Chapter 8 - Health
Health is an essential component of active citizenship as
without health a person cannot access other rights and cannot enjoy quality of
life. Equitable access to health prevention services and care is therefore
Affordable and timely access to healthcare services is vital for all
Australians, including the poor and the disadvantaged. It was emphasised during
the inquiry that the provision of healthcare should be on the basis of need and
not the capacity to pay; and that Australia needs to avoid the development of a
two-tiered healthcare system where an inferior and underfunded health system
would be reserved for the poor and disadvantaged.
Poverty and health
The link between health and socioeconomic status has been clearly shown
in studies both in Australia and overseas, with lower socioeconomic status
generally being associated with poorer overall health. For example, people from
lower socioeconomic status are more likely to have serious chronic illnesses
than people from higher socioeconomic backgrounds. Australian Institute of
Health and Welfare (AIHW) data show that the proportion of people who report
their health as only 'fair' or 'poor' shows a marked trend across socioeconomic
groups. People who are less well educated, unemployed or living in households
with low income report poorer health.
Poor health can in turn lead to a compounding of poverty, because
illness reduces an individual's capacity to take up opportunities such as
employment or training. The ill-health of children within families may also
result in a cycle of poverty that is difficult to overcome. The extent to which
illness may be said to cause poverty depends largely on the type of illness and
the preparedness of the community to support the economic participation of
people who are ill and the living costs of people who are unable to work. The
onset of illness can, however, profoundly affect individuals and families and
place them at high risk of poverty.
A range of health and related social problems, including suicide, are
also linked to poverty. One witness noted that a number of clients, who are
experiencing financial difficulties, actually present to the local council with
issues relating to suicide, depression, family breakdown and domestic violence
– 'so they may not come in and say, "Look, we can't afford to eat" –
they are presenting with other issues – but when you get to the underlying
cause, it is financial'.
The importance to people's lives of ensuring access to healthcare
services was emphasised in evidence, with advocacy groups indicting that many
people are missing out on a range of health services. SACOSS told the Committee
...the issues of health for a growing number of [poor] people are
evident, particularly in the homelessness sector, where we are constantly
paying for people to have prescriptions filled and constantly calling doctors
into our services because people do not have money to visit doctors.
Another witness noted that:
We had two women who were sharing a pair of glasses. It was not
quite down to the dentures. It is not just for prescriptions.
Even for those people in employment, affordable healthcare is often
problematic. One witness in a low paid job stated that:
I have got no health care for my children. I dread every sniffle
and cough because I cannot afford to go to the doctor and, if I do go to the
doctor, I cannot afford to pay for the prescriptions that they are going to
need when I am finished. We may be at the top end of the poverty scale but we
are on a downward slide and, if something is not fixed, then that is where we
will end up.
A number of issues were raised in relation to ensuring equitable and
accessible health care to people in poverty, including:
- access to Medicare;
access to public hospitals;
- access to ancillary and specialist health services;
access to preventive health and related services;
- access to maternal and child health services; and
- access to dental care.
Access to Medicare
It was emphasised during the inquiry that the role of Medicare in
providing free or reduced-cost hospital and medical services is of great value
to all Australians but particularly important for people on low incomes.
Medicare provides people with access to free treatment as public (Medicare)
patients in hospitals, and free or subsidised treatment by medical practitioners
and participating optometrists. People on low incomes often cannot afford
private health insurance and even relatively small medical costs can be a
serious obstacle in accessing health services.
Concerns were expressed that that the Commonwealth Government is increasingly
moving towards a 'two-tier' health system in which Medicare will become a 'second-class'
system reserved for the disadvantaged.
8.10 Despite the many
positive features of Medicare, a number of submissions and other evidence
identified gaps in relation to Medicare coverage and services. Firstly,
Medicare does not cover a number of important heath care services such as
dental care, counselling, physiotherapy and podiatry. Access to these services
is severely limited in the public system but widely available to people who can
afford to pay privately, either out of their own pocket or through private
health insurance. Secondly, Medicare permits the unregulated levying of patient
co-payments for medical services, including specialist, diagnostic and GP
services. Thirdly, Medicare has not delivered equitable access to health
services for certain sections of the community, especially ATSI people and
people living in certain areas of the country, such as rural and remote areas
and outer urban areas.
Decline in bulk-billing
8.11 Another key
concern identified during the inquiry impacting on the lives of all Australians
but particularly many poorer Australians is the decline in the numbers of GPs
who provide bulk billing.
Bulk billing is vital to the health of people experiencing poverty and
disadvantage – it enables people to seek medical checks and assistance as the
need arises and allows continuity of care, which improves the success of any
intervention. Welfare agencies noted that their work with people on low incomes
shows that people in these circumstances rely on bulk billing by GPs for access
to affordable medical services.
8.12 Since the
introduction of Medicare, bulk billing had grown to cover 80 per cent of GP
services by 1996. In recent years bulk billing rates have declined – by the
September quarter 2003, only 66.7 per cent of GP services were bulk-billed, a
decline of 3.7 per cent compared with the September quarter 2002. The rate had
declined further to 65.7 per cent by the December quarter 2003.
8.13 In addition to
the decline in the proportion of bulk-billed out-of-hospital services, there is
a marked geographic disparity in access to bulk-billed services, with
bulk-billing rates varying widely between regions (see Table 8.1). As a general
rule, people in capital cities are much more likely to be bulk-billed than
those outside cities, that is, those in rural centres and remote areas.
8.1: Proportion of non-referred attendances to GPs bulk-billed, by region
Other metro centre
Large rural centre
Small rural centre
Other rural area
Other remote area
Source: Productivity Commission, Report on Government
Services 2003, January 2003, Table 10A.36 available at
noted that this decline in bulk-billing results in uneven access to health
services for people on low-incomes, especially in country areas where there is
little choice of GP. The decline in bulk billing also impacts on older people,
families with children, and people with a chronic illness and/or disability.
COTA National Seniors stated that 'for an individual on a full age pension
needing to see a doctor once or twice a week, his or her income can be reduced
by amounts in the order of $6-$12 per week or more. This is yet another factor
contributing to the financial hardship reported by many older people'.
8.15 VCOSS cited
anecdotal evidence of people delaying visiting a GP to seek diagnosis and
treatment. This means that people are not able to access preventive health care
measures or receive early intervention treatment or support, raising the
likelihood of longer-term health costs due to reliance on treatment at later
stages of an illness.
Statistics show that the total number of GP visits declined by 1.3 per cent in
the December 2003 quarter compared with the December quarter 2002 which may indicate
that many people are avoiding visiting the doctor because of the cost.
8.16 Patients are
facing increasing out-of-pocket costs for GP visits. The out-of-pocket
contribution made by patients for GP services increased from an average of
$5.61 in 1984-85 to $12.46 in 2002-03 and to $13.57 by the December quarter
8.17 The decline in
bulk billing is also resulting in people turning to already over-stretched
community health centres and the emergency units of public hospitals. The
Queensland Government stated the emergency departments in that State are
currently being 'inundated' with people who should be treated by GPs – 'these
people are reporting that they can not get access to, or can not afford a
general practitioner'. The Government stated that over the past three years
there has been a 10.3 per cent increase in the number of patients treated by
emergency departments, and a 14 per cent increase in the number of
non-urgent or semi-urgent cases presenting to the emergency departments.
8.18 The Victorian
Government expressed similar concerns. The Government stated that there was an
11.5 per cent growth in emergency department presentations between June 2001
and June 2002 in Victoria and it is estimated that around 30 per cent of
emergency department presentations could be better serviced by a GP – 'this
suggests that significant numbers of people are not receiving the accessible
and responsive primary care they require in a setting most appropriate to their
argued that it is vital that bulk billing is maintained and expanded to ensure
access to health services for all Australians.
The Brotherhood of St Laurence (BSL), while suggesting that bulk billing be
maintained, also argued that it should be extended to a wider group of
practitioners, particularly specialists, and be available to people on low
incomes in all geographical areas.
Addressing the decline in
8.20 Measures to
amend Medicare and address declining bulk-billing have been the subject of
considerable debate between the major political parties since the Government
released its A Fairer Medicare package as part of the May 2003-04 Budget.
The package aimed to reduce the costs of accessing health care, particularly
for concession card holders. The key element of the Government's proposals was
a system of incentive payments for practices that agree to bulk-bill all
concession card holding patients and the capacity for participating practices
to receive rebates for all their patients directly from the HIC.
8.21 The ALP
announced a policy in May 2003 in response to the Government's package that
proposes to immediately lift patient rebates to 95 per cent of the schedule
fee, with a subsequent increase to 100 per cent for every bulk-billed GP
service by 2006-07. In addition, GPs who meet bulk-billing targets would
receive additional incentive payments. The ALP initiatives are designed to
reach a national target level of bulk-billing of 80 per cent. Overall, the ALP
policy represents a rejection of all elements of the A Fairer Medicare
package except for the workforce initiatives aimed at alleviating doctor
shortages, and measures to increase the GP rebate for veterans and war widows.
8.22 The Senate
established a Select Committee on Medicare to review the Government's package
of reforms. At a practical level, the Select Committee found that the
Government's policy 'is focused on 'guaranteeing' bulk-billing of concessional
patients in a way that is quite simply unnecessary, since the majority of these
people are in all likelihood already bulk-billed'. The Committee concluded that
the scheme as proposed would trigger a fall in bulk-billing for all those who
are not concession cardholders – 'many Australians in genuine need of
bulk-billing will fall just outside the threshold of concessional status –
including many working families and those with chronic illnesses. These people
will face both more gap payments, and overall, a rise in the level of such
8.23 In response to
criticisms of its original proposal, the Government announced changes to its
reform package. Under the new MedicarePlus arrangements, announced on 18 November 2003, the Government will pay GPs an additional $5 for every bulk-billed
medical service provided to concession card holders and to children aged under
16 years. New safety net arrangements were also announced. The MedicarePlus proposals
were also considered by the Select Committee that reported in February 2004.
The Senate had yet to debate the legislation at the time of drafting this
8.24 The Committee
believes that bulk billing is a cornerstone of access to primary health care in
Australia, playing an indispensable day-to-day role for all Australians and
particularly for the poor and the disadvantaged. Bulk billing has been
important in limiting barriers to low income people for mainstream health care
by minimising out-of-pocket costs and thus impacting positively on the living
standards of the poor and disadvantaged in the community.
8.25 The Committee
notes that the two reports by the Select Committee on Medicare contain a range
of recommendations to improve bulk-billing, in addition to other measures to
improve access to health services by low income and other disadvantaged groups
and people in society.
Access to public hospitals
8.26 Submissions and
other evidence to the inquiry noted the importance of ensuring timely access to
hospital services for those on low incomes and commented on the increasing
pressures placed on public hospitals in providing adequate services as a result
of, inter alia, a general lack of funding, the diversion of funds to the
private system and the funding complexities arising out of the
Commonwealth-State division of responsibilities in the area of health.
The Doctors Reform Society stated that:
Public hospitals cannot meet the demands on them. Despite
promises that propping up the private health insurance industry with an
enormous public hand-out – somewhere between $2 billion and $3 billion annually
– would take pressure off the public system, the demands are still increasing.
8.27 This Committee's
2000 report into public hospital funding concluded that public hospitals in Australia
need an urgent injection of funds. The Committee found that:
Whilst the current funding shortage has arisen because of the
Commonwealth's failure to properly index hospital grants, the problem is
deeper. There has been a long term pattern of cost shifting by both the States
and the Commonwealth which has continually squeezed the public hospital
system....Evidence presented to the inquiry has indicated that the key problems
that needs to be addressed as a priority is the fragmented nature of the roles
and responsibilities of the Commonwealth and the States and Territory
Governments in the funding and delivery of public hospital services.
Australian Health Care Agreements
8.28 Under the
Medicare arrangements, public hospital services are provided under Australian
Health Care Agreements (AHCAs) with the State and Territory Governments. Under
the 2003-08 AHCAs, the Commonwealth will provide funding of $42 billion to the
States, a 17 per cent real increase over the 1998-2003 AHCAs. The AHCAs provide
funding growth on the basis of inflation, population growth, ageing, and other
demand factors such as increased availability of medical technology. AHCA
expenditure in 2002-03 was over $7.240 billion.
Governments argued that the 2003-08 AHCAs fail to provide an adequate level of
funding to the States. The NSW Government argued that the new AHCAs left NSW
about $1.3 billion worse off than the previous five year Agreement and will
place further pressure on the public hospital system in that State. The Government
argued that the Agreement did not take sufficient account of the impact on the
public hospital system of increased health-related costs, the ageing population
and the cost of new technologies.
8.30 While the
Commonwealth and States continue to argue over funding levels and cost-shifting
within the public hospital system, it is Australians at the lower end of the
socio-economic spectrum that are further disadvantaged in accessing timely and
appropriate health care.
8.31 The latest AHCAs
have been criticised for not including health reform proposals and should have
had an emphasis 'on illness prevention strategies and developing a new model of
8.32 A number of
access and equity issues in relation to public hospitals were identified during
the inquiry and by commentators in the healthcare area. These include:
- the increasing occurrence of hospital access block and hospital
ambulance bypass – 'the effects of access block on acute hospital services are
most disturbingly reflected by patients on trolleys in emergency department
corridors and ambulances circling hospitals, waiting to deliver ill
patients...Access block has been with us since the 1980s, but in recent years,
in Australia, it appears to have become both endemic and critical across all our
increasing waiting times for elective surgery – 'public hospital
waiting lists, which disproportionately apply to those without private health
insurance, constitute a real problem of equity'.
- the problem of hospital exit block, reflecting the short supply
of community-care services, particularly for older people – 'concurrently with
decreasing acute hospital bed numbers, access to residential care beds in the
community has decreased, especially beds designed for high-dependency patients.
This has increased demand on acute hospital services as elderly inpatients wait
for long term placement or are inappropriately sent back to the community to
avoid pressure on an already congested residential care system'.
- the inability of a system organised for acute, episodic care to
efficiently provide continuous long-term care.
8.33 Evidence and
commentators also pointed to the need to improve public hospital
infrastructure, including substantial additional capital funding, as well as
Impact of the private health
8.34 Submissions also
argued that the introduction of subsidies for private health insurance further
undermine the capacity of the health system to provide equitable access to
health care. VCOSS claimed that the current funding of private health care is 'unsustainable,
inequitable and, arguably, an inappropriate use of public funds.'
The Commonwealth has estimated that it will spend $2.26 billion on the private
health insurance (PHI) rebate in 2003-04.
8.35 The Doctors Reform
Society noted that the major users of public hospitals are people from lower
SES groups who suffer from chronic illnesses – 'it is the same people who
cannot afford private health insurance who do not get the alleged benefits of
the private health insurance rebate. Public hospitals are in crisis because the
money spent on the private health insurance rebate is not being spent on health'.
The Centre for Public Policy similarly noted that 'if private insurance was
funded at a lower level or not funded at all by the state, there would be funds
available to pay for a great deal more of the sort of universal public health
provision which the poor are most in need of'.
8.36 The Select
Committee on Medicare, which reviewed the impact of the PHI rebate, concluded that
while there was limited data on the equity and effectiveness of the rebate to
make unequivocal judgements:
...sufficient evidence has already been presented to cast doubt on
the overall effectiveness of the PHI rebate in contributing to the improvement
of Australia's health system. In the light of the large amount of money
involved in the subsidy, and the alternative uses to which it could be put,
these criticisms must be taken seriously.
emphasised that for efficiency and equity reasons it is essential that public
hospitals continue to provide a viable and quality alternative to the private
system. The Victorian Government stated that, for these reasons, 'balance needs
to be exercised in ensuring that incentives to take up private health care
through the health care rebate are not achieved at the expense of efficiency or
the wellbeing of the public health system'.
8.38 The Committee
believes that the public hospital system needs to be adequately funded and
supported and that the Commonwealth should re-examine its funding priorities
vis-à-vis the public and private health systems to ensure equitable access to
hospital services for low income and other disadvantaged Australians.
Access to ancillary and specialist health services
8.39 Ancillary or
allied health services play an important role in overall health care. Allied
health professionals can provide both primary care services and a wide range of
specialist diagnostic and treatment services for both referred and unreferred
patients. These services are provided in an effort to create a more integrated
and prevention-focused health care system. Allied health services presently
included on the Medicare Benefits Schedule (MBS) are limited to prescribed
psychiatry and optometry services. No other allied health services are funded
8.40 Submissions and
other evidence raised concerns that people on low incomes have limited access
to a range of ancillary or allied health services such as dental and optical
services, chiropractic and out-of-hospital specialist medical practitioner
8.41 COTA National
Seniors Partnership illustrated the problem as it relates to older Australians.
COTA stated that:
Medicare also does not cover many important areas of treatment
under the umbrella of allied health services such as physiotherapy, podiatry,
chiropractic and psychology. Low income, older people have difficulty accessing
these services if they have not taken out "extras" in private health
insurance. However insurance is expensive and may not offer a large enough
rebate to make the premium affordable, especially for people paying health
insurance out of a full age pension.
8.42 A NATSEM study
found that a range of ancillary and specialist health services are more heavily
used by people on higher incomes than those on lower incomes. Most notable were
dental, chiropractic and out-of-hospital specialist medical practitioner
services. There was also less use made of podiatry and optometry services by
lower income groups, although this was less marked than for the services
previously referred to. The study found that differences in access between high
and low income groups was largely due to the high out-of-pocket costs as these
services are mainly provided through private practices. The study concluded that
there are some ancillary and specialist health services which, because of their
high out-of-pocket costs fall into a 'second tier' of health services that are
less accessible to people with low incomes.
8.43 It has been
argued that there should be an extension of the MBS to cover allied health
services. A reform of this nature has, however, considerable economic and
The Select Committee on Medicare noted that the cost implications would be
substantial, requiring an increase in Commonwealth funding of potentially $3-4
billion, depending on the scope of the additional services covered. While the
measure would in all likelihood result in overall savings from reduced demand
for GP and public hospital services, these savings would be difficult to
8.44 Secondly, the
broader cost effects of wide scale additions to the MBS are difficult to
predict. An extensive range of allied health services included on the MBS could
lead to a substantial rise of supply-induced demand for allied health services,
with attendant stress on Medicare funding. Thirdly, extending the MBS to cover
allied health services also raises the issue of which services would receive
priority for Medicare funding and which would not qualify. The decision about
which allied health services to include on the MBS is difficult because of, inter
alia, the varying allied health needs of different regions in Australia.
Finally, given the problems inherent in the fee-for-service model of payment
used by Medicare, it is not desirable to exacerbate the issue by increasing the
number of MBS rebateable items.
8.45 Accepting the
arguments of the Select Committee, this Committee also does not favour any immediate
broadening of the scope of services covered by the MBS. While there is a need
to enhance accessibility to allied health services, the Committee considers
that there are more targeted and effective mechanisms for addressing the issue.
These include enhancing successful aspects of current initiatives, such as the
More Allied Health Services Program. This program began in 2000-01 as part of
the Commonwealth's Regional Health Strategy: More Doctors, Better
Services. The program has facilitated links between rural GPs and allied
health professionals by allocating targeted funding to employ additional allied
health professionals in rural areas. Other initiatives that should be further
encouraged include the funding of primary health care teams, and providing
funding for shared access to resources via groups such as the Divisions of
Access to preventive health and related services
health services/public health interventions focus on prevention, promotion and
protection rather than on treatment; on populations or population groups rather
than on individuals; and on factors and behaviours that affect health and cause
illness and injury. Well-structured health priorities and interventions have
the ability to reduce illness, cut healthcare costs and improve quality of
life. Studies have demonstrated the value to the community of such
interventions, in particular the substantial benefits, relative to costs,
flowing from immunisation and tobacco control campaigns.
pointed to the value in promoting preventive health strategies, especially for
people from socio-economic disadvantaged backgrounds. Data indicate that people
from these backgrounds make greater use of doctors and outpatient/casualty
services, but are less likely to use preventive health services.
disadvantaged people generally experience greater ill-health than people from
higher SES groups. The mechanisms by which socioeconomic status influences
health status are many and varied. However, those most often postulated are
diet, health behaviour, education, access to heath services (both preventive
and treatment), quality of housing and psychosocial factors. On all these
indices people from disadvantaged backgrounds perform less well than people
from higher SES groups. Socioeconomic disadvantage as a risk factor for ill
health also interacts with other risk factors. People from lower socioeconomic
groups, when compared with people of higher socioeconomic status groups, are
more likely to smoke and smoke regularly; report less physical activity during
their leisure time, and are more overweight or obese, all of which are
significant risk factors for a number of major health conditions, such as
cardiovascular disease and respiratory diseases.
8.49 The Committee
believes that preventive health measures as well as other measures such as
early childhood programs; nutrition programs; and other programs to assist
families, the elderly and people with disabilities and others in the community;
especially community-centred programs where services are provided at the local
level are important in addressing poverty and disadvantage, especially in more
socioeconomically disadvantaged areas.
8.50 That the
Commonwealth provide additional funding for preventive health and related
measures, and that this funding be directed particularly at socioeconomically
Access to maternal and child health services
indicates the importance of universal maternal and child health services.
Increasingly, research demonstrates that maternal health influences health outcomes
for the child. Recent research has given new insights into the long term health
outcomes which relate to birth weight and growth through infancy. For the
child, low birth weight is associated in the short term with delayed growth,
and in the long term, with the development of conditions such as adult
hypertension, coronary heart disease and diabetes.
8.52 Improving the
accessibility and appropriateness of health services for children is important
especially for children living in socioeconomically disadvantaged families,
Indigenous children, children with chronic illnesses and/or disability and
children living in rural and remote areas. This recognises the poorer health
outcomes of children from these backgrounds. Improving health outcomes for
children requires a reorientation of health services to focus on prevention and
early intervention strategies.
8.53 One example of a
successful strategy in this area is home visiting. This has been advocated as a
means of supporting the development of healthy parenting; as a strategy to
promote child health; and as an intervention to protect children from abuse and
neglect. These programs have been shown to impact positively on a number of
health indicators including breastfeeding rates; decreased accidental injury
rates; increased immunisation rates; decreased behaviours among parents
associated with physical abuse and neglect; and decreased Emergency Department
visits and paediatric inpatient admissions.
Access to dental care
8.54 Evidence to the
Committee highlighted the serious lack of access to affordable dental services
for people on low incomes.
Under current arrangements, dental health care in Australia is largely
performed by privately billing dentists, with relatively small public dental
programs provided by State and Territory Governments.
8.55 The Centre for
Public Policy, commenting on the parlous state of dental care for the poor in Australia,
...[it] is an absolutely extraordinary and worldwide scandal. If
you are poor, your teeth can rot...They rot because it is impossible to get an
appointment with a publicly funded dentist within the period of time when the
condition can be repaired Even emergency cases are often in a situation where
they have to put up with pain and bleeding if they cannot find a pro bono
noted that people living on low incomes visit dentists less frequently than the
rest of the community; are likely to have teeth extracted rather than filled;
and are less likely to get preventive care. Some people who have all their
teeth removed during emergency treatment may wait up to a year to receive
observations were reflected in the findings of this Committee's 1998 report
into public dental services. The report found that:
- people aged 45-64 in the lowest quintile of household incomes are
eight times more likely to have no natural teeth and 1.7 times more likely to
wear a denture, than people from the wealthiest quintile;
- Health Card holders aged 45 years and over are more than 1.7
times more likely to be edentulous (without teeth) and 1.4 times more likely to
wear a denture than non Health Card holders; and
- people from disadvantaged backgrounds are more likely to have
poor oral health than the general population and are about twice as likely to
have lost their natural teeth.
It is evident from the
submissions received that the situation with oral health has not improved since
the 1998 report, indeed it appears to have deteriorated.
8.58 Poor dental
health causes a range of consequences including pain, difficulty in eating and
the avoidance of certain foods (which can lead to wider health problems), and
is associated with a range of serious medical conditions. It also affects
self-esteem, employability and social and community participation. Generally, a
person's overall quality of life is affected.
8.59 For many people
on low incomes the high dental fees charged by private dentists are prohibitive
and thus they are reliant on public dental services. However, access to public
dental services has declined dramatically since the cessation of the
Commonwealth Dental Health Program (CDHP) in 1997 with a significant increase
in waiting lists since that time. One witness noted that with the abolition of
the CDHP 'all those who were on, below or in the vicinity of the poverty line
found themselves disadvantaged to a degree comparable to a Third World country'.
8.60 The CDHP was
introduced in 1994 and provided basic levels of dental care for holders of
Health Cards and their dependants aged 18 years and over and Commonwealth Seniors
Health Card holders. Full and partial dentures were excluded from the Program,
as were specialist services such as crowns, bridges, and orthodontics. Under
the Program a total of 1.5 million services were provided to eligible adults. A
total of $245 million was provided by the Commonwealth under the Program over
the four years from 1993-94 to 1996-97 inclusive. The Commonwealth ceased
funding the Program on 31 December 1996, following which the States resumed
full responsibility for public dentistry.
Evaluation studies of the Program found that it was generally successful in
providing improved access to services for low income groups; a reduction in
waiting lists; and a shift in treatment options away from extractions and
towards restorative treatments.
8.61 Waiting lists
and waiting times have increased significantly since the cessation of the CDHP.
There are currently about 500 000 people on waiting lists around Australia
for public dental treatment and only about 11 per cent of those eligible for
treatment receive it each year. Waiting times are three to four years in some
In NSW, NCOSS stated that in 1997, when the CDHP ceased, there were
111 8504 people on the waiting list in that State for public dental
treatment. This number had increased to over 250 000 by March 2001.
In Victoria, waiting lists for dental health services provided through
community health services are up to three years or longer in certain regional
areas as well as in some urban centres.
noted that it was ironical that since the abandonment of the CDHP access to
public dental care has decreased, however, tax subsidies are provided for
private dental care to assist wealthier members of the community. The Victorian
Government stated that the Commonwealth Government has spent some $360 million
over the period 1997 to June 2000 subsidising private dental treatment through
the private health insurance rebate.
argued that there is a need for the establishment of a publicly funded national
dental health scheme to improve access to dental services for people on low
While the States direct funding into dental health services, funding is clearly
not sufficient to meet unmet need and there is a clear case for Commonwealth
involvement in this important area to reduce the numbers of people on low
incomes who experience poor oral health without access to adequate dental
8.64 ACOSS suggested
that funding needs to be targeted to disadvantaged groups with particular
dental health needs including nursing home residents, Indigenous people, people
living in rural and remote areas, people with a disability, homeless people,
people with a mental illness and people on social security benefits.
8.65 NCOSS proposed
that a public dental program should incorporate a number of targets, including:
- that no person should have to wait more than 24 hours for
emergency dental care;
- that treatment should be available for preventive care in time to
avoid expensive, complicated dental care or tooth loss; and
- that regular dental checkups should be available, at least every
8.66 Dental health
plays a crucial role in a person's overall health, and the Committee is
concerned that many low income Australians experience significant problems in
accessing timely and effective dental care. The Committee believes that there
is an urgent need for the Commonwealth and the States to address the dental
health care needs of low income Australians. The Committee sees public dental
care as a responsibility that is shared with the States, and one in which the
Commonwealth should take an active leadership role.
8.67 The Committee
considers that a national dental health scheme needs to be established to
provide dental services to people on low incomes and that such a scheme should
be jointly funded by the Commonwealth and the States. Evidence to the inquiry
pointed overwhelmingly to the benefits of the earlier Commonwealth Dental
Health Program. This program represented a targeted measure of limited cost
that was shown to achieve significant increases in access to dental care for
those most in need. As with the original scheme, the introduction of a new
public dental health program needs to be developed in close consultation with
State Governments to ensure that it does not simply substitute for current
8.68 That a jointly
funded Commonwealth-State national dental health scheme be established to
improve access to dental services for people on low incomes, and that it be
modelled on the former Commonwealth Dental Health Program.
Navigation: Previous Page | Contents | Next Page