Last week Greens Senator Richard Di Natale and Labor Health Minister Tanya Plibersek announced a $4.1 billion dental package for children – set to begin in January 2014 – and low income Australians, raising a great deal of optimism that dental care might come within the reach of the 30 percent of Australians who presently cannot afford it. The package is a result of the agreement reached with the Greens following the 2007 elections to gain their support for Labor to govern. “It’s one of the most significant reforms to the health sector since the introduction of Medicare. It’s a huge reform and such an important reform because for a very, very wealthy country we have very poor oral health,” Di Natale said. A former GP, the Greens Senator gave a firsthand account of the impact poor dental health can have on people’s general heath and wellbeing, and on the health system itself.
The package allocates $1.3 billion to be paid to states and territories over four years from July 2014 to expand public dental services for an estimated five million low income adults who are eligible for treatment in the public system. This is in addition to $345 million in the last budget to reduce public waiting lists. Plibersek said it is contingent on the state governments “continuing to invest as they have been, at least to the level that they have been, in public dental” services. This is by no means guaranteed, especially by budget-slashing Coalition governments who are not wedded to public dental services. Whether it is enough to clear the 400,000 plus on waiting lists and enable people to access timely treatment or prevention before complications develop is questionable.
The package replaces the existing Medicare Teen Dental Scheme for check-ups with a $2.7 billion (over four years) program for children whose parents are eligible for the means tested Family Tax Benefit Part A. An estimated 3.4 million children will be entitled to dental services (not just check-ups) of up to $1,000 over two years under Medicare. “So kids will be able to get the check ups they need, they’ll be able to get fillings and sealing of fissures, fluoride treatment – all of the basics. … it can be used in the public or the private system.” Details such as scheduled fees and level of rebates, extent of copayments where dentists do not bulk bill, have still to be revealed. Answers to these questions will determine the success of the program.
The package also includes a welcome $225 million for regional and rural staffing and infrastructure. Including the allocation in the 2012-13 budget, it comes to $4.6 billion over six years. A government inquiry last year found that $10 billion was needed over the next four years. It is a start as the Greens point out. They hope we will see Medicare coverage extended to other age groups over time. The government see it politically, along with the National Disability Insurance Scheme and the Gonski reforms, as a key policy for electioneering purposes.
Apart from the shortfall in required funding, the package creates dangerous precedents. It introduces the concept of means testing (the children’s scheme) for eligibility to Medicare rebates and bulkbilling which is in breach of one of Medicare’s most important principles – universal access. Likewise, it limits Medicare dental coverage to “basics”; it does not provide comprehensive coverage for more expensive services. The idea of restricting access to Medicare and limiting the range of services has previously been raised in both Liberal and Labor circles. It could well appear on the agenda following the 2013 elections in the name of “fairness” and achieving a budget surplus. It still leaves pensioners, the unemployed and other low income adults without any guarantee of affordable treatment, in particular during the period up to July 2014.
The Greens remain fully committed to universal access to dental care under Medicare and have extracted what they can at this stage from the government. Despite its dangers and shortcomings, the package announced last week is a modest step in that direction but pressure will have to be maintained if it is to be delivered, let alone extended and improved. Most importantly, it is a step towards the acceptance of the mouth as part of the body and requiring Medicare coverage.
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