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Thursday, 23 August 2012
Page: 6185


Senator BOYCE (Queensland) (09:31): I am delighted to have this chance to continue my remarks on the Health Insurance (Dental Services) Bill 2012 [No. 2], which has been brought to this chamber by Senator Bushby.

The issue that we are looking at here really is one of trying to maintain what has been a very good and privately based service in Australia. At a recent inquiry the Australian Dental Association was forced to make the point that they hope that private practice will continue to be a centrepiece of the dental offers made to Australians all over Australia, but particularly in rural areas. There have been a number of instances of this government trying to change the way that dental services are offered, along with others, and the Australian Dental Association has made the point that it believes that clinical independence is a very vital part of the way that dentistry is practised in this country.

The Australian Dental Association has also slammed the way the government has gone about establishing Medicare Locals. It is a bit startling to find that dentistry has generally been completely excluded from the Medicare Locals model. Eighty-five per cent of the dental services provided in Australia are provided by the private sector, and without those private sector dentists there would be virtually no dental services in rural and regional Australia in particular.

The practitioners of dentistry need to be fully consulted and to become part of any change in dental care delivery, otherwise there is a very real risk that rural and regional areas will lose the dental care that they already have. I think it is worth noting that a survey of members by the Australian Dental Association showed that dentists in rural and regional areas offer a higher mean number of services at a discounted rate compared to metropolitan-based services. In the country—rural and regional areas—39 per cent of services are discounted on average, compared to nine per cent in cities and urban areas.

Rural and regional dentists also offer a higher mean number of free consultations compared to their metropolitan counterparts. I must add that I have yet to come across a free dental consultation, but apparently they do exist. And rural and regional dental practitioners offer an average of 63 per cent free consultations compared to 50 per cent in urban areas. These results suggest that, in spite of the additional challenges that dentists face in rural and regional dental practice, dentist practitioners in these areas strive to provide a quality service at a reasonable rate, in the interests of their patients.

But, of course, there continues to be a problem with dental services in the country, and nothing that this government is doing is likely to improve that. There has been a large increase in the supply of dental professionals recently, with the opening of three new schools in 2007, and the number of new dentists entering the workforce, including new graduates and overseas trained dentists, will be double the number of new entrants that there were in 2006.

There was an Australian Institute of Health and Welfare report released recently on dentists, specialists and allied practitioners in Australia which, unfortunately, uses 2006 labour force data—simply because that is the most recent that we have. It indicates that there were 12,212 dentists registered in Australia in 2006. That was a 21 per cent increase on the number of registered dentists compared to 1996, and during the coming decade about 250 new dentists will enter the workforce each year.

Based on these figures, the Dental Board of Australia, in May 2011, estimates that there are now 13,750 dentists with just over 300 new dentists a year coming into our workforce since 2006. Along with the large number of new doctors that will come into the system over the next decade, there will also be a large number of new dentists and other dental professionals, I should point out, and the number of allied dental service practitioners will also increase at a substantial rate.

Despite this, the odds of the figures in rural and regional areas improving is not high given the government's current policies in this area. The number of practising dental practitioners per 100,000 of population ranges from 59.5 in major cities down to 17.9 in remote and very remote areas. How we go about improving those numbers is something that was the subject of an inquiry by the Community Affairs Committee, and it is also something this government needs to focus on. We do not need to be still saying in years to come that the supply of dentists has been found to decrease dramatically with remoteness, and that the allied health workforce is found to be largely based within the major cities, as the DOHA report titled Audit of the health workforce in rural and regional Australia found in 2008. We need to work on policies to improve this, and might I suggest to the government that a good place to start is the inclusion of dental services and dental practitioners in the people who are consulted about the structure of Medicare Locals. The idea of a needs-based locally-developed medical and health provision is an excellent start, if it works—and of course the 'if it works' is in very large letters when you look at the way this government has gone about it.

The issue that the Australian Dental Association raises is:

Medicare Locals in rural/regional Australia to date has been implemented hastily and has excluded dentistry which will affect dental care delivery for Australians in these areas.

It should go without saying that dentistry must be adequately included in the development of primary healthcare responses to ensure that activities such as dental health promotion and oral disease prevention are undertaken in what, in many cases, are more vulnerable communities. The Australian Dental Association makes the point that establishing a dental surgery is an expensive exercise, considering the equipment that is needed, so establishing it in a small town is a very problematic approach unless there are (a) incentives for people to do so and, (b) a sense that the care they are offering has been integrated into a well-structured health service provision for the local community. No dentist in private practice is going to set up in an area where they know they will not be fully occupied servicing customers.

I commend Senator Bushby for this bill. It seeks to correct some of the attempts of the government to undermine private practice for dentists in Australia and it seeks to ensure that the sorts of programs that have been so extraordinarily successful—for instance, the chronic disease prevention program involving dentistry that was established by the Howard-Costello government—will be maintained.

The Australian Dental Association points out that a number of factors limit the supply of dental practitioners in rural and regional areas. As I said, not only are there financial constraints such as the very high capital cost, but also the lack of resources and professional support coupled with the lack of social and local infrastructure in the community. Not only do we need to attract dental practitioners to rural and regional areas but we also need to find methods of ensuring that they stay in those rural and regional areas. This involves not just looking after the financial needs of practitioners, but also fostering and supporting their professional, social and community needs. Just as we have had concerns raised during the recent Community Affairs Committee inquiry in terms of the support needed for younger doctors and other health professionals moving into rural and regional areas, the same issue arises of course for dentists and allied dental professionals. It is not going to happen if we do not support it and foster it.

The Australian Dental Association did a survey of its members in September 2011 that found that 17 per cent of the metropolitan-based members would be willing to consider relocating to rural or regional areas to practise dentistry. If this were to occur, if that whole 17 per cent were to move, we would in fact end up with an oversupply of dental professionals in the rural and regional areas. But there are a number caveats on this. The ADA members survey said that there were things that would encourage dentists to move to rural practice. For example, 44 per cent of members said that the quiet rural lifestyle would encourage them to move to rural practice; 23 per cent said the demand for services, the need—thought to be unmet—for services; and 21 per cent believed there were greater employment opportunities for rural and regional dental practice.

But these members also identified what they needed to stay in the area. Some of the very large concerns expressed by the 17 per cent who would consider moving were that there would be social and community issues and professional issues.

The social and community issues that were identified by members of the Australian Dental Association were a lack of access to quality secondary schooling, spouse or partner's unhappiness in moving to a rural setting, the potential lack of employment opportunities for partners, the lack of community resources and what was perceived as a lack of 'cultural fit' with the local community. Professionally, these dentists' concerns were a lack of financial incentive to compensate for a more isolated lifestyle, heavy workload and high community expectations, professional isolation—a very, very important point—and inability to access continuing education. They referred also to the lack of access to general anaesthetic facilities in hospitals, a lack of mentoring for recent graduates and more inexperienced operators, a lack of access to specialist services and support, and—perhaps one of the most important issues for families of an overworked dentist in a rural area—a lack of leave cover for holidays. The lack of access to further education was one of the greatest areas of concern. There have been a number of suggestions made by the Australian Dental Association with regard to this. Certainly the government's view is not going to succeed. Senator Bushby's bill will assist.