every health professional should take at least a compulsory 10, 15 or 20 patients a year for the amount that the government introduced. Whether it is $2,000 or $4,000 or $1,000, it does not matter who it is. We as health practitioners have an obligation to health, not only to make money. In the system, you see it everywhere. I was in Alaska. It is the same. Money is money, and you see it is a long, long way from very poor people with social problems, teeth problems and health problems. It is not a system.
It does not have to be communism or socialism. I think it is common sense that when you live in a community you take care of everybody. It is in school and in the soccer club, and so like this. I love this place. I tell you what: politics is why I quit. I have to address this; it is my only chance. I am 64 years old. I will work for another six years and that is it. So if I cannot address this and I do not want to address this, and if I ignore this, then I am not a good practitioner. That is what I have to say.
CHAIR: Thank you very much. It is wonderful to have somebody that has the passion that you have for your work and for your community come to address the committee. It is also fantastic to see that you have thought about it and you have come up with a solution that you think will work. You identified the problems and the reason that the Chronic Disease Dental Scheme was closed down: the cost blow-out, the misuse of the system and the gap fee, plus the fact that there were many people that needed to access dentures and other dental health treatment that could not because they did not have a chronic health disease. They are the types of reasons that the scheme closed down. What I find really interesting about the idea of Medicare dental is that basically we have universal health care for other health diseases and illnesses but we are not covered universally for dental. If I am correct, what you are suggesting is that we put in place a universal dental scheme.
Mr Muller : Yes.
CHAIR: Would you like to see that funded with a dental health levy, the same way that Medicare is funded?
Mr Muller : Yes. Also, at the moment we have research from the ADPA, who are going now to the Gold Coast, where they have a big meeting.
There are a lot of dental prosthetists who are unemployed now. I have had about 95 per cent government jobs—Greater Western and AMS. They have lower-end fees, and I have no problem with that. It was roughly $600 for Greater Western, and I was happy; I helped. I could go to the city and say I work for $2,000 or $3,000. That is not the point. They are coming from school, and you will not see anybody researching: can I live in the country? There is Dubbo, Wagga, Canberra, Armidale; you can go to Queensland. They are beautiful inland towns that need, for instance, health professionals, psychologists, GPs. They can live very, very nicely here in the country. We have got everything, and it is cheap—real estate is cheap.
So I do not understand this. The communication is stuck somewhere. I do not know if it is just a personal attitude. I was born in 1949; is it me? But I do not care. I have to address this, and I think they should implement this in schools, in high schools and in universities far, far more. If people do not come around to this idea, they will have to address it by making it compulsory: 'You have to go to the country.' We live in a democracy, and we know democracy is not free; you have to work for it. You could make it compulsory just for two years. In Germany, for instance, you cannot immediately work as a dentist in your own practice; you have to go work for somebody else first. Having two years of good training in solid dentistry work, from extraction to implant, gives them basically a good start to having their own practice. There is nothing wrong with that. But they should do it with dental prosthetists as well.
I am lucky that I have enough experience through the army and air force. I have people skills, I can read people, I have a little bit of psychology. But I say that, if you do not have that, you will fail in your job—and repeatedly. That is what has happened.
The CDDS was excellent. I would say the EPC was a very good scheme. But patients do not know what it means. I had a patient come to me a second time. I said, 'It's only been a year.' They said, 'Oh, I lost it—stolen.' That means Medicare said 'exceptional circumstances' were if a denture was stolen or lost. For me it is common sense: the only circumstance should be when there is a change in the mouth. So something was not right. What they did was they sold this denture, got a couple of bucks, came back with a new EPC form, and I did a second denture. I was suspicious, so I said, 'Wait a minute; I have to ask Medicare.' Everything was right. I said, 'Can I talk to you privately?' He said yes. I said, 'I have the feeling there is something going on.' So I did not do it. I said, 'You have to go somewhere else.' And this happens. It is not only once that it has happened. What has also happened is that a Medicare form was filled out and was claimed, but there was no service—no service at all. There are plenty of patients who will back me up if there is any deeper inquiry, and that is then getting more into the criminal area, because this is fraud—absolute fraud. We as taxpayers pay for this, and we as health professionals lose the confidence of patients. They do not trust us anymore. We have to rebuild that. This is a problem.
We are dealing with country people. To me they are no different from city people; they are just different. But they do not have the connection, they are not as engaged with information—they have no time, they do not want to know or they do not care.
My protest run around the country was very successful. I am not one to say, 'I'm a hero.' This is my opinion. It is my feeling. If I have my mother in the chair, or my neighbour or my uncle, it does not matter; it is a patient. I worked for Justice Health, so there was a criminal in the chair. He is my patient. You have to have that attitude or just say, 'I don't do that anymore.'
My problem with the system is that—I will say it straight—the people in Canberra who make these decisions have no idea. I do not have anything against them, but they should ask for far more feedback. We are dealing with humans here.
If somebody is suddenly ill, they get the best care under Medicare. If somebody takes preventative action and goes to the doctor and they are told that they have something, they are asked, 'Do you have private insurance?' If they yes, there is no problem. Here we are talking about dental problems. Dental problems are the same as any other problems in your body. I am just a technician and prosthetist. I am not a doctor. I have three kids, including a little one. I want to do something preventative. The government needs to change things so that everybody can do that. Having some backing would make people happy. That is what I want to say.
CHAIR: I fully understand that you would like see a dental Medicare system as well as the Medicare system that we currently have. We will look at that in our recommendations. Currently, though, there is some national partnership money that I understand has led to a climb in the number of people on the public health waiting list. I am sure that they are being referred to. Thank you for your passion and for caring so much.
Mr COULTON: Since the closure of the chronic disease scheme—and you pointed the plusses and the minuses, the positives and the negatives, in that—are your patients able to find financial help anywhere? What is happening there? How are you treating these people now?
Mr Muller : Good question; very good question. For thirty per cent, I work for nothing for a period of time. I set my goals. There is something coming up after the election—there must be something, otherwise I will have to find a way to finance it. I never want to react to the patient, unless he is rude, naughty and pushy. I have four, five or six cases. They are Medicare patients. They came back from other professionals. I had to redo their dentures. I said that I would do it but I said that they had to complain. They said, 'No, I'm not complaining.' I said, 'Okay: we'll solve the problem.' I did those six dentures for free. The price in the market can be about $50,000; I bring it down to about $3,000. I do not care. What I achieve is trust. That is the most important part for me—the trust of the community; the trust of the patient. They will then come back to me. I do not rip off people. If some have some money and they are stretched and the price would normally be $200, I say: 'Give me $100. That will be fine.' But that is not a permanent solution.
CHAIR: Are you accessing any funds through the national partnership money? I do not know whether vouchers are being handed out her.
Mr Muller : There are vouchers coming in now with the new scheme. I had a good discussion with one patient. I went through it with him for a long time. I said to him: 'Wait a minute; you have to understand the system. That is not for nothing. This is very expensive. This is just for a period of time.' I explained it by saying that if they want to take care of your health you should cut this down and afford a cheap denture—at least for two or three years to fill the gap. And they said, 'Yes, okay.'
CHAIR: So vouchers are starting to come through?
Mr Muller : Yes.
Mr COULTON: Does the voucher cover all of the cost of a denture or just part of it?
Mr Muller : For my service, yes.
Mr COULTON: It covers all of it?
Mr Muller : Yes. There is no problem. I will tell you the truth: even at $1,000 for a full denture, if you have 10 or 12 patients a month—and that is not many—that is $10,000 to $12,000. Living in the country, that is a good income. Our expenses are not high. I am telling the truth. If I wanted to make big bucks, I could. I would move to the city. I would make $60,000 or $100,000 a month. It is out of the question. We cannot help the community or the government if we go to Sydney. When I walked from Dubbo to Sydney, I went through Orange and I saw only two dental facilities. In Bathurst there was only one. Then I came to Sydney, and within 25 kilometres in inner Sydney I saw hairdressers, butchers, dental facilities, dental facilities and mechanics. It goes on and on. It is so competitive. They do this, but they do not want to come out, or they come out by helicopter, aeroplane or whatever and do a fast service like fast food, and then come the complaints. I cannot mention the name, but this has happened. You need people living here, whose kids go to school here and who go to the RSL or the soccer club and do a decent job. That is it. Then we would have a good community.
Mr IRONS: Mr Muller, we recently did a report on overseas trained doctors, and part of the difficulty was getting them into rural and remote areas. Even though that report is a separate one, do you have any suggestions that we could add to it, particularly with dentists?
Mr Muller : Dentists, hygienists and therapists. I think this problem will be solved in time when they go through this university. Some will stay. It is a time factor. I worked here for Jenni Floyd, the general manager. It is a good place. I can only recommend it. The reason I quit was nothing personal; it was just politics. But we had a good social evening, and that is what you need. You merge them in and connect them. We had a couple of dentists. It is fun, and they love it. Some want to stay. I met one dentist who is in Darwin, and he said: 'How is Dubbo going? It was good at the time.' This socialising does not need to be deep; it can just be basic. We can discuss some problems. We connected with dentists, including young dentists. I can teach him a little bit of technique, and he can say, 'Look, what is this?' This environment in the country is far more successful than in the city, because in a city you see everybody on a phone; you cannot talk to them. There is no vision; there is no eye contact. Everybody is in a hurry. Why are they in a hurry? I do not know. To pay the next bill for their boat or their house? This is what happens. This is the problem. That is why I say we have social problems. There are negatives and positives—money and non-money. We have a problem. That is why we carry all this violence here. It is coming from somewhere, and I believe the trigger is unhappiness. You cannot eat or socialise. It is a percentage. That is more important. But this is what happens not only in Australia but everywhere.
Mr IRONS: So you would agree that, with this type of facility training in remote and rural areas, it is far better to try to attract overseas trained doctors and get them to work in remote and rural areas?
Mr Muller : Yes, that is good too. If you have overseas trained doctors, you have to understand first where they come from. I am not a racist. In Germany with the Turks in the seventies we had no problem—we had some problems. You have to understand the culture. You have to understand where they come from and under what circumstances. If they come to Australia, wherever we have this problem—I want to touch on this—you have to invite them into your community and say: 'That's how we live. That's how we work.' You do not have to match people up. I have never had a problem wherever I was. I have lived in Canada, in Wales, in Germany—I worked in the former East Germany for three years; that was the hardest part—and then in Australia. I was in South America—not as far as Central America, but I could not come down, because there are issues as well. So, if people are coming to Australia from Bangladesh, Brazil or India, they are people. They are coming because of some problem. But, if you engage them in our community, you will have very good people. They are good people. They just need time, and we have to accept them.
But, to say you prefer dentists from India or from Australia—I think we have not got enough dentists, and we need dentists in the country. The ADA said, 'We have enough.' No, we do not have enough. Do you know why? Because there is a big gap—dentists here, and dentists here. They are competitive. They make millions in the city, and here they are hardly surviving. If you go to, say, a very remote area where there are 4,000 people and one dentist, mostly they will come from Asia because nobody else will live there. That is what I said: the government should make it compulsory for two or five years—simple. And then engage them with dentists from overseas. That is how we become a multicultural country. Multiculturalism is good and it works when everybody thinks the same way. There is no racism. There is no 'yellow' or 'red' or whatever—they are all just people.
In particular, with the Aboriginal people, I had so many positives. Walgett was probably the best place, where I was for the first time deep in Aborigines. I was the brother—'Thank you, brother.' There is a communication problem and a little bit of a logistical problem, but we can solve those. We need the practitioners who understand the system and want to change something. That is all it is. I would say merge them together, and mix them, and exchange.
CHAIR: Thank you. I know Mr Lyons would like to ask a question now.
Mr LYONS: You seem to be saying that we should increase the Medicare levy to cover dentistry, basically.
Mr Muller : Yes.
Mr LYONS: Politically, this is not an easy thing to do.
Mr Muller : I know.
Mr LYONS: People do not like increasing tax and so on.
Mr Muller : That is why I said this: if you buy a Coke, that is more than you would spend. When you address something and you have to tax this, then you have to say why. The dumbest citizen will understand this: 'Or you want pain, or you want not to be served in a hospital—you have choices. Choose now. Cut this down, or pay one dollar or four dollars a week.' I think it is up to the politicians how you address this to the community. If our MP needs support, I support him totally—it does not matter which party; it is the people.
It is not easy to sit here and tell the government what you have to do. But this is my experience and I feel sad for people, particularly the handicapped or the ones who do not have the guts to stand up or who cannot talk or who are elderly and say, 'I do not have the money or the time left—four or five years; it does not matter.' No. It is my job.
CHAIR: There being no further questions, can I thank you very much, Mr Muller, for coming along today. We really appreciate your contribution to our inquiry and we appreciate you thinking about the issue and coming up with ideas for us to look at when we are developing our report.
Mr Muller : Thank you for the opportunity.