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Wednesday, 10 October 2012
Page: 11799


Ms LIVERMORE (Capricornia) (12:52): The member for Cowper and his colleagues on that side might be happy to vote against a measure which will see 3.4 million Australian children receiving dental care, but I, for one, will be supporting the Dental Benefits Amendment Bill 2012 and supporting it wholeheartedly. I am pleased that I am able to join so many of my colleagues on this side of the House in doing so. From, for example, the approach taken by the member for Lyne on the disallowance motion yesterday, I know that there is support for this bill from other parts of the chamber as well. Adequate Commonwealth government funding for dental health in Australia is something Labor have been arguing for since the earliest days of the Howard government, when Peter Costello axed the Commonwealth dental scheme in his first budget.

I will come to the specifics of this bill in a moment. First, however, I want to make the point I have made at the start of my contributions on all of the health related bills introduced in recent years—the establishment of the Australian National Preventive Health Agency, plain packaging of cigarettes, workforce measures funded through Health Workforce Australia and the creation of Medicare Locals and hospital boards. All those measures have been component parts of the overarching health reform agenda of this government. When we came to government, we wanted to get past the blame game and the cost-shifting between the federal and state governments which had come to characterise the health portfolio under the Howard government. That was no better illustrated than in the debates we had about the Commonwealth government's responsibility—or, in the case of the Howard government, denial of responsibility—for dental care. That same approach saw the Howard government cut funding for public hospitals and then criticise Labor state governments for the consequences of those cuts.

We came to government prepared to take responsibility for the delivery of health services. To do that properly we needed to understand the demands on our healthcare system, the barriers to meeting those demands and the best design for removing gaps and inefficiencies from the current system. The National Health and Hospitals Reform Commission did that work for us and all the measures we have legislated and implemented have been consistent with the commission's recommendations for achieving an integrated and efficient healthcare system capable of meeting the needs of the Australian community both now and into the future.

This bill is no different from those other measures and is a significant part of the broader reform framework. The report of the Health and Hospitals Reform Commission identified three reform goals to guide our restructuring of the health system. One of those goals is tackling access and equity issues which affect health outcomes for people. Following on from that, one of the five priority access and equity issues singled out for attention by the commission was improved access to dental health care. I point out that this report came out after the Chronic Disease Dental Scheme, which the other side is so supportive of, had been in operation for some years. So clearly very large gaps remained despite that scheme.

The report sets out the challenge very clearly and makes the following points: that Australia is in the bottom third of OECD countries for rates of dental decay; that nearly one-third of Australian adults avoid or delay visiting the dentist due to cost; that, at the time of the report in 2009, nearly a quarter of a million people were on public dental waiting lists; that there has been a 20 per cent increase in tooth decay among children since the 1990s; and that poor dental health is detrimental to people's general health and wellbeing. So better access to dental care has always been a priority for the government within our broader health reform agenda. Access to dental care is a matter of equity and is key to achieving the health outcomes we need if Australia is to be a healthy and productive nation.

The Dental Benefits Amendment Bill puts in place the first step towards the comprehensive dental health reform package announced by the Minister for Health on 29 August 2012. That reform package has a number of elements, which I note the opposition continue to ignore in this debate—focusing instead on the one fig leaf of dental care they came up with in their 12 years in government. Our comprehensive scheme includes the national partnership arrangements with the states for the expansion of services to adults in the public dental system. Those national partnership arrangements will mean $1.3 billion to fund around 1.4 million additional services for adults on low incomes, including pensioners, concession card holders and those with special needs—greatly improving access to dental care in the public system. Our comprehensive scheme also includes a flexible grants program to provide additional dental infrastructure in support of improved services and workforce development. It also includes the Child Dental Benefits Schedule, known as 'dental for kids', which is the subject of this bill.

This bill amends the Dental Benefits Act, which has been in place since 2008. It fulfilled Labor's promise at the 2007 election to help families with the cost of accessing dental health check-ups for their teenage children. The existing act supports that through the Medicare Teen Dental Plan by providing for the issuing of vouchers to eligible teenagers between the ages of 12 and 17. The government has, however, responded to the advice of the National Advisory Council on Dental Health to expand on that scheme by extending the potential support for a greater range of dental services to a much larger group, including children from the age of two. This bill gives effect to that commitment and amends the Dental Benefits Act by expanding the age range of eligible children. Currently the Medicare Teen Dental Plan covers eligible young people from the ages of 12 to 17. Following the passage of this bill, vouchers for dental care will be issued to eligible children and teenagers from ages two to 17—a very significant expansion of the program. The Child Dental Benefits Schedule this bill provides for will replace the existing Medicare Teen Dental Plan from 1 January 2014.

These amendments are just the first step in setting up the new 'dental for kids' scheme, which will see millions of kids getting better access to dental care. Those families who qualify will be entitled to $1,000 per child every two years. The eligibility test remains the same as the one for the Medicare Teen Dental Plan, which basically means it is targeted at low- to middle-income families. It is for children in households receiving the family tax benefit part A, Abstudy, the carer payment, the parenting payment, the disability support pension or a number of similar payments. With that $1,000 every two years, those families will be able to take their children to either public or private dental clinics for services ranging from preventative check-ups to basic treatments such as fillings and extractions—another important improvement on the Medicare Teen Dental Plan. It is expected that this scheme will subsidise dental care for over three million children.

The precise range of services and benefit level under the Child Dental Benefits Schedule will be established at a later date under the Dental Benefit Rules. As the minister made clear in her second reading speech, she intends to consult with oral health professionals to design the fee schedule under the Child Dental Benefits Schedule. We understand that the schedule needs to contain an appropriate mix of dental services and fees that encourage participation by the dental professions and the right level of servicing. That will take time and the cooperation of the dental and oral health professions, but it is a very important part of making sure that this scheme gives children the care they need and the oral health practices that will carry them through into adulthood and old age.

We also need to ensure that families and the government are getting good value for the money that is subsidising particular dental services and treatments. That question of value for money is a good one and highly relevant to this debate, because a large part of the funding for the government's new dental health initiatives comes from the closure of the Chronic Disease Dental Scheme. We all know now, from the debate that has gone on in the House for the last week or so, that the Chronic Disease Dental Scheme was introduced by the Leader of the Opposition when he was health minister in the Howard government, and the opposition have been defending it ever since, including in this debate. They defended it, even as it became obvious that it was poorly targeted, subject to rorting and the costs were blowing out, while leaving so many other areas or dental care underfunded and neglected.

The Chronic Disease Dental Scheme, which entitled patients to receive over $4,000 of dental treatments every two years, was supposed to cost $90 million per year but is now costing $80 million a month because, as I said, it is not means-tested and it has been used in many cases for treatments that go way beyond what was needed to address people's basic dental problems and it left so many other areas of dental services unaddressed and left to the states to deal with. While that money was being shovelled out the door with the blessing of the opposition, thousands of low-income Australians sat on public dental waiting lists and our population fell further behind on comparative measures of our oral health. It was a shameful situation and one that we cannot stand by and ignore to the same degree as opposition members will continue to defend it.

We need our health dollars to go as far as they can towards improving the health of all Australians. The way to do that is to target spending on programs that have the biggest impact and reach those who we know are the most disadvantaged when it comes to accessing dental health services. With that in mind, last year the government sought expert advice on what needs to be done to lift the standard of dental health and access to dental care.

The National Advisory Council on Dental Health reported to the government in February this year and made it clear that, among its other recommendations, the No. 1 priority had to be providing subsidised dental services to children. Once again, we have seen the opposition accusing the government of some kind of arbitrary, knee-jerk reaction and a vendetta against the Chronic Disease Dental Scheme. That argument cannot be sustained when you look at the genesis of this measure and the other measures within our dental health scheme. These are things that have been recommended to us by experts, at the same time as we were receiving advice over and over again about the inadequacy of and the rorting that was going on within the Chronic Disease Dental Scheme.

As I was saying, the National Advisory Council on Dental Health told us that dental health for children was the top priority for funding. One of the reasons for that is the deterioration in the state of children's teeth right across the population—rural and urban, high and low income. After decades of improvement, since the 1990s we have seen children's dental health decline. In that time, the prevalence of dental disease has increased. The advisory council report quotes the Child Dental Health Survey Australia from 2003-04, which showed that nearly 50 per cent of children aged five to six years experienced dental caries in their baby teeth and 41 per cent had untreated decay. An Australian Institute of Health and Welfare survey found that 45 per cent of 12-year-olds had decay in their permanent teeth and 25 per cent of that age group had untreated decay. An important point is that the prevalence, severity and level of untreated decay is higher in low-socioeconomic groups in the community. We can see from those statistics that children's teeth are getting worse, which highlights the lack of preventative care, and that a significant number of children are obviously not getting the treatment they need when decay sets in.

So 'dental for kids', which this bill supports, will allow children from families where the cost of going to a dentist is a barrier to regular visits to start having yearly check-ups and follow-up treatment where necessary. This will make a big difference to the rates of childhood dental disease that I just quoted and, very importantly, will reduce the burden of dental disease on those kids, our community and the health budget when they grow up. We know that those high rates of decay and dental disease that we are seeing in primary school children are not going to improve without treatment and, unless we make preventative dental care a regular part of their lives, we face the prospect of having to provide much more expensive and much less effective remedies further down the track.

The fact is that poor childhood oral health is a strong predictor of poor adult oral health, so of course it makes sense for the government to invest in better dental care for our children from the age of two and through their teenage years. Regular visiting patterns and good dental care will mean that they have the best chance of going through their life with healthy teeth and without the terrible medical and social detriments of dental disease. It is the best result for those children and their families, and the best use of government money to realise our health goals.

As I said, this is part of a much larger package, a $4 billion package, of dental health measures, which itself comes on top of half a billion dollars in the budget going towards addressing public dental health waiting lists. So we are making big inroads into addressing those access and equity issues for people when they need dental health care.

Another important investment in oral health, in my electorate, was money that came from Health Workforce Australia for the Central Queensland University's new allied health clinic, which includes 12 dental chairs which will be available for members of the public to come in and receive treatment from new Bachelor of Oral Health students, who have commenced their studies at CQU this year. We have seen 30 students enrol in this first year. They will, in effect, be doing their clinical placements at this facility built on the grounds of the university. So we are training our future oral health workforce at the same time as greatly increasing the dental health care that is available to people in Rockhampton and in Central Queensland more broadly. That is just another example of the government looking for very practical and cost-effective ways to address the issue of access to dental care.

I fully support the dental for kids measure as an important step towards better access to dental services in this country.