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Wednesday, 18 June 2008
Page: 2669

Senator ALLISON (Leader of the Australian Democrats) (12:10 PM) —The Democrats also support the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. The legislation provides the framework to allow for the payment of dental benefits in accordance with the Labor Party’s promise during the last election campaign for a preventive dental plan for teens. The legislation also provides for the provision of other dental benefits through the establishment of a dental benefits schedule. Unfortunately it does this at the expense of the program that was established by the previous government for dental services for people with chronic illness. I do not think we have had a reasonable explanation from the government so far as to why that program is to be cut and why this should take its place. However, the teen dental program was widely promoted by the Labor Party during the election campaign as part of the solution to Australia’s dental problems, along with the reinstatement of a Commonwealth dental scheme similar to the one that the Howard government was very quick to get rid of back in 1997.

While we welcome the federal government’s increased role in the provision of dental care, it is difficult to see how these measures will deal with the most serious problems that exist when it comes to oral health. That is because a scheme that offers parents $150 in a rebate on a dental check-up for their teenage children will only cover half the cost of the average check-up, according to the government’s own estimates. Without funding for further appointments to treat established disease, oral examinations, a scale and clean and X-rays are going to do very little. A scale and clean contributes very little to disease prevention and X-rays can identify signs of decay and treatment needs but of course neither of those procedures will stop problems from occurring or fix any existing problems that are identified.

It is encouraging that the minister’s second reading speech included fluoride application, oral hygiene instruction, provision of dietary advice and fissure sealing as part of the check-up. But, at the end of the day, what is the point of X-rays identifying early decay if you cannot afford the fillings and follow-up sessions. There is good value in targeting teenagers because it is, after all, at the beginning of the teenage years that the last baby teeth are lost and young people get their new permanent teeth. These teeth are particularly vulnerable to decay due to the immature tooth enamel and so it is timely that teenagers are able to access dental care. But the Australian Dental Association has pointed out that teens already have relatively good dental care available to them through state and territory school programs, while Australians in their early twenties have shown a significant susceptibility to dental decay. Many young Australians in their early twenties are not privately insured, no longer have parental support and have incomes that are not high so they struggle to access the extent of care that they require.

The Democrats have on a number of occasions called for targeted assistance to provide basic dental care to young people at risk of oral disease. High levels of youth unemployment and youth poverty mean that many people go without dental treatment and experience unnecessary dental decay and long-term dental problems. The Australian Dental Association wants to see the government expand the group of people who are eligible for these vouchers to include people up to the age of 25. Of course, under the current arrangements, that would mean more people facing out-of-pocket costs for check-ups, with no follow-up or treatment.

Under the proposed Teen Dental Plan, eligible teenagers will be issued with a voucher, which will then entitle them to receive a preventive check from a private or public sector dentist. The dentist will then have similar billing options to those that are available to GPs: they will be able to bulk-bill, and the teenager and their family will have no out-of-pocket costs; or, the dentist will be able to bill the teenager and then the teenager will be able to ask Medicare to issue a cheque in the name of the dentist. The teenager will then have to get the cheque to the dentist and pay any outstanding amounts over and above the $150, which is the maximum the cheque can be made for; or, the teenager will have to pay the dental bill and get their rebate back from Medicare.

Putting aside the reality that many dentists will be put off by the administrative red tape, this approach ignores the reality that over the last decade we have seen an ever-increasing shortage of dentists. Not only is it difficult to attract dentists to work in the overstretched public dental health services, but many people struggle to find a private dentist to see them without having to wait several months for an appointment. Experts looking at the growing gap between demand and capacity to provide dental services estimate that we need 1,500 more oral health professionals just to maintain current levels of access.

The distribution of dentists in regional and remote areas remains significantly less than in metropolitan areas. Major cities have 57.6 dentists per 100,000 of population, inner regional areas have 34.5 dentists, outer regional areas have 27.7, and in remote areas it is just 18.1 dentists per 100,000 people. It is encouraging that the dental plan proposes to allow funding for dental services to be delivered by oral health professionals such as dental therapists and dental hygienists. Increasing the number and the range of clinical services that can be undertaken by oral health professionals—instead of just dentists—should be expanded, but this, too, will not solve all of the workforce issues. We need a comprehensive dental workforce review and more Commonwealth supported places in dental schools.

The Democrats would also like to see the government introduce a dental intern program. Unlike other health professions, dental graduates are able to practise without supervision as soon as they graduate, and we argue that dental graduates should undertake a period of supervised practice before obtaining registration. These training places would be primarily in public dental programs and private practices in rural and remote areas. Such a scheme could provide dental graduates with valuable practical experience and would address some of the gaps in public dental service provision. We think that implementing a clinical placement year for overseas-trained dentists is also worthy of consideration.

The major shortage of dental specialists also needs to be addressed. Unlike medicine, there are few salaried specialty training positions. For the poor, the socially disadvantaged, the critically ill, or geographically distant there are very few—and in some cases, no—specialist services such as those provided by paediatric dentists, orthodontists, periodontists and oral surgeons. Salaried, specialty trained positions, with a requirement of two years of return-of-service in the public sector, is an idea that would ensure access for the truly needy. I think we also need to improve the salaries and conditions of dentists working in the public sector. While dentists are in short supply and are free to set their own fees, it is very hard to see why private dentists with full lists will take on new patients and bulk-bill them under this Teen Dental Plan.

That means that families will face high out-of-pocket costs, costs that will not be reimbursable by private health insurance and which will not count towards the Medicare safety net. If any of the families of teenagers who do make use of the $150 voucher can afford the extra $150 they will probably face for a dental check-up are then told that the young person needs treatment, they can always go onto the waiting list for the public dental services if they cannot afford private dental care. But given that there are half a million Australians already on those lists, waiting an average of 27 months, they will probably have to wait for quite a while for that treatment.

It is true that the Rudd government has provided $290 million over three years to the states and territories to clear public dental waiting list backlogs, but with 650,000 estimated to be on those lists this money will not go very far, particularly as the government wants the states and territories to specifically target those with chronic disease, Indigenous people and preschool children—all groups worthy of additional resources. Given that the Rudd government has funded its dental proposals by scrapping the previous government’s scheme that provided subsidised dentistry to those with chronic illness, it is likely that public dental services will continue to be stretched by those with chronic illness who cannot afford private dental care.

Aboriginal and Torres Strait Islander people have more decay and gum disease than non-Indigenous Australians, and this starts at a very young age. There are many reasons for this poor dental health, such as poor dental care, lack of access to fluoride, greater exposure to risk factors such as smoking and poor diet, as well as higher rates of other health problems such as heart disease, diabetes, stroke et cetera, and changing lifestyle patterns. This is not to mention poor living conditions, social exclusion, poverty and unemployment, which contribute to poor health and poor oral health. Significant and sustained efforts are required to reduce these factors. We need to train Aboriginal health workers in oral health, focusing on oral health promotion. We need additional vocational and higher education places set aside for Indigenous and Torres Strait Islander people to study oral health, and we need more outreach services for remote Indigenous communities.

The dental health of preschoolers and toddlers also needs attention. There are reports that the average child starts school with three to four teeth decayed, missing or needing fillings. Some children have extensive decay, which requires hospital treatment under general anaesthetic. Access to education and information about nutrition and caring for the teeth of babies and small children can prevent much of this decay occurring. Integrating information about the importance of preventing dental disease into the care provided by maternal and child health nurses and training them in identifying the early signs of dental disease would go some way to improving the oral health of very young children.

Dealing with the oral health needs of the chronically ill, Indigenous Australians and preschoolers requires substantial investment, and unfortunately the additional funding the Labor government is handing over to the state and territory governments to prop up already floundering systems is barely more than was provided back in 1996—without any greater accountability than we have seen previously, I must say. So we may end up seeing the states and territories simply using the additional funding from the Commonwealth as a way to reduce their own funding contributions to dental health. It will be essential that the federal government holds the states and territories to their obligations when it comes to dental health. We need more investment.

Dental health should not be seen as separate from someone’s overall health—the concept that your mouth is different from the rest of your body is pretty ludicrous. There is a complex interplay between dental disease and general health, and each impacts on the other, so we need a comprehensive response to addressing oral health needs. The legislation we will deal with today addresses some coverage for teenagers and there is also some money to support the states in dental care, but it is by no means a comprehensive or long-term strategy.