Home - Claire Moore - Labor Senator for Queensland

Dental Services

It is quite distressing to hear the comments made by Senator Bushby this morning in speaking to his private member's bill, the Health Insurance (Dental Services) Bill 2012 [No. 2], and in beginning his whole statement by trying to make this into a political exercise. I was particularly interested in his use of the term 'machiavellian'. There was an open statement by our government from the very start that the scheme we are discussing today was one with which we disagreed. There was no lack of transparency. We argued from the start that this dental scheme would not meet the requirements of the Australian community. You can go back to Hansard and read that. To pretend in this place that the methodology that our government has used-both in opposition in 2007 and since that time-to raise our genuine concerns about the way this scheme operated has been to attack a profession which we hold in great regard is not only inappropriate; it is dangerous, because it means that there is no longer any attempt from either side of the chamber to acknowledge that we need to work effectively and with professional trust with a very strong group of professionals in our community, the dental profession. Senator Bushby's statements and private member's bill are trying to continue the politicisation of a clear disagreement about the way dental schemes should operate in the country.

When we look at the outpourings that we have had about the operation of the Medicare audit process, dentists have been treated in no different way to other professions who are using the Medicare system. There are clear requirements on people in any profession about what they need to do before they can access Medicare payments. That operates for professionals using the scheme and it operates for-a new term we use a lot in the Department of Human Services-citizens who are accessing the scheme. You need to know the process which you are entering and you need to know what your responsibilities are and then you need to work through it all. It is not onerous.

When this particular scheme was introduced very quickly to the Australian public in 2007, a process was put in place at that time to educate the people in this place-and I well remember the debate in this place when that particular piece of legislation came through. There was also a process used to educate the community in the beginning, in 2007, widely publicising this new program that was going to come in. I do accept Senator Bushby's statement that the Liberal and National parties claimed to be the only government to provide access to an effective Medicare system for dental services because they told us that in this place in 2007 and they also told the community that when they were promoting this scheme to everybody. They told everybody what you had to do to access the scheme, which was not income tested-a point that we raised at the time. They said anybody who wanted to access this scheme had to be aware of their chronic disease situation, they had to work with their GP and they had to work with their dentist. The process was that the person who wanted to access dental services would need to work with their doctor-clearly a GP in most cases-and their chronic disease situation would have to be clearly identified. Then, only after that step had been taken, would they move through to their dental practitioner, also under the specific requirement that they would understand the chronic disease aspects of the patient and work with that patient on what treatment would be undertaken and what would be the real cost of that treatment. I well remember that the process was clearly focused on understanding your rights in a chronic disease situation, which was identified in the legislation-and all this was sent out to people across the community-and then you would see what the cost was going to be and what changes would happen.

When we were debating this at that time there were many statements made about the fact that we thought that some people would benefit from the scheme. We did not say that no-one would benefit. I remember also that one of the things that I most celebrated was that there would be the requirement to have a written quote given to the patient before they undertook the treatment so that they would know how much it was going to cost-something that people on this side and, to be fair, people on the other side of the chamber, had argued over many years for: having informed consent before you undertake any form of medical or dental practice. So the requirements for everybody were set out. There were those for the patient, the citizen, who was going to undertake the treatment and the referring GP, because the government continued to be concerned about how we would actually ensure that the intent of the then scheme would actually be maintained so that it would be linked specifically to dental treatment that would be linked to chronic disease. How it would operate was quite narrowly defined. There were those for the dentist, who for the first time was going to access Medicare.

Dentists was told what their responsibilities were. As a very well-educated and strongly advocating profession-we all know that dentists have been advocating for many years that they should have access to Medicare services-there was no ignorance of the Medicare system. In fact, dentists clearly understood how it worked and they had come to many inquiries to talk about how they should be able to access Medicare. So they had their responsibilities set out and, as I repeat, these were not onerous. In fact, they were commonsense ones. They had to ensure that the patients and the doctors would know what work was being done. So if I were going to have work done I would know exactly what work was going to be done and why and, as a patient, I would have in writing a quote about how much it was going to cost. It does not seem to me to be too onerous a requirement that a professional working with a patient would understand that responsibility and, in particular, the core element of the program, as described to this chamber in 2007, which was about this special link between the referring doctor and the dentist so that everybody knew what work was being done and how it would operate. That is how the scheme started in 2007. The dental profession then had access to Medicare, the doctors continued with that access to Medicare and patients across our community were then having this service that was actually being promoted so strongly by the previous government as to what would be the benefits.

So once you have access to Medicare, no matter which part of the system you are in-the patient, the doctor or the dentist-there are responsibilities because this is a government taxpayer-funded scheme. As we know, consistently in this place, at a number of levels, we actually scrutinise the use of Commonwealth funds to see that they are used effectively and to ensure that people are working effectively and legally within the system. There is a general agreement that people should understand their rights, that they should practise within those rights and that they would understand where they operate.

Now what has happened over the period of time has been that people within the dental profession have been exposed as not effectively using their Medicare entitlements and not fulfilling the requirements of the scheme. That does not mean that everybody is undertaking criminal activity. That does not mean that they are labelled in any way and that certainly does not mean-as has been put forward by Senator Bushby and other members on the other side of the house in an attempt to politicise again what should be an open process, one which has operated since Medicare started-that people who are working in Medicare or members of the government or, in fact, the wider community, are labelling or condemning dentists in any particular or general or personal way as being criminal. Again, I think it is important to note that what we are talking about is the integrity and the trust that the community has in the Medicare system. No individual profession, individual practitioner or in fact individual patient should be treated differently. There should be a clear under­standing about how the system operates, how people should be assessed and communica­tion should operate on the basis that there are rules, that people need to have those rules understood, that those rules are actually scrutinised from time to time and everybody knows where they fit.

I think it is fair to say that in this program there have been some misunderstandings. No-one pretends that every person who has actually had an audit under the particular dental scheme should be presumed to have either acted in a criminal way or in any sense not understood their rights. Each individual case should be looked at in exactly that way, individually, which is in fact how the audit system operates. There is not a general assessment, there is not a general statement-individual patient files are taken by the Medicare inspectors and looked at and there is a discussion process between the Medicare officers and the practitioner. One point I do accept, and we have discussed this many times in this place, is that sometimes the process takes too long. I accept that from the time the original communication was made with the practitioner the audit process should operate in as quick a time as possible for everyone, so that the individual assessment is done and people understand the reasons on which a decision is made.

There has been quite a degree of effective lobbying. As I said before, the dental profession are extremely effective lobbyists and they have been for many years. On that basis they are well regarded and respected. There have also been some issues within this place at different times with the Senate estimates process and also through lobbying from across the chambers; no individual person has lobbied more strongly or more effectively. In fact, on 29 May in the Community Affairs Senate estimates process, and I am quite pleased to say that many of us were actually at that Community Affairs inquiry, Minister Carr announced that they were going to reconsider the process around the audits of this dental scheme. I think that is an entirely appropriate way to operate to respond to the concerns that have been raised-to look at some of the issues that were raised in the Senate Finance and Public Administration Committee, where there were genuine issues raised by people who claimed they did not understand what was going on. I think that is fair, and it does not matter whether you are a dentist or a medical practitioner or a nurse or from other areas that have recently received Medicare coverage, there is an important responsibility that people need to understand the system, they need to have their own responsibilities clarified, and that everyone in the process must have a genuine understanding of what is going on and their own responsibilities.

Minister Carr has announced that, as a result of the process that had gone on, the department is going to reconsider the area around the audits. They are going to go back and have a look at some of the decisions that had been made. Each individual case will be considered. We do not accept that there has been a general attack on the dental profession. We do not believe that we have stigmatised dentists in this process. There will be some practitioners who have misused the system and we do not pretend that this review that Senator Carr has put in place will automatically write off what has occurred. That does seem to me the intent of the Bushby bill: that there will be an automatic acceptance that any dentist who has had an audit that resulted in a negative response and has had a debt accrue will have their debt written off. I do not think that is fair and I do not think that is in the true sense of the Medicare process. In that case we reject the Bushby proposition in this bill.

We also think it is difficult to start changing the way regulations operate to have the Minister for Health and Ageing being able to write off payment, which is not under the current regulations and creates more confusion and-dare I say it, since we have these discussions every day in this place-could actually create more red tape, which would be an awful thing to happen in terms of more bureaucracy taking place. So for that recommendation in this particular bill, that is not the most effective way to operate.

I think it is important that when people have concerns about our system those concerns are able to be discussed openly. I also think that the dental profession should be able to have that open and professional discussion with the departments, with Medicare and also with the minister. I believe that is occurring. Over this whole process, Senator Bushby has accused the government of making it political. I think that certain elements-and I would hesitate to say it is the opposition-have made an attempt to politicise this process as well.

The system is not, we believe, the best way to operate dental services. The system has in fact benefited some Australians; no-one doubts that. We do not believe that dentists should have special treatment under the Medicare system. They are like any other professional that operates within the system. We also believe that people need to have confidence in the system and that if they truly believe that the audit has not worked effectively for them, or if there is some element in the education process that did not work for them, they should be able to work effectively with the government through the Medicare process to have that heard in an open way, but not necessarily agreeing that debts will be waived.

I am saddened that in this debate about various dental schemes we-and I say we on both sides of the chamber-have caused distress to some people in the community who are still crying out for improved dental schemes. The stories we have heard, that dentists have withdrawn their services because they have been so traumatised by the audit process, are very worrying because the role of a medical practitioner of any kind, including a dental practitioner, is to provide services to those patients who come to them seeking their services. So I am quite saddened that people claim that members of the community now are not going to be able to receive dental processes. I know that other people in this debate will talk about the significant investment that the Labor government has put into dental services in this community and I do not think there is anyone in this parliament who is unaware of the desperate need for effective dental services across the community. Our government has a number of proposals to respond to that. Also, we have been pushing to have alternative dental processes put through the parliament.

But on the particular Bushby bill-we should be discussing the bill before us-we do not think it responds effectively to the issues that have been raised. The Senate Finance and Public Administration Committee heard from dentists who felt they had been poorly treated, as well as from their families and from their staff members-again, an extraordinarily effective form of advocacy. The response from the government is that we have listened and there will be consideration again of the audit process in that area. However, from this point forward, should this particular scheme continue to be in place and, again to be completely transparent, the government wishes to end the scheme and put in place another scheme.

No-one can claim ignorance of the process. The quite standard expectations of medical practitioners, including dentists, are to be up-front with their clients, to talk about the actual processes and treatments and to be clear about how much it is going to cost. No-one can claim ignorance from this point forward about the responsibilities of the profession working within this scheme. In fact, for several years no-one could claim ignorance of the process. If there is a claim around ignorance of the responsibilities, it must be for a very short period of time, because in terms of when people started this process and continued to operate within this scheme, surely there was a time when the clear understanding cut through. We are looking at the claims of particular people in the profession. They must have faith that they will be listened to.

As for the argument in the Bushby bill that there was complete ignorance in the dental profession of their responsibilities, I reject that. I reject also the premise that we have demonised the dental profession or treated individual dentists without respect. I reject that. I also reject the proposals in the Bushby bill around the methodology of wiping out the debt. I do not think it is an effective way of doing it. I also disagree with the way the bill treats the issue of the act of grace payment; it is not an accurate representation of how such a payment should operate within the financial system. The current situation is this: the minister has announced a process for dealing with the concerns and the Medicare audit process will continue for dental and any other medical practitioners in the system. We as a government continue to be completely committed to the need to respond effectively to the community with better, more targeted and effective dental assistance.