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Wednesday, 12 September 2012
Page: 10301

Ms PLIBERSEK (SydneyMinister for Health) (09:10): I move:

That this bill be now read a second time.

Since I came into this parliament I have been talking about the importance of better dental health for all Australians. Over the course of my work as a member of parliament and as a local member, and certainly in my time as Minister for Health, I have seen so many examples of the importance of better teeth for Australians. One of the very early constituent issues I had that has stayed with me throughout my career involved a woman who had had a very difficult life. She had been a victim of domestic violence and was now a single mum with two kids. They were living in public housing in my electorate. Her son, against many hurdles, had won a scholarship to a very prestigious school in Sydney.

In fact, she did not contact me herself; her neighbour contacted me and said that she could not go with her son on his first day because she did not have any teeth and she was too embarrassed and did not want to humiliate her son by turning up with her teeth having been extracted. She had been waiting months and months for new dentures, because she was relying on the public dental system. That story has always stayed with me because it was such a strong message to me about the way that bad teeth can exclude you not just from getting a job and not just from economic participation but also from social participation, the normal social interactions that people should be able to take for granted. We have heard so many stories about older people not wanting to go out for afternoon tea with their friends because they are worried about not being able to chew the food on the table. I have seen so many children, including in my own electorate, with little brown stumps instead of teeth, because their baby teeth had not been taken care of. Some people think that baby teeth do not matter. In fact, Senator Lin Thorp told me that in her early days she told a young girl she had met, 'You know you have to start looking after your teeth.' This girl alternated between having a pack of hot chips for lunch one day and a tub of ice-cream for lunch the next day. Senator Thorp told her that she could not allow her teeth to fall out to which the girl said, 'Well, I lost one lot and they grew back.' She thought that she would just keep getting new teeth as the old ones rotted away.

We have a huge challenge in Australia to ensure that our oral health opportunities are as strong as the opportunities we have to look after the rest of our bodies. For many decades the dental health of children has been improving, but in fact since the 1990s we have started to see a reversal of that trend.

Since the late 1990s, the prevalence of child caries and the mean number of teeth affected by dental disease in children has increased. A recent Australian Institute of Health and Welfare report showed that 45 per cent of 12-year-olds had decay in their permanent teeth and almost 25 per cent of 12-year-olds had untreated decay. If a decline in oral health of children becomes established, we are going to see a need for increased services in the future.

Investment in our children’s teeth is an investment in the future. We know that poor childhood oral health leads to poor adult oral health. You are not going to have bad teeth as a kid and have good teeth as an adult. This has wide-ranging impacts not just on dental health but of course on general health and wellbeing, including, in the worst cases, increasing the demand on our health and hospital system.

So today, I am very proud to be introducing the first step in the legislative process that will make almost 3½ million children eligible for taxpayer supported dental care. The Child Dental Benefits Schedule is one part of the Dental Health Reform package: an unprecedented package of initiatives to address increasingly poor oral health among Australians including our children, low-income adults and those living in outer metropolitan, rural and remote areas.

The six-year package I announced on 29 August includes:

$2.7 billion for around 3.4 million Australian children who will be eligible for subsidised dental care;

$1.3 billion for around 1.4 million additional services for adults low-income earners who will have better access to dental care in the public system; and

$225 million for dental capital and workforce measures, aimed to provide expanded services for people living in outer metropolitan, regional, rural and remote areas.

While Medicare and free hospital treatment been a basic right for Australians for decades, millions of people in this country still go without adequate dental care.

I believe we have a responsibility to ensure that Australians who are least able to afford to go to the dentist, particularly children, should be given access to taxpayer supported oral health care.

As I have travelled around Australia to discuss the Dental Health Reform package with parents, with young people and with dental professionals, I have listened to so many stories of children in need of dental care, and the great work that dentists, public and private, are doing to repair young mouths, prevent further harm, and keep them healthy. This bill will see the Commonwealth government taking its share of this important work.

This bill will establish a Child Dental Benefits Schedule for children from the age of two until they turn 18. Access to the schedule will commence on 1 January 2014 and will effectively see the Commonwealth assume primary responsibility of funding basic dental services for children in families receiving Family Tax Benefit Part A. Funding will be targeted in line with current Medicare Teen Dental Plan eligibility. This will target expenditure to children in low- and middle-income families.

This means that benefits will be available for children who receive (or in households that receive) payments under:

Family Tax Benefit Part A;


Carer Payment;

Disability Support Pension;

Parenting Payment;

Special Benefit;

Youth Allowance;

Double Orphan Pension;

the Veterans’ Children Education Scheme; or

the Military Rehabilitation and Compensation Act Education and Training Scheme.

Currently, a family of two parents and two kids can be earning as much as $112,000 and be eligible for Family Tax Benefit Part A, but of course eligibility will vary depending on indexation at the time and on the number of children in the family.

The Child Dental Benefits Schedule will provide a benefit for basic dental services including prevention and treatment. Subsidised services will include, for example, check-ups, fillings and extractions. However, items such as orthodontics will not be included.

This proposal will provide a Commonwealth funded capped benefit entitlement of $1,000 over two years for basic dental services for children that could be used for services in the private sector, where most dentists practice. The states and territories would also be able to provide services as they currently do under the Medicare Teen Dental Plan, as long as they bulk-bill those services.

This means that parents and independent teens will be able to continue to visit their usual dentist, provided that dentist participates in the scheme. Including the public system will leverage existing state resources, provide a guaranteed no-cost pathway for those who really need it, and allow states to continue to provide services to children if they choose to do so.

Benefits would be available for services provided by dentists and para-dental professionals such as oral health therapists and dental hygienists, as currently provided for by the Medicare Teen Dental Plan. The level of this $1,000 cap is designed to allow coverage for higher-needs children, but the average amount spent per child is expected to be lower.

This bill is a first step in implementing this government’s dental reforms. Further detail on the scheme, including the schedule of services and fees, will be contained in subordinate legislation.

In designing the fee schedule under the Child Dental Benefits Schedule, I will consult with oral health professionals to ensure that it contains an appropriate mix of basic dental services. I will also seek to ensure that the access to the schedule by professionals and the fee structure will encourage appropriate levels of servicing and the matching of workforce capability with oral health need.

Although states and territories currently provide services to children through the public sector, eligibility and service availability is not consistent across all states and territories. The introduction of a Commonwealth funded Child Dental Benefits Schedule would build a unified national system for patient eligibility and service delivery, replacing disparate state and territory public dental schemes for children.

Focusing Commonwealth funding on children through the Child Dental Benefits Schedule will address declining child oral health and will be a cost-effective longer-term strategy to deliver improved population-wide oral health into the future.

As part of the Dental Reform Package, the Gillard government is providing $1.3 billion to states and territories under a National Partnership Agreement to expand public dental services for low-income adults, including pensioners and concession card holders, and those with special needs. This funding will depend on the states and territories at least maintaining their current level of dental care services.

In addition, $225 million in funding for dental infrastructure in outer metropolitan, rural and regional areas will assist more Australians, regardless of their location, to gain access to high quality dental care.

As part of implementing the Dental Health Reform package, the Howard government’s Chronic Disease Dental Scheme will be closed. Unlike the initiatives in the Dental Reform Package, the Chronic Disease Dental Scheme is poorly targeted and fails to address the problems in the existing dental system.

This dental reform package is in addition to the $515 million announced in the 2012-13 budget, which includes a blitz on public dental waiting lists and additional dental training and support for people in rural and remote areas. Together with these measures, the dental reform package will deliver a better and fairer system of dental health care for Australians that is accessible and affordable and focuses on prevention to deliver future improvements in Australia’s oral health.

And if I may I will take one final minute to say that the introduction of this children's dental scheme really represents the life work of many people in the dental health profession—the members of the Dental Advisory Council that advised me on how we might improve Australia's dental health system; many public and private dentists across the country who have campaigned for this; other oral health professionals and academics; the staff of the Department of Health and Ageing; and, in my own office, Kate Lee. So many people have put so many years of thought, effort and fight into providing a system that will mean that the children of Australia will be able to get dental care that meets their needs for both prevention and treatment.

Debate adjourned.