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Thursday, 29 May 2008
Page: 3837

Ms ROXON (Minister for Health and Ageing) (3:54 PM) —I move:

That this bill be now read a second time.

The bill will allow the government to deliver on a key part of its election commitment to improve dental health for working families and address Australia’s dental crisis.

The Medicare Teen Dental Plan is the first part of the Rudd government’s plan for improving dental services in Australia. The second part is a new Commonwealth Dental Health Program, through which the Commonwealth will provide additional funding to the states and territories to reduce public dental waiting lists.

In the recent budget, the government announced funding of $780 million over five years for these two new dental programs. We are providing $490 million over five years for the Medicare Teen Dental Plan and $290 million over three years for the Commonwealth Dental Health Program.

These significant commitments will help ease Australia’s dental crisis, end the blame game, and start addressing the parlous state of Australia’s dental health—the dire state of which should be laid at the feet of the Howard government: they closed the Labor government’s previous Commonwealth Dental Health Program and refused point-blank to work with the states on addressing this growing problem for a decade.

Before discussing in greater detail the policies which the Rudd government is implementing through this bill, I want to outline the magnitude of the problem which we have inherited from the previous government.

Latest estimates still remain at about 650,000 Australians languishing on public dental waiting lists. Thirty per cent of Australians are reported to have avoided dental care due to the cost of services.

Fifty thousand people end up in hospital each year with preventable dental conditions, putting more pressure on our public hospitals not to mention the pain and agony those individuals go through.

These problems with accessing affordable dental care have contributed to the dismal and deteriorating state of Australians’ dental health. Tooth decay is Australia’s most prevalent health problem, with gum disease ranking as the fifth highest. Over a quarter of the Australian adult population have untreated dental decay—untreated because they are not accessing the dental care they require.

What is most troubling is that poor dental health is starting with our kids. It then becomes entrenched as our kids transition as teenagers to adulthood.

For example, between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous decay. Children in lower socioeconomic groups experience tooth decay at twice the rate of children in higher socioeconomic groups. In New South Wales, in the decade between 1994 and 2004, there was a 91 per cent increase in hospitalisation rates for children under five for the removal or restoration of teeth—that is, the hospitalisation rate has nearly doubled. I know that the Deputy Speaker and I share a particular interest in this being mothers of children of that age. Neither of us would like to see our children unnecessarily in hospital, as I am sure no parent would.

This poor dental health deteriorates even further through teenage years. According to dental health experts, there is a fourfold increase in dental decay between the ages of 12 and 21. Almost half of all teenagers have some signs of gum disease. According to the OECD, the rapid deterioration in dental health occurring in teenage years leads to the dental health of Australian adults ranking second worst in the OECD. This comes after a history of very good ratings in the past.

This alarming state of affairs is even worse among the poorest and most needy Australians. Concession card holders, such as pensioners, have lost on average 3.5 more teeth than non-concession card holders. The children of concession card holders have over 50 per cent more decayed teeth than those of non-concession card holders.

Above all, when we talk about statistics and waiting lists, preventable hospitalisations and decay rates, we must always remember we are talking about people. We are talking about Australians who sometimes have such severe dental problems that it affects not only their health, but their work and personal lives. We are talking about pensioners who may not be able to eat food comfortably or easily and teenagers whose confidence to go out in the world to study and work is badly affected. We are talking about everyday Australians who will not visit their friends, who cannot apply for a job or cannot get a job, simply because they cannot get the dental treatment that they need.

It is clear from these terrible facts that Australian working families need action on dental health. As we know, rather than addressing these problems, the Howard government spent much of the past decade cynically playing the blame game.

Rather than taking any responsibility, the previous government passed the buck. They shifted blame. They repeated the all too familiar mantra that it was the states’ fault. For the past decade, the previous Commonwealth government did nothing to address the dental crisis in Australia. They did nothing but say that dental health was not their responsibility and blame the states.

But it was the Howard government that helped create some of these problems in the first place. As I have mentioned, one of the first acts of their government was to scrap the previous Labor government’s Commonwealth Dental Health Program, ripping $100 million a year from the public dental system—and this led to the explosion in public dental waiting lists that we see today.

Then, belatedly, the Howard government introduced a dental scheme whose referral processes and eligibility criteria were so complex and restrictive that few people could access it.

I do acknowledge that, for those able to navigate their way through the complicated referral process and the red tape, the program offered some help. But many people missed out—often the most needy in our community.

For example, over four years of the previous government’s scheme, right up to 30 April 2008, in the whole of the Northern Territory, no services at all had been provided to children and young adults up to the age of 24.

We know that the Northern Territory has some of the poorest, most marginalised people in our Indigenous communities. We know that they have some of the worst dental health problems in Australia. But how many of these young people did the previous government’s scheme help? Not one at all—zero. Across all age groups in the Northern Territory the picture is similarly poor—only 28 people accessing treatment over nearly four years.

In South Australia, over four years, no services at all had been provided to children up to the age of 14. Again, zero.

This means that, during the entire term of the Howard government, no child born and raised in South Australia or the Northern Territory got any assistance at all from their failed dental scheme.

In Tasmania, over four years, only eight people up to the age of 24 have received these services. That is only two young people a year on average.

And the picture is similarly poor in the larger states.

Only 52 people in Queensland under the age of 20 accessed the previous government’s program over four years. On average, that is only about one young person a month over four years across the whole of Queensland.

Only 94 people in the whole of Victoria under the age of 20 have received services in nearly four years. On average, that is only about two young people a month over four years across the whole of Victoria.

These figures are nothing to be proud of. They clearly show that the previous government’s dental scheme had failed.

In total, over almost four years to 30 April, the Howard government’s failed dental scheme will have spent less than $50 million (currently it stands at about $42.8 million). This compares to the investment provided in the budget of $780 million by the Rudd Labor government and the new dental programs that will be introduced and run over the next five years.

Moreover, even the limited support provided by the Howard government’s failed scheme was poorly targeted. As I said, we recognise that some people here and there received assistance under the failed scheme. But the problem is that it was not a targeted program. It did not help those most in need.

The poorest people with the worst dental health did not get access to the previous government’s failed scheme. If you were simply poor and had bad dental health because of your poverty, you could not get treatment under the program. However, if you were wealthy and had a chronic disease with complex care needs, you could get access to the program. Meaning that a millionaire could get access to the program—once they got through the red tape. A pensioner with an excruciating toothache but no chronic disease got no assistance at all.

The failings of the Howard government’s approach are manifest. They failed pensioners. They failed the poorest, most needy people in our community with the worst dental health. They failed our kids and teenagers—failed to help them maintain their teeth and prevent much worse problems later in life.

In implementing our dental commitments, the Rudd government is helping to fix these problems. We are not going to let the Howard government’s failed scheme continue, while the dental health problems of millions of needy Australians go unaddressed. That is why the government is redirecting funds from this underutilised scheme to support better targeted dental programs, such as the Medicare Teen Dental Plan that is being introduced today and the Commonwealth Dental Health Program.

We have made a decision, as governments need to do, that we should be helping the most needy people in our community first, in the most effective way possible.

We have made a decision that providing up to one million dental consultations and treatments under the Commonwealth Dental Health Program, and enabling more than one million teenagers every year to access preventative dental checks under the Medicare Teen Dental Plan, is a good investment for our money.

We will work with the states and territories and the dental profession to expand the provision of dental care, with a focus on treatment for those in greatest need, and preventative care for eligible teenagers.

Both of our programs are squarely targeted at people who are most in need of help, many of whom could not afford dental care without this assistance.

Commonwealth Dental Health Program

Under the Commonwealth Dental Health Program, the Rudd government will be providing an additional $290 million over three years to improve access to public dental services, working in cooperation with the states and territories.

This marks a stark change from the last decade of the Howard government criticising the states for not doing enough on dental health.

We do agree that the states and territories should be encouraged to do more—but instead of just passing the buck, the Rudd government is going to do its bit to help the states to do better.

Discussions with the states and territories about the implementation arrangements for the Commonwealth Dental Health Program are well advanced. As health minister, I am keen to end the blame game and to work with the states and territories to fix Australia’s dental care system, and the health system in general. We have already made a good start through COAG discussions over the last few months.

Commencing in July this year, the Commonwealth Dental Health Program will assist the states and territories to reduce waiting times by funding up to one million additional dental consultations and treatments over the next three years.

The states and territories are well placed to ensure that this extra funding will have maximum impact. Often public dental services are the only services available to treat people with the most severe dental conditions, especially in rural and remote areas. The public dental services target the most needy people in the community, and the additional $290 million in funding will ensure that these vulnerable and needy people will be assisted.

We will be putting strict conditions on the states and territories to ensure the Commonwealth funding goes where it is most needed. We will be requiring the states to target people with chronic disease as a priority, such as patients with cancer, cardiac patients and people with HIV-AIDS. Another priority will be people with increased oral health needs, including preschool children and Indigenous Australians.

States and territories will also be required to maintain their existing efforts in dental health, and report consistently on expenditure, the number of services being provided, and the number of people on the public dental waiting lists.

This means that pensioners will get more help. It means that concession card holders will get more help. It will assist the poorest members of our community, and the people with the poorest dental health. It will also give priority to Indigenous people, and preschool children—groups that the Howard government’s program so spectacularly failed.

In government we have to make choices. And, instead of persisting with a failed dental scheme, we are choosing to provide up to a million more dental consultations and treatments for the most needy Australians.

Medicare Teen Dental Plan

The Medicare Teen Dental Plan will also commence in July 2008, subject to the passage of this bill and the Dental Benefits (Consequential Amendments) Bill 2008.

Under the Medicare Teen Dental Plan, the government will provide up to $150 per eligible person towards an annual preventative check for teenagers aged 12 to 17 years in families receiving family tax benefit part A. Teenagers in the same age group receiving youth allowance or Abstudy will also be eligible for the program.

About 1.1 million teenagers will be eligible for the Medicare Teen Dental Plan each year.

The program will assist families to help keep their teenagers’ teeth in good health, and encourage young adults to continue to look after their teeth once they become independent and move out of home. This is an investment in preventative care.

Adolescence is a time when many young people strive for independence from their families, and move outside the parental structures which have supported their health. It is precisely at this stage in life that many young people’s dental health declines. As I noted earlier, there is a fourfold increase in dental decay between the ages of 12 and 21. Dental experts also tell us that the highest levels of reported toothache are in those aged between 18 to 21.

We need to stem the dramatic decline in dental health that occurs among our children in adolescence. We need to avoid the terrible health consequences this leads to in later life—which requires more expensive treatment, as well as entailing personal and social costs.

We have said on many occasions that preventative health is a key priority of the Rudd government. The health system needs to be refocused so that it keeps people well and prevents disease. The $490 million investment that the Rudd government is making in the Medicare Teen Dental Plan demonstrates our determination to make this priority a reality.

Under the Medicare Teen Dental Plan, we are going to encourage teenagers to care for their teeth properly—to get annual check-ups, so that any problems that might arise do not get worse further down the track. Providing preventative checks is also an effective way to maintain good oral health and reduce the need for expensive treatment in the future.

The Medicare Teen Dental Plan will operate as part of the broad Medicare arrangements, through a new Dental Benefits Schedule (DBS). The Dental Benefits Schedule will be administered by Medicare Australia and will operate in a similar manner to the existing Medicare arrangements. However, unlike the Medicare Benefits Schedule, the DBS will be targeted to specific age groups and working families receiving family tax benefit part A.

The annual preventative dental check will include an oral examination and, where clinically required, X-rays, scale and clean, and other preventative services. These include fluoride application, oral hygiene instruction, provision of dietary advice, and fissure sealing.

Eligible families and teenagers will be automatically sent a voucher by Medicare Australia once the program commences. Once the voucher is received, the teenager can receive a preventative check from his or her dentist. Teenagers or their parents will be able to claim a rebate back from a Medicare Office, or their dentist may decide to bulk bill the dental check. Up to $150 towards the cost of the service can be reimbursed through Medicare Australia.

Eligible teenagers will be able to use their voucher to receive a preventative dental check either from a private or public sector dentist. The dental check may be performed by a dental therapist or dental hygienist on behalf of a dentist, under appropriate supervision.

The Dental Benefits Bill establishes a legislative framework for the payment of dental benefits under a new Dental Benefits Schedule.


In summary, the Rudd government is delivering on its election commitments and making a $780 million investment in Australia’s dental health through the Medicare Teen Dental Plan and the Commonwealth Dental Health Program.

This marks the end of the blame game that, thanks to the previous government, has afflicted dental health for more than a decade.

It marks the end of the buck-passing and blame-shifting that has prevented the poorest, most needy people accessing the dental care they need.

It demonstrates that the Rudd government can make tough decisions to close down ill-targeted programs which have demonstrably failed, and replace them with targeted programs that help Australians most in need, such as pensioners and concession card holders.

It also demonstrates our commitment to investing in preventive health, ensuring our kids preserve their dental health today, rather than only treating their dental problems tomorrow.

The programs demonstrate the Rudd government’s determination to address the immediate pressures on Australia’s dental health system, the 650,000 people on public dental waiting lists who are the Howard government’s sad legacy.

And they also demonstrate the Rudd government’s commitment to building for Australia’s future, by encouraging our teenagers to develop good dental habits and preserve their dental health for the long term.

Together, these programs will attack the sorry state of dental health in Australia. They will address Australia’s dental crisis by delivering up to one million more consultations and treatments through the public dental system. And, by enabling more than a million teenagers to take better care of their teeth, they will support better dental health into the future.

This is the start of a new era in dental care. I commend the bill to the House.

Debate (on motion by Mr Ian Macfarlane) adjourned.