4 October 2011 an opinion piece as appeared on The Punch from the Shadow Minister for Health and Ageing, the Hon Peter Dutton MP, regarding the Gillard Government’s intended closure of the Medicare Chronic Disease Dental Scheme and the targeting of dentists for administrative errors through Medicare audits
Excruciating pain requiring urgent dental work can be debilitating and when treatment is withdrawn we condemn people to a period of absolute misery.
Therefore, it is difficult to understand why any government would seek to disadvantage those in need and jeopardise the health of its people.
Yet that is precisely what the Gillard Government intends to do from next January when it proposes to close the Medicare Chronic Disease Dental Scheme (MCDDS). The MCDDS provides $4,250 in Medicare benefits for dental treatment over a two year period for those with chronic disease referred to a dentist by a GP.
The only reason apparent at the moment for government’s intended action is sheer ideology. The Gillard Labor Government wants to close the Howard Government’s MCDDS which provides for dental treatment with private practitioners and instead direct funding to the states’ public dental services under its Commonwealth Dental Health Program (CDHP).
The impacts and outcomes of such a move should be examined thoroughly because there are strong indications that it will be detrimental, delivering fewer dental services and worse health outcomes.
It is clear Labor’s CDHP is inferior to the existing chronic disease dental scheme.
Figures revealed during the last Senate Estimates hearings showed that around 700,000 Australians (experts now estimate more than one million) have been treated under the MCDDS since its rollout in 2007 and they’ve received more than 11 million dental services.
By comparison Labor’s program is promised to deliver just one million dental services over a four-year period.
It will be flawed reform. Health Department officials admitted during the hearings that the Labor plan was unlikely to meet its target.
Even more concerning, they revealed that the Gillard Government had not bothered to check whether the workforce in the public dental sector was sufficient to provide that amount of additional services.
Actual delivery of policies and programs has been both Rudd and Gillard’s big downfall and here is yet another example where the most basic question had not been asked – can we deliver?
The chronic disease dental scheme is not perfect. All new programs need to be monitored, tweaked or adjusted as they develop in practice.
As government changed hands in 2007, it became Labor’s responsibility to do exactly that, particularly when all non-government Senators – Coalition, Independents and Greens – combined twice to reject the Rudd Government attempts to close the MCDDS.
Instead Health Minister Nicola Roxon’s response was to do nothing, to criticise and denigrate the scheme portraying it as ‘scandal-plagued’ and full of ‘rorts’.
It is clear the government’s strategy was to stand back and build its case for closure, instead of adopting sensible changes to further strengthen the scheme.
The latest element of this attack was to unleash a Medicare Australia taskforce to audit dental practices across the country for ‘rorting’ Medicare. The dentists were going to be the government’s scapegoats for its failure to monitor and manage the scheme.
The Coalition would rightly condemn anyone who has done the wrong thing.
But the anecdotal evidence now emerging is that in many cases, well intentioned, honest dentists are being pursued for political purposes and are being called to account for, in many cases, minor administrative errors.
Repayments of Medicare benefits are being demanded despite firm evidence being available that full treatment has been provided to patients.
There are shortages in the dental workforce and these heavy handed tactics are alienating dentists who are providing treatment under the chronic disease scheme to those in most need. The experience may mean they may not continue to provide their services in the future.
Already one small Tasmanian community has lost the services of a dentist who is no longer prepared to treat patients under the Medicare arrangements; of course those who lose out are the patients.
If the Minister expects them to receive treatment in the public sector, she knows there are already lengthy waiting lists and a workforce that is struggling to meet existing demand as it is.
Little official information has emerged on the results of the audit process across the country since it began.
However the government will have to reveal the results in the coming month to comply with a Senate motion requiring it to detail the findings of the audits undertaken until October 31.
It is unfortunate it has come to this.
Sensible changes to the MCDDS have been suggested to the Minister, but unfortunately they were rejected out of hand.
Adoption of procedures long implemented by the Department of Veterans Affairs in relation to veterans’ dental care, whereby high cost treatments such as crowns and bridges have to be submitted for approval and checked for clinical appropriateness before they can be carried out, would go a long way to improving the chronic disease scheme.
For a Government that should have learned lessons from its other multiple policy failures through the intervening timeframe, the way remains open to such necessary adjustments to the existing scheme.
To do otherwise courts another policy disaster.
The NSW Branch of the Australian Dental Association summed it up in the most recent edition of its journal, the NSW Dentist:
“ADA NSW anticipates that should the CDDS cease on 31 December, there will be flow-on effects for public dental services in NSW. Increased demand for services (beyond the additional funding and capacity made available under the proposed CDHP) will increase both the number of people on public dental waiting lists and the length of time they wait for treatment.”
There is no reason to believe the situation would be any different in other states.